n h iIm k h u a n b e n h v ie n
MUC TIEU
1. Neu diidc dinh nghia vd ke nhiing nhiim khuan benh vien thiidng gap.
2. Trinh bay diidc nhiing dac diem chinh cua chu trinh nhiim khuan va cac loai vi
khuan hay gap gay nhiem khuan benh vien.
3. Neu diidc cac tieu chuan giam sat nhiem khuan benh vien.
4. Trinh bay diidc cac bien phap phong ngiia nhiem khuan benh vien.
1. DINH NG H lA
Nhiem khuan benh vien la nhiing nhiem khuan m£c phai trong thdi gian
n&m vien (thtfdng sau 48 gid). Nhilm khuan nay khong hien dien cung nhtf
khong d trong giai doan u benh tai thdi diem nhap vien.
2. CHU TRiNH NHIEM KHUAN BENH VIEN
Doi vdi nhtfng ngtfdi benh dang mac hoac nghi ngd mac cac benh truyen
nhiem, quan trong ve mat dich te hoc can ap dung cac bien phap dtf phong
nhlm cat dtft qua trinh lan truyen benh trong pham vi benh vien va ra cong
dong. Chu trinh nhilm khuan co the tom tat theo sd do sau:
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- Tac nhan (1): la vi sinh vat co kha nang gay benh. Tac nhan gay benh
phu thuoc vao: so lUdng, doc tinh, kha nang thfch ling cua vi sinh vat,
moi trtfdng va stfc de khang cua cO the con ngudi.
- Ngudn chtfa (2) vat chu: la moi trtfdng song va sinh san cua vi sinh vat.
Nguon chtfa cd the la ngtfdi (ngtfdi benh hoac ngtfdi lanh mang vi khuan),
cd the la dong vat (cho, chuot...), cd the la cac do vat (dat, ntfdc, khdng khi,
thtfc an...).
- Dtfdng ra (3): la ndi vi sinh vat rdi khoi ngudn chtfa: dtfdng hd hap, tieu
hda, tiet nieu.
+ Phtfdng thtfc lay truyen (4):
+ Lay truyen trtfc tiep: sd md, tiem chich...
+ Lay truyen gian tiep: qua vat chu trung gian nhtf ruoi, muoi, chuot...
- Dtfdng xam nhap (5): la dtfdng vi sinh vat rdi vat chu cu xam nhap vao
vat chu mdi. Vi du: vi rus HIV lay b^ng dtfdng mau, quan he tinh due,
trtfc khuan lao lay bang dtfdng ho hap, phay khuan ta lay theo dtfdng
tieu hda...
- Tinh cam thu cua chu the (6): tinh cam thu cua chu the hay con goi vat
chu no phu thuoc vao:
+ Tuoi, gidi.
+ Tinh trang stfc khoe hien tai: tre em, ngtfdi gia, ngtfdi gay yeu, suy
dinh dtfdng, m&c cac benh man tinh.....
+ Kha nang mien dich.
3. VI KHUAN GAY N H lilM KHUAN BENH VIEN HAY GAP
3.1. Tu cau
Dac biet la tu cau vang (Staphylococcus Aureus) khang vdi Methiccilin).
- La loai cau khuan gram dtfdng, khong cd dang bao ttf, song dtfdc trong
mdi trtfdng ky khi va tfa khi.
- Nguon nhiem.
+ Mdi trtfdng: tu cau vang lan truyen rong rai, cd the gap trong khdng
khi, ntfdc, cd the ton tai ca d trong mdi trtfdng kho.
+ Ngtfdi: chu yeu d vung mui hpng, da, dtfdng ruot....
- Phtfdng thtfc lan truyen: vi khuan cd the lan truyen bang cach.
+ Trtfc tiep: dtfdng mui hong.
+ Gian tiep: ban tay, dung cu, ntfdc, khdng khi, thtfc pham bi nhiem.
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- Bieu hien lam sang.
+ Nhiem khuan da niem mac: mun nhot, choc 16...
+ Ap xe trung that, nhiem khuan mau, nhiem khuan dudng tieu. ho hap,
tieu hoa.
3.2. Vi khuan dtfdng ruot
* Escherichia Coli.
- Trtfc khuan gram am, ky khi va tfa khi khong co dang bao ttf.
- Nguon nhiem.
+ Moi trtfdng: rau, ntfdc song, dat... Stf co mat cua E. Coli trong ntfdc la
mot bang chtfng ve stf nhiem khuan ttf phan.
+ Benh vien: noi nha tam, nha ve sinh....
+ Ngtfdi: vi khuan co mat chu yeu d dtfdng tieu hoa.
- Phtfdng thtfc lay truyen: trtfc tiep: qua dung cu, chat lieu, dung cu bjin
khong dtfdc xtf ly dung, qua ban tay nhan vien y te ngtfdi benh, ngtfdi
nha trong qua trinh cham soc...
- Bieu hien lam sang: gay nhiem khuan dtfdng tieu, dtfdng ruot, mau.
* Kebshiella.
- La trtfc khuan gram am, tfa khi va ky khi, khong ton tai dang bao tii.
- Nguon nhiem.
+ Moi trtfdng: vi khuan co nhieu trong ntfdc, dat, rau...
+ Benh vien: vi khuan co the ton tai trong cac dung dich khii khuan bao
ve khong tot, cac loai md boi, xa phong, mat na khi dung, binh l&m am
oxy... khong dtfdc khii khuan dung quy dinh.
- Phtfdng thtfc lay truyen.
+ Trtfc tiep: dich tiet mui, hong.
+ Gian tiep qua ban tay, dung cu va cac loai dung dich dung trong benh
vien bi nhiem khuan.
3.3. Trtfc khuan mu xanh (Pseudomonas Aeruginosas) da khang thuoc
khang sinh.
- La loai trtfc khuan gram am, tfa khi, khong tao bao tii, co kha nang sinh
trtfdng trong nhieu moi trtfdng cua benh vien hoac moi trtfdng nuoi cay
ngheo chat dinh dtfdng.
- Nguon nhiem.
+ Moi trtfdng: ntfdc, dat, rau, qua...
+ Benh vien: dung cu, dung dich khu khuan, md boi... bao quan khong
dung.
+ Ngiidi: thiidng phan lap diidc vi khuan tii ngiidi benh mac benh man
tinh, thdi gian nam vien lau.
- Bieu hien lam sang: thiidng gay cac nhiem khuan da, viem phoi, tiet
nieu, nhiem khuan mau, tieu hoa.
3.4. Trtfc khuan lao
- La loai vi khuan khong tao bao tti, khong co vo, bat mau khi nhuom, kho
nuoi cay phan lap vi khuan. Nhay cam vdi nhiet do va tia ctfc tim.
- Nguon nhiem.
+ Moi trUOng: khong khi, bui, dung cu khii khuan khong dam bao dung
quy trinh.
+ Ngiidi: ton tai d ngiidi benh co hoac khong co trieu chtfng.
- Phiidng thiic lay truyen.
+ Trtfc tiep: bang diidng ho hap thong qua cac hat ntfdc bot khi tiep xuc
noi, ho, khac, hat hdi....
+ Gian tiep: khong khi co vai tro quan trong trong viec lay truyen benh.
Cac giot ntfdc bot ban ra ttf mieng ngtfdi benh, tao nen nhting hat bui
ctfc nho chiia vi khuan Id ltfng trong khong khi, moi ngtfdi co the hit
phai. Trtfdng hdp dac biet co the lay truyen qua diidng tieu hoa do an
phai sfla bi nhiem trtfc khuan lao bo.
3.5. Cac vi khuan khac
- Legionella.
- Acinetobacter Baumanni.
- Cau khuan diidng ruot khang Vancomycine.
4. NHIEM KHUAN BENH VIEN HAY GAP
4.1. Nhiem khuan tiet nieu
- Nhiem khuan tiet nieu benh vien co trieu chiing.
- Nhiem khuan tiet nieu khong trieu chiing xong co vi khuan trong ntfdc tieu.
- Cac nhiem khuan benh vien khac cua diidng tiet nieu: than, nieu quan,
bang quang, nieu dao...
4.2. N hiem khuan dtfdng mau
- Nhiem khuan huyet lam sang.
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- Nhiem khuan huyet co ket qua phan lap vi sinh.
- Nhiem khuim dong mach hoac tinh mach.
4.3. N hiem kh u a n vet m o
- Nhiem khuan vet mo nong.
■> / ■> A
- Nhiem khuan vet mo sau.
- Nhiem khuan vet mo tai cO quan hoac khoang cO the.
4.4. Nhiem khuan vet bong
4.5. Nhiem khuan benh vien dtfcfng ho hap
- Nhiem khuan ho hap tren.
- Viem phe quan, viem khi phe quan, viem tieu phe quan.
- Viem phoi.
4.6. Nhiem khuan tai mui hong
- Viem tai.
- Viem xUdng chum.
- Nhiem khuan hoc mieng.
- Viem xoang.
4.7. Nhiem khuan benh vien dtfdng tieu hoa
- Viem da day ruot.
- Nhiem khuan dtidng tieu hoa (trti viem da day ruot va viem ruot thtia).
- Viem gan.
- Nhiem khuan trong o bung.
- Viem ruot non, ruot gia hoai tti.
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4.8. Nhiem khuan da va mo mem
- Nhiem khuan da.
- Nhiem khuan mo mem.
- Nhiem khuan viet loet do n&m (nong va sau).
4.9. Nhiem khuan so sinh
- Viem ron.