NSHiENCfhi-nuoedi 3-C, ii>^
OE PHONG VA \d TRf NGO DOC THLTC AN
TS. Mai Van Quang *
1. Tinh hinh ngp dpc thyc an Dam bao chat lypng ve sinh an toan thye pham giy vj tri quan trpng trong sy nghiep chdm sdc, bao ve syc khde nhan dan, gdp phan giam ty le mac benh, duy tri va phat trien ndi gidng, tang eyPng the lye, hpe tap, lao dpng san xuat, thuc day sy tang trydng kinh te, van hda xa hpi va t h i hien ndp sdng van minh.
Mac dd eho den nay da ed nhieu tien bp khoa hpc ky thuat trong cdng tac an toan ve sinh thyc pham, ddng thdi cd nhieu bien phap ve quan ly, giao due nhy ban hanh luat, dieu le va thanh tra giam sat ve sinh an toan thyc pham, nhung cac benh do kem chat lypng ve vd sinh an toan thyc pham va ngp dpe thye an (NDTA) van chiem ty le kha cao.
Tren the gidi: Moi ndm, ydc tfnh d Hoa Ky xay ra 76 trieu ea NOTA (26 nghin ca/10 van dan), d Anh (3,4 nghin ca/10 van dan) va d Phap (1,2 nghin ca/10 van dan). 6 Uc, hang nam ydc tfnh eo khoang 5,4 trieu ea ngp dpc thyc an, cu the: 18 nghin ca nhap vien, 120 ca ty vong, 2,1 trieu ca phai nghl lam vi ngp dpc
d Viet Nam nhieu vy ngp dpc thye pham hay xay ra, dae biet la ngp dpc tap the, rdi nhieu vao ddi typng cdng nhan (khi an, udng tai cac bep an tap the khdng dam bao ve sinh, an toan chat lypng thyc pham). Theo bao cao thdng ke cua Cue an toan ve sinh thyc pham, BpYte, ty 2008-2012 mdi nam d Viet Nam co 190 - 200 vu NDTA vdi 6 - 7 nghin ngydi mac va trung binh co khoang 52 ca td vong.
Tai Thanh Hda: Nam 2012, tdng sd ngyPi bj NOTA la 220 ngypi, trong dd cd 05 vu ngp dpc vdi 97 ngyPi mac (68 ngydi phai cap eyu nhap vien, khdng co ty vong), trong sd nay, vu ngp doe thyc pham Idn (hon 30 ngydi) la 02 vu
(01 vu xay ra tai bu^ an gla dinh va 01 vu tai bep an tap the); trydng hpp ngp dpc thye Sn le te la 123 ngydi, nguydn nhan chfnh Id do thyc pham bj nhidm vi sinh vat (Bao cao cda Chi eye An toan ve sinh thyc pham).
2. Nguyen nhan dan den ngp dpc thyc an (4 nhdm)
a) Ngg dgc do an phai thOc an nhiem vi sinh vat
- Vi khuan la mdt trong nhSng nguyen nhan gay ngp dpc thyc pham nhiiu nhat.
Thydng gap do vi khuan gay benh thyong han (Salmonella) vi khuan gay benh ly (Shigella), vi khuan gay benh tieu chay (E.Co li) hodc nhiem cac dpc td eda vi khuan tu clu (Staphylococcus aureus). Trieu chdng ngp dpc thye an do vi khuan thydng xuat hien sau 12- 72 gid sau khi dn thyc an bj nhiem khuan.
- Do vi rut: Thydng gap do cac loai vi rut gay viem gan A (Hepatitis virut A), Virut gay benh bai Net (Polio Picornavirus), virut gay tieu chay (Rota virus).
- Do ki sinh trung: San la gan, san bd, au trung san Idn, cac loai ddn bdo (Amip, trung long...), cac loai giun va au trung giun.
- Do nam mdc va nam men: Thydng gdp do loai Aspergillus, Penicilium, Furanium Candida... Nguy hiem hdn la mpt sd loai nam mdc CO kha nang sinh dpe td gay dpt bidn gen, ung thy de non, quai thai. Aflatoxin, cd ngudn gdc ty nam mdc Aspergillus parasiticus va Aspergillus flavus. Cae nam mde nay thydng ed trong cac loai qua, hat ngu cdc, hat cd diu.
Cac dang aflatoxin la B l , B2, G I , G2 vd Ml, trong do aflatoxin B l . Kdt qua nghien eyu d An Dp cho thay dpc td vi nam aflatoxin thudng gay cac benh nhy xd gan, ung thy gan, dpt bien
* PTP Nghiep vu Y. Sd Y te Thanh Hda.
22 50 2/2013
NGHI£N dRi' THAO DOI
gen, quai thai,... Theo Cue quan ly thut pham va dupe pham Hoa Ky, gidi han quy djnh ddi vdi aflatoxin tdng sd la 20 jig/kg, trtf aflatoxin Ml trong sya dype quy dinh d myc 0,5 |ig/kg.
Altertoxins gdm Altemariol (AOH), Alternariol methyl ether (AME), Altenuene (ALT), Altertoxin-1 (ATX-1), Tenuazonic acid (TeA) va Radicinin (F?AD), cd ngudn gdc ty Altemaria spp. Mpt sd dpc td loai nay ed trong ngd, Ida va khoai tdy. Mdt sd nghien eyu ehl ra rang eac dpe td nay de dang bj nhiem cheo trong eac loai hat thyong pham do qua trinh bao quan va che bidn. Nghien culi eho thay Altertoxins gay ung thy gan d chupt va ung thy thyc quan d ngydi.
b) Ngd dpc thite an do bi nhiSm cac chat hoa hoc
- Do d nhiem cac kim loai nang: Thydng gSp do an cac thye an ddng hpp hay an thye phim dype nudi trdng ty nhung vung dat, nyde d nhiem kim loai ndng (Chi, Oong, Asen, Thuy ngan, Cadimi...).
- Do thudc bao ve thyc vat: Thydng la cac loai thudc diet edn trdng, thudc try dpng vat an hai, thudc diet mdi, mpt. Nguydn nhan, do an cac loai rau xanh, hoa qua... cd lypng tdn dy thudc bao vd thye vat cao.
- Do cac loai thudc thu y: Thydng gdp ia cac loai thudc kich thich tdng trydng, tang trpng, thudc khang sinh.
- Do eac loai phy gia thye pham nhy Thudc dung bao quan thyc phim (ca, thjt, rau, qua...), cae loai pham mlu dpc dung trong chd bidn thye pham.
- Do eac chat phdng xa.
c) Ngd doe do an phai thOc an eo sin ch^t ddc
Ban than chat dpc eo san trong thye pham, khi chdng ta dn cae thuc pham cd chda sin cdc chdt dpe nay rat eo t h i bi ngd dpc.
- Dpng vat dpc: Thydng do dn phai cac loai nhuyen thi, ea nde dpc, dn cdc, mat ea tram...
- Thut vat dpe: Nam dgc, khoai tdy mpc mlm, sin, mpt sd loai dau qua, Id ngdn,...
d) Ngd dgc do an phai thiic an bi bien eh&, thCfe an di thiu
Mpt sd loai thye pham khi de lau hoac bi 61 thiu thudng sinh ra cae chat dpc nhy Cac chat Amoniae, hpp chat Amin sinh ra trong thye an nhieu dam (thit, ca, tryng...) hay eac Peroxit e6 trong dau md d l lau la cac chat gay dpc hai eho ed the. Cac chat dpe nay thydng khong bj pha huy hay giam kha ndng gay dpc khi dype dun sdi.
Cae nguyen nhan khac: Nhieu nguyen nhan gay d nhidm thyc pham d rat nhieu khau trong chudi day chuyen san xuat, bao quan, che bien thyc pham nhU cac dung eu dung (dao, thPt, rd, bat, dTa, ndi, xoong chao, ban tay ngydi che bien, nyde rda...).
3. Nhung trieu chijng khi bj ngp dpc thyc an
Thdng thudng, khi bi ngd dpc thyc an, ngydi benh cd cac trieu chung nhu: Dau bung, ndn mda, tieu chay, ddi khi eo kem theo hoac khdng cd cac trieu chyng nhy nhdc dau, chdng mat, dau cd, kho thd, sot,...
Ngydi bi ngp dpe eung cd trieu chiJng tim mach do mat nyde - dien giai hoac do chinh chat dpc gay nen (mach nhanh, huyet ap giam, loan nhjp); sdt cao, ha nhidt dp (thydng do vi khuan va dpc td vi khuan). Tuy theo nguyen nhan ngp dpc, benh nhan cd the suy ho hap (do dn ca nde), tim tai (do ngp dpe san, mang tyoi), suy gan va rdi loan ddng mau (do ngp dpe nam dpe), tilu ft, vd nieu (do ngp doe nam dpe, mated tram,...).
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NGHIEN cifu - TRAO D6I
4. Cach xurtri khi bi ngp dpc thyc an Tryde mpt ngydi bi ngp dpc hoac nghi bi ngp dpc con tinh tao, can lam eho chat dpc lan trong thye an bi dao thai ra ngoai cang nhanh cang tdt bang each dung 2 ngdn tay eda chinh benh nhan de ngoay hong hay dung mpt thia nhd hoac tam bong dya vao gdc lydi gay phan xa non. Chu y, khi benh nhan ndn de dau eui thap hon ngyc, tranh bj sac vao phdi. Trong trydng hpp neu biet chat dpe la dau hda, xang, hda chat try sau thi khdng gay non, vi gay non cd the se lam benh nhan hit chat dpc vao phdi hoac len cdn co giat khi dang gay ndn; each tdt nhat la den ngay eo sd y td, neu cd dieu kien thi tien hanh rda da day eang sdm eang tdt, Cham nhat !a 4 - 6 gid sau khi an phai thyc an cd chat dpc (khdng rda da day neu benh nhan CO giat, Id md). Sau do nhanh chong cho benh nhan udng than hoat tfnh de hap phy chat dpc con trong dydng tieu hda (ngyoi I6n: Ig/kg can nang; tre em: 0,5g/kg can nang); than hoat tfnh cd the udng nhac lai vdi lieu nhy vay sau 3 - 4 gid. Tiep theo eho udng thudc tay sunfat magnesium hoac sorbitol de tong chat dpc con lai trong rupt va than hoat tfnh qua dydng hau mon.
Sau khi cap eyu tai chd, nen chuyen benh nhan den ed sd y te tuydn tren de dypc theo doi va dieu trj chuyen khoa.
5. Mpt so bien phap phong tranh a) Cach li/a chon va sipdung thifc an Khi mua thyc pham can chpn cae thyc pham tyoi sdng, tranh dung thye pham kem chat lypng (6i thiu, yon...) khdng dung thyc pham da het han sd dung. Nen mua cac ioai thyc pham d nhyng ndi tin cay. San pham phai ghi thanh phan, ngudn gdc xuat xd ro rang, ngay san xuat va han sd dyng, cung nhy co sd dien thoai de lien lac. Nen mua cae loai thyc pham c6 bao gdi rieng de d l bao quan, khdng bi lan mui vdi thyc an khac va tien sy dung.
s y dung nyde da phai la nyde da sach, an toan, Cd sd san xuat nyPc da cay dam bao ve sinh, cd giay chdng nhan ATVSTP do co quan cd tham quyen cap.
Thyc an khong dung het, phai dun sol lai tryde khi cat. Tryde khi an lai, phai dun sdi lan 24 30 2/2013
nya, ft nhat 10-15 phut. Chi nen dung lai thye an cda bCfa tryde them mpt lan.
Ddi vdi thyc pham nau chfn, tranh tdi thieu tay tiep xuc vdi thyc pham, d l giam sy xam nhap cda mam benh; phai cd dung cu rieng de gap thye an chfn.
b) Phi/ang phap bao quan thue pham Nhiet do, anh sang, dp am cua moi trydng bao quan; thdi gian bao quan; chat lypng bao bi phai bao dam dap yng rieng cho tyng loai thyc pham bao gom:
- Bao quan d nhiet dp thap (lanh hay ddng lanh);
- Bao quan d nhiet do cao (thanh trung d nhiet dp tren lOCC, say khd, xdng khdi);
- Bao quan bang phyong phap hda hpc (ydp mudi, dydng; ngam giam; len men);
e) Mpt so' thiirc an cd nguy ca gay ngp dpc cao
- Go! hay thit chya chfn ky.
- Ca va hai san tyoi sdng hay chya chfn ky.
- Cac mdn trung chya hoan toan dyoc nau ky
- Cac loai qua bj nhidm hoa chat, dap nat,...
- Cac loai rau so'ng bj nhilm ban.
- Nyde giai khat chya dypc diet khuan, - Ny6c da khong ro nguon gdc - Sya hpp phdng, ddi mau va cac san pham ty sya chya qua diet khuan.
- Cac thyc pham 6i, thiu, qua han, bien chat, ...
d) Thi/c hien tot 10 nguyen tac "vang"
phdng ngCra ngp dpc thiyc an - Chpn thyc pham tyoi sach.
- Thyc hien "an chin, udng chin"; ngam ky, r^a sach rau qua khi an sdng.
- Thye an sdng, chfn phai de rieng; khong dung lan dyng cu che bien.
- Giy dung cu, noi ehe bien luon khd sach.
- RCra tay tryde khi che bien va tryde khi an.
- Che bien thyc an bang nyde sach, - Che day, bao quan can than thyc dn da nau chin.
~ An ngay thyc an khi vya nau xong.
- Oun ky thyc an tryde khi dung lai.
- Khdng an thye an 61 thiu./.
