VIETNAM MEDICAL JOURNAL N°1 • OCTOBER - 2017 2. Iran Van Tru'dng, Lam Ngoc An, Trjnh Binh
Hai (2002). Dieu tra sdc khde rang mieng toan quoc, Nha xuat ban Y hoc, 23-70,
3. Tran Van Dung va coiig sir (2011), Nghien culi thu'c trang benh sau rang^ viem nha chu trong nhan dan thanh pho Hue qam 2011. 45-53.
4. Le Long NghTa (2013). Anh hUdng ciia benh dai thao dUdng va cac roi loan toan than len vung quanh rang. Benh hgc quanh rang. Nha xuat ban giao due. 44-52.
5. Ho^ng Thj Xiem (2016). Nghien ciTu kien thii'c, thai do va tinh trang ve sinh rang mieng tren smh
vien nam nhat ki tuc xa flat hpc Y Ha Noi nam 2016. Luan vMn tot nghiep y khoa, tru'dng dai Im y Ha IVpi. 30-39. " ^ 6. Hoang Thj Otfi (2014). Nghien ciTu thut b ^
benh sau rang, viem ItJi, kien thifc, thai do va tfiut hanh VSRM d sinh vien dieu dUSng nam thu'c Iva nam thir 3 trUdng cao ding y te Ha Noi. Luan m thacsfyhgc, dai hoc YHa Noi. 44-51. ' 7. Tran Anh Tuan (2012). Nghien ciili mS lien quan
glDa thiTc hanh cham soc rang mieng vdi benli sau rSng va* viem ldi d hpc sinh THFT tai Hoa Binh nam 2011. Luan van diacsfyhoQ dai hoc YHa Ndi. ^S-Si.
NHU'NG BANG CHU'NG Cff BAN VE KIEM SOAT NHIEM KHUAN PHUC VU BENH N H A N GHEP TE B A O GOC TAO MAU
TAI BENH VIEN TWQD108
Dinh Vsin Trung*
T O M TAT
Mgc tieu: dUa ra cac bang chiTng cd ban ve kiem soat nhiem khuan phuc vu nhffng benh nhan ghep te bao gde tao mau. £>di tu'dng va phu'dng ptiap:
Nghien cu\j can thiep, mo ta cat ngang co phan tich tai khu ghep tiiy - Benh vien TWQD108, ttj' thang 9 nam 2014 - 9 nam 2016. Ket qua: Ty le benh nhan song tren 5 nam sau ghep te bao goc tao mau la 91,0%. Khong co benh nhan nao bi nhiem khuan benh vien. 0am bao moi trUdng sieu sach trong buong benh nhan ghep tiiy bang eae bien phap kiem soat nhiem khuan hieu qua. Sau can ttiiep, 100%_cac mau nude cho benh nhan siT dung khdng bj 6 nhiem. Trong thdi gian n§m buong benh, cac benh nhan ^ va nhan vien deu phai tuan thii cac quy djnh ve kiem soat nhiem khuan trong dieu kien sieu sach.
Tl/" ArAda/ghep te bao goc tao mau, sieu sach, mdi trUdng, kiem soat nhiem khuan
SUMMARY
BASIC EVIDENCE OF INFECTION CONTROL SERVES PATIENTS W I T H HEMATOPOIETIC STEM CELL TRANSPLANT I N 108 MILITARY
CENTRAL HOSPITAL Objects: Provides basic evidence of infection control for hematopoietic stem cell transplant recipients. Subject and method: Intervention studies, cross-sectional descriptive analyzes at the area for hematopoietic stem cell transplantation - 108 Military Central Hospital from September 2014 to September 2016, Results: Survival rate more than 5 years after hematopoietic stem cell transplant was 91.0%. No patients have hospital-acquired infections.
*Benh vien tw quan dgl 108 Chiu trach nhiem chinh: Oinh Van Trung Email: [email protected] Ngay nhan bai: 28.6.2017 Ngay phan bien khoa hoc: 30.8.2017 Ngay duyet bai: 6.9.2017
Ensure a super clean environment in the patient's room by effective infection control measures. After intenrening, 100% of water samples for patient use are not conlaminated. Dunng treatment In the stem cell transplant area, patients and medical staff are subjedto strict adherence to infection control regulations.
Key word: Hematopoietic stem cell i super dean, environmental, infection control I. OAT VAN OE
Ghep te bao gde tao mau (edn gpi la ghep tiiy) hien nay diTde coi la phu'dng phap dieu tri tot nhat, cd the du'a lai cP hdi sdng cho nhilhg benh nhan bj mac cac benh ly huyet hoc va rat nhieu benh ly khac nhau thuoc nhieu chuyen khoa nhd: cac ung thu' dang dac (ung thu" vu, ung thu' than), eae benh tiT mi§n nhu' viem da khdp dang thap, xuat huyet giam lieu cau... Ghep te bao gde lam tang dang ke thdi gian song them khong benh va thdi gian sdng them toan bp cho benh nhan, nhu'ng day la mot ky thuat khd, nhieu cong doan, ddi hdi phai co su' ket hdp ciia nhieu chuyen nganh va co ty Ie tai bien, bien chiTng cao. Tren the gidl ghep Te bao goc dang du'dc thi/c hien kha pho bien cf nhieu nu'de. Tai cac nu'de phat trien nhu': My, Phap, Nhat, Y, Han Quoc... hang nam co hang nghin ca benh hiem ngheo da du'dc ciTu song nhd phu'dng phap ghep Te bao goc,
Benh vien TWQO108 la mdt tnDng cac cd sc(
ghep tuy cd uy tin trong ca nu'de, da tich ci/c dao tao can bp, dau td trang thiet bi, dam bao hda eliat, thuoc va cac loai sinh pham, giai quyet cac van de ve phap ly va bao hiem y te. TiT narn 2014 den nay da trien khai thu'dng quy cac ky thuat ghep te bao gde ngay tai Benh vien.
Mdt trong cac bien ehdng nguy hiem nhat cua benh nhan ghep te bao goc la nhiem cae vl sinti
70
TAP CHl Y HOC VigT HAM TAP 459 - THANG 10 - SO 1 - 2017 vat gay benh do benh nhan trong thdi gian ghep
bj mat het kha nang mien dich ciia cd the ddi vdi cac^ mam Jaenh [1]. Chfnti vi vay, kiem soat nhiim khuan cd mot vai trd rat quan trpng trong thanh edng cua cac ca ghep te bao goc. Chung
^ i thiTc hien de tai nay nham muc tieu: du'a ra cac bang chiTng cd ban ve kiem soat nhiem khuan phuc vu nhu'ng benh nhan ghep te bao goc tao mau.
II. Odi TU'DNG VA PHl/CTNG PHAP NGHI§N COl) 2.1. Ddi tddng nghien edu: Khu ghep tiiy - Benh vien 7WQO108
2.2. Thdi gian nghien cuii: td thang 9 nam 2014 den thang 9 nam 2016
2.2. Phu'dng phap nghien edu: Can thiep, md ta eat ngang cd phan tich.
*Cac bien phap can thiep;
- Nguon nu'de: Nu'de may cua thanh pho, du'dc Ipe qua may RO sau dd nu'de du'dc loc cuoi ciing tru'dc khi cho BN sir dung hang ngay qua qua Ipe Nano do hang Anios (Phap) san xuat.
- Khong khi: Phun khiT khuan khdng khi bang may phun AeroseptlOO vdi dung dich Anios Special DJP SF (Phap).
- Sau khi benh nhan diTdc phep vao buong benh, bat may Ipe khdng kht AiroCide (My).
- Lau be mat san, tu'dng, ban, ghe, glu'dng, til, trong khu ghep tuy bang dung dich Surfanios pha loang 0,25%
- Xet nghiem vi sinh vat cac mau nu'de, khdng khi, be mat: do eac ky thuat vien khoa Vi sinh vatthi/c hien.
* f i e u chuan WHO 902 (2002): quy djnh ve mat dp vi sinh vat trong khdng kini cho tiTng cap dp phdng sach benh vien [6,7]:
Ky hieu cap dd So vi khuan toi da cho phep (ufc/m^)
A
< 3 B 10
c
100 D 200 2,4, Xd ly so lieu: Bang phan mem thdng ke SPSS 16.0
III. K ^ QUA NGHIEN CCrU
Bang 1, Ty IS bSnh nhin sdng theo thdi gian SoBN
n = 22
Thdi gian song 1-2 nam n (%)
01 (4,5)
4 - 5 nam n (%) 01 (4,5)
> 5 nam n (%) 20 (91,0)
Nhiem khuan benh vien n (%)
00 Nhanxet:Ty le benh nhan song sdt tren 5 nam sau ghep tuy la 91,0%. Khdng ed benh nhan nao bj nhiem khuan benh vien trong thdi gian nam dieu tri ndi tru.
Bang 2: Kiem soat nhiem khuan mdi tru'dng Noi dung
Lau cac be mat KhiT khuan khdnq khi Loc khdng khi buong
Loc nddc Trao ddi khdng khi budhg
Vat tu'suf dung Surfanios 0,25%
Anios Special DJP SF May AiroCide May RO va qua loc Nano
Mang loc HEPA
T^n suat 11a n/nqay 1 lan/tuan
Lien tuc Lien tuc Lien tuc Nhan xet: cac bien phap sir dung deu dam bao hieu qua khiT khuan mdi tru'dng buong benh.
Bang 3. Vi khuan trong khong khi dat cap do eua WHO V j t r i Tru'dc
ghep
Trong thdi gian BN nam dieu trj lan 3 ran 4 Buong BNl
BuSng BN2 Buong BN3 Buong tiem Buong giao ban
Hanh lang
Nhan xet: Sau khi phun khiT khuan khdng khi, 100% cac buong benh nhan nam deu dat tieu chuan A (<3cfu/m^), cac buong khac dat tieu chuan B hoac C.
Bang 4: Kei qua xet ni V j t r i (Cac voi nu'de)
Buonq BNl Buonq BN2 Buonq BN3
ihiSm mau ndd frUcic ghep
(ran 1) + + +
c
Trong thdi gian BN nam diieu tri lan 2
- -
Tan 3
-
lan 4 Tan 5
- -
-
t/IETNAM MEDICAL JOURNAL N^l OCTOBER-2017 Buonq tiem
Buong qiao ban
+
+
-
- -
- -
Nhan xetilrddc khi ghep, eac mau nddc deu nhiem vi sinh vat ( + ) , cae vi sinh vat gay d nhiem nguon nu'de la E.coli, Klebsiella va Bacillus. Nu'desau khi can thiep tat ca cae mau niTde deu co k i qua (-) trong sudt thdi gian benh nhan nam dieu tri.
Bang 5. Dieu kien trang thiet bi cho bSnh nhan Vat tu' benh nhan suT dung
Chan, qa, gdi, khan...
Bat, dua, cde, ban chai, thude danh ranq ....
Trang phuc (quan ao, dep, khau tranq...)
Dieu kien Vd khuan Vd khuan Vd khuan
n 22 22 22 Nhan xet: Jatea eac vat dung cho benh nhan sir dung deu du'dc hap bet khuan Bang 6. Tuan thu eac yeu to'tru'dc va trong ghep ciia benh nhan
Cac yeu to kiem soat nhiem Ichuan Ve sinh long tde mdnq Tam xa phdnq khd khuan Thay quan ao vd khuan sau tam
Thay chan, qa, gdi vd khuan
Tan suat Hang ngay Hang ngay Hanq nqay 3ngay/lan
n 22 22 22 22 Nhan xet: Jrddc ghep^ 1 tuan^ trong thdi gian nam buong benh, cac benh nhan deu tuan thii cac quy dinh ve kiem soat nhiem khuan trong dieu kien sieu sach.
Bang 7. Tuan thu cae yeu td tru'dc va trong ghep cua nhan vien y te Cac yeu to kiem soat nhiem khuan
Ve sinh tay vdi dunq dich chiTa edn
Manq phdnq hd ea nhan vd khuan (Quan ao, mu, khau tranq, dep...) Ve sinh tay bang xa phdng khiT khuan, Mang gang vd khuan
Ve sinh tay vdi dung dich chiTa cdn
Tan suat Tru'dc khi vao khu qhep Tru'dc khi vao khu qhep Tru'dc khi lam eae thii thuat Sau khi ra khdi budnq benh NhanxetiJrdde va sau khi vao khu ghep tiiy, cac nhan vien deu tuan thii eac quy dinh ve kiem soat nhiem khuan trong dieu kien sieu sach.
III. B A N L U A N
Nghien ciTu nay ciia chiing toi du'dc thu'c hien sau khi st^ dung cac bien phap kiem soat nhiem khuan can thiet de dam bao clio ghep te bao goc tao mau thanh edng . Ket qua nghien ciTu d bang 1 cho thay, trong so 22 benh nhan du'dc ghep tuy, ty le song sdt ciia benli nhan tir 1-2 nam la 4,5%, song sot tiT 4-5 nam la 4,5%, song sdt tren 5_nam la 91,0%. Khdng cd benh nhan nao bj nhidm khuan benh vien trong thdi gian nam dieu trj ndi tru. Cho den thang 3/2012 Vien Huyet hpc - Truyen mau TW da ghep dUde 44 ca (trong dd ghep Te bao gde tu' than ia 34 ca, ghep Te bao gde dong loai la 10 ca). Ty le thanh edng cho nhdm ghep td than b| benh Da u tuy xu'dng la >70%; cho nhdm bi Suy tiiy xu'dng du'dc ghep te bao goc dong loai la >75%. Nhieu benh nhan sau khi ahep mdt nam, hai nam ...
tham chf la 6 nam van edn on dinh, ed the trd lai cupe song hoan toan binh thu'dng (theo ban tin tren https://wviw.nihbt.org.vn > Te bao goc ciia Vien Huyet hpc Truyen mau Trung Udng).
Vie mdi tru'dng khu ghep tiiy, ket qua nghien ciTu d bang 2 cho thay, eae bien phap sir dung de khu" khuan mdi tru'dng khu ghep tiiy deu tien tien dam bao du'dc hieu qua khiT khuan mdi tru'dng buong benh va eae khu vdc lien quan.
KhiT khuan khdng khi bang phun khi dung veil ham lu'dng la 4ml/m^ khdng khi dung dich Anios Special DJP SF (Phap). Pho diet khuan: EN 1040, pr EN 14561.Diet nam: EN 1275 (Candida albicans), pr EN 14562 (A. fumigatus) tai 7 buong trong dd cd 3 buong benh, 1 buong giao ban, 1 buong thay quan ao eiia nhan vien, 1 buong tiem va 1 buong lam hanh lang cho benh nhan di dao hang ngay. Neu cd 2 benh nhan se du'dc tinh toan luan chuyen hdp ly trong 3 buong benh de sao cho buong benh nao cung diTcfc phun khiT khuan khdng khi dinh ky vdi tan suat phun 1 lan/tuan. Sau khi phun 24h, benh nhan dddc phep vao buong benh, bat may Ipe khong khi AiroCide - My, may sd dung qua trinh quang sinh hda du'di UV chieu len hat nano Oxit Titan (TiOj) pha vd cac lien ket hdu ed (vl khuan, nam, moc, viriit..) ed hai trong khong khi chuyen hda thanh chat vd cd (CO2, H2O) khdng gay hai cho benh nhan. Cae be mat nhu' san nha, tu'cfng, ban, ghe, glu'dng, t i i , trong khu ghep tiiy cung du'dc lau bang dung dich Surfanios pha loang 0,25%. Sau khi thiTc fiien cac bien phap khtf khuan d tren, 100% cae buong benh nhan narn dieu tri deu dat tieu chuan A (<3cfu/m^), cac buong khac dat tieu chuan B hoac C [5,7]. Ket qua nghien cu\j eua chung tdi thap hdn ket <M
TAP CHi Y HOC VIET NAM TAP 459 - THANG 10 • SO 1 - 2017 nghien ciTu ciia Kieu Chi Thanh (2010) tai Vien
Quan y 103 khi lay m l u tiT 8h30-14h30 tai cac phdng md, so lu'dng vi sinh vat dao dpng tiT 234- 312 cfu/m^ [ 2 ] . Nguon nu'de la rat quan trpng doi vdi benh nhan ghep tuy, ciua bang 4 chiing tdi thay, tru'dc khi ghep, cac mau nu'de deu nhiem vi sinh vat ( + ) , cac vi sinh vat gay d nhiem nguon nu'de la E.coli, Klebsiella va Bacillus, sau khi can thiep bang loc RO va lap qua Ipe Nano d dau vdi, lat ca cac mau nu'de deu cd ket qua (-) trong sudt thdi gian benh nhan nam dieu t n .
Oe dam bao mdi tru'dng sieu sach, khdng chi khong khi va nguon nu'de, ket qua d bang 5 va bang 6 cho thay, tat ca cac vat dung cho benh nhan sir dyng^deu du'dc hap tiet khuan tai Trung tam tiet khuan cLia_ Benh vien, trong tlidi gian nam buong benh ke ca thdi gian tru'dc ghep va sau ghep cac benh nhan deu tuan thii chat che eae quy dinh ve kiem soat nhiem khuan trong dieu kien sieu sach. Doi vdi cac nhan vien tham gia dieu tn va cham sdc cho benh nhan, tru'dc va sau khi vao khu ghep tiiy, deu phai tuan thu cae quy dmh ve kiem soat nhiem khuan mot each nghiem ngat.
V. K^T LUielN
- Ty le benh nhan song tren 5 nam sau ghep te bao goc tao mau la 91,0%. Khdng cd benh nhan nao bj nhiem khuan benh vien.
- Dam bao mdi tru'dng sieu sach trong buong
benh nhan ghep tuy bang eae bien phap kiem soat nhiem khuan hieu qua. Sau can thiep, 100% cae mau nu'de cho benh nhan sir dung khdng bi d nhiim.
-Trong thdi gian nam buong benh, cac benh nhan va nhan vien deu phai tuan thii chat che eac quy dinh ve kiem soat nhiem khuan.
TAI LIEU T H A M KHAO
1 - Pham Thj Tuyet Nhung, Nguyen Thi Minh Phtfdnp (2015), "Bao cao ca lam sang': Benh nhan dau tien du'Oc ghep te bao goc tao mau dong loai thanh cong tai Benh vien TWQD108", Tap chi Y hoc Viet Nam, Tap 429, tr 88-94
2- Kieu Chi Thanh (2010), "Oanh gia thu'c trang vi khuan khong khi d benh vien 103", Tap chi Y dUdc hgc Quan su' 9 : 55-50.
3- M.Fleischer et al (2005) "Microbiologycal Control of Airborne Contamination in Hospitals".
Indoor BuidEnviron IS ; 1 : 53-6.
4- Agnieszka Gnladek, Anna B. Macura (2011),
"Air-conditioning vs.presence of pathogenic fungi in hospital operating theatre environmental".
Wiadomosci Paratoiogiczne 57(2), 103-6.
s- ISO 14698-1:2003 (E), Cleanrooms and associated control environment -Biocontamination control, First edition.
6- Merck (2009). Microorganism titers in different environments, care unit: newborns and infants can be contaminated while being fed. Jpn J Infect Dis.
2006 Aug;59(4):213-5.
7- WHO (2002), WHO expert committee on specifications for pharmaceutical preparations, thirty sixth report, 902, 2002.
TINH HINH BENH NHAN CHAN THiraNG DO TAI NAN GIAO THONG TAI BENH VIEN DA KHOA NONG NGHIEP GIAI DOAN 2 0 1 4 - 2 0 1 6
Ha H&u Tung*
T O M TAT
Hang nam, Tai nan giao thong (TNGT) da lam tren 1000 ngu'di chet, Cliu^ day 10% sd nan nhan bi tai n?n giao thdng du'dng bo du'dc cap edu ban dau tai cho. Nghi§n eiru du'dc su' dung trong de tai la phUdng phap hoi CLiU md ti 10126 ho sd benh an cua benh nhan TNOT trong 3 nam tir 2014 den 2016 tai Benh vien Da khoa Nong nghiep nam tren Quoc 15 IA, Ttianh Tri, Ha Ngi. Ket qua nghien ciTu cho thay benh nhan vao cap edu do tai nan giao thong chii yeu la do sir dung phu'dng tien la xe dap va xe may; nhom tuoi bl nh'iieu nhat tiT 16 den 60 tuoi cd 7686 trUdng hdp
*Benh vien Da khoa Nong nghiep Chju trach nhiem chinh: Ha Hffu Tiing Email: [email protected] .vn Ngay nh?n bai: 17.7.2017 Ngciy phan bien khoa hpc: 30.8.2017 Ngay duyet bai: 12.9.2017
(75,9%). Ty le nam bj TNGT gap 2,13 lan so vdi ty le d nu'; Ty le thiVong tat cao nhat la chan thuong sg nao va gay xu'dng chi; BN TNGT dUpc dUa den benh vien cap cull chii yeu do ngUdi di dUdng va ngUdi than dUa den; Ty le benh nhan bj shock tren nhu'ng benh nhan khong dudc sd eiru hoac cd sd ciTu nhu'ng sai cao gap ddi ty le benh nhan bj shock tren nhOtig benh nhan dupe sd edu diing.
SUMMARY
SITUATION OF PATTENT INJURIES IN TRAFnC ACUDENTS AT GENERAL HOSPTTAL OF AGRICULTURE FOR THE PERIOD 2014-2016
Every year, traffic accidents have killed more than 1,000 people, less than 10% of victims of road traffic accidents are inibally on the spot The study used in the study is a retrospective method that describes 10126 patent records of traffic accident patients in three years from 2014 to 2016 at the General Hospital of Agriculture located on Highway IA, Thanh Tri,
