VO KHUAN - TIET KHUAN
MUC TIEU
1. Neu dtfdc dinh nghia khii khuan, tiet khuan vd cac khai niem vi nguy cd nhiem
khuan.
2. Trinh bay dtfdc cac phtfdng phap khii khuan.
3. Trinh bay dtfdc cac dac diem cd ban cua mot so dung dich khii khuan hay dung.
4. Trinh bay dtfdc cac phtfdng phap tiet khuan.
1. DAI C l/O N G
Tiet khuan va khii khuan nham bao dam an toan cho moi trUOng benh
vien, benh nhan va nhan vien y te (khi xii ly dung cu va sii dung dung cu). Co
nhieu phtfdng phap tiet khuan va khii khuan khac nhau do vay trong thtfc te
can chon ltfa mtfc do khii khuan thich hdp tuy thuoc mot so' yeu to: chat lieu
lam dung cu, loai va ltfdng vi khuan bam tren dung cu, nguy cd nhiem khuan
cho benh nhan va nhan vien y te va ca van de kinh phi ntfa.
2. DINH N G H fA
* Khii khuan: la qua trinh lam giam toi thieu so ltfdng vi sinh vat gay
benh tren dung cu hoac tren da tdi mtic khong gay nguy hiem tdi stic khoe,
qua trinh khii khuan khong diet dtfdc hoan toan bao tii cua vi khuan.
* Tiet khuan: la qua trinh tieu diet tat ca cac vi sinh vat ke ca nha bao
cua vi khuan.
3. NGUY C d N HIEM KHUAN
* Nguy cd nhiem khuan thap: nhtfng dung cu tiep xuc vdi da nguyen ven
hoac da binh thtfdng, hoac cac moi trtfdng it tiep xuc vdi benh nhan (ttfdng
nha, tran nha, san nha, do go).
* Nguy cd nhiem khuan trung binh: nhtfng dung cu nay khong xuyen qua
da hoac di vao nhtfng ndi vo khuan cua cd the, chung chi tiep xuc vdi niem
mac va da khong nguyen ven (dung cu ho hap, noi soi tieu hoa,...).
* Nguy cd nhiim khuan cao: nhtfng dung cu di vao cac mo cd the vo
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khuan nhu cac hoc trong co the va he thong mach mau (dung cu ngoai khoa,
catheter mach mau, dung cu dat trong tu cung...), cac dung cu nay phai dtfdc
lam sach sau do tiet khuan. Vdi nhtfng dung cu khong the tiet khusin phai
dtfdc khtf khuan mtfc do cao.
4. CAC PHI/ONG PHAP KHU1 KHUAN
4.1. Lam sach
La qua trinh dao thai cac vat la (dat, chat htfu cd, vi sinh vat) khoi mot
do vat.
- Lam sach toan dien va de kho se dao thai mot phan ldn vi sinh vat tren
be mat dung cu, dong tac nay luon luon phai di trtfdc viec khtf khu&n
hoac tiet khuan.
- Lam sach dtfdc thtfc hien nhd ntfdc, chat tay rtfa va cac dong tac co riia,
co the dung tay hoac may moc cho viec co riia.
4.1.1. Lam sach dung cu
* Co rufa b a n g tay.
- Tat ca cac dung cu phai dtfdc thao rdi trtfdc khi co riia.
- Ntfdc may rat thich hdp bdi no dao thai hau het cac chat htfu cd (mau,
ddm...).
- Phtfdng phap ddn gian va hieu qua nhat la dung ban chai ch& khdp be
mat dung cu dtfdi mat ntfdc.
- Xuc riia dung cu vdi ntfdc sach, am va de kho.
Chu y: khi co rtfa dung cu nhan vien phai mang gang tot khi thilc hien.
Ban chai phai dtfdc khtf khuan va phdi kho sau khi s\i dung.
* Co rufa bang may.
- Nguyen tac hoat dong cua may:
+ Ntfdc sii dung ban dau la ntfdc lanh: cho phep loai trtf nhtfng san
pham khtf nhiem va tranh nhtfng yeu to" khong ttfdng hdp.
+ Riia lai vdi ntfdc nong tii 65°C - 95°C trong vong tii 15 - 20 phut (chon
nhiet do la tuy thuoc vao loai dung cu xii ly).
+ Trung hoa nhtfng san pham acid nham loai trii nhiing vet ban do tac
nhan tay rtfa.
+ Rtfa lai sau cung vdi ntfdc nong vdi muc dich khii khu^n (95°C doi vdi
nhtfng dung cu khong chiu nhi^t) va sau do lam kho.
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+ Boi trdn thtfdng dtfdc ap dung rieng cho cac loai dung cu kim loai (lau
bang dau theo chi dan cua ttfng loai dung cu).
+ Lam kho (neu khong co chu trinh lam kho. thi viec lam kho dtfdc thtfc
hien bang khan sach, doi vdi nhtfng phan rong thi lam kho bang khi
nen stf dung trong y te).
- Cac diem can ltfu y khi stf dung.
+ Xac dinh chtfc nang hoat dong cua may.
+ Xac dinh vi tri dat cac ro dung cu xem co stf qua tai khong?
+ Ltfa chon chtfdng trinh hoat dong cua may va nhiet do phu hdp vdi cac
dung cu dtfdc xii ly.
+ Kiem tra stf hoat dong cua chu trinh lam viec.
+ Kiem tra giai doan lam kho cua may.
- Nhtfng dieu nen lam:
+ Sap xep nhtfng dung cu sao cho phu hdp ddng chat vdi nhau (kim loai
di vdi kim loai, thuy tinh di vdi thuy tinh, nhtfa vdi nhtfa).
+ Chon ltfa chat san pham tay rxia. thich hdp vdi loai may cung nhtf loai
dung cu xii ly.
+ Md cac khdp noi cua cac dung cu.
+ Chai lo phai md nSp va up xuong.
+ Luon luon bat dau chu trinh bang riia ntfdc lanh nham loai bo cac san
pham khii khuan va tranh stf co dinh cua cac chat ban la protein.
+ Kiem tra chat ltfdng cua ntfdc, ntfdc mem la toi can thiet. Giai doan
riia sau cung thtfdng bang ntfdc da dtfdc lam mat muoi khoang tranh
lang dong muol tren dung cu.
+ Thtfdng xuyen lau chui may moc (phin loc va ong noi).
- Cac dieu khong nen lam.
+ Khong nen tron dung cu da bi an mon tren be mat vdi nhtfng dung cu
con tot.
+ Khong nen ket hdp trdng mot lan nhtfng dung cu bang Crome va Inox.
+ Khong nen dat qua nhieu dung cu trong may tao ra nhtfng “vung toi”
anh htfdng tdi stf co riia cua may.
4.1.2. Lam sach moi tri/dng
- San nha, cac be mat, bon ntfdc, ong d in ntfdc nen dtfdc co riia vdi ntfdc va
xa phong.
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- Viec sii dung thtfdng xuyen cac chat khii khuain la khong can thiet.
+ Neu co vUdng vai cac dich cd the (chat tiet, mau, mu,...) phai dtfdc khtf
khuan trtfdc khi co riia nhat la d cac khca phong co nguy cd cao.
+ Lau ngay ndi vtfdng vai cac chat tiet cua ngtfdi benh vdi sodium
hypochlorit 0,5 - 1%, hoac dung dich presept 1%.
+ Lau kho vdi ntfdc sach.
+ Phai mang gang tay (than trcng khi dung chlorine bdi vi hdi chlorine
cc the gay doc).
+ Neu dich cd the vtfdng vai phai dtfdc giai quyet ngay khong can thiet
phai khii khuan buong benh, chi co riia khap phong la du.
4.2. Khuf khuan bang nhiet
- Sii dung may Autoclave hoac noi ap suat la mot hinh thtfc khii khuan tot
nhat. Hap tfdt (moist heat) d 70°C - 100°C.
- Dun s6i d 100°C trong it nhat 5 phut ke tti luc b it dau soi la bien phap
ddn gian va dang tin cay nhat trong viec bat hoat cac vi sinh vat bao gom
virus viem gan B, HIV va vi khuan lao, mien la no dtfdc thtfc hien mot
cach ty mi (khtf khuan bac cao - dun soi 20 - 30 phut). Noi luoc phai dtfdc
de kho va thay ntfdc moi khi dtfng.
- Dun soi d nhiet do thap 80°C trong vong 5 phut doi vdi cac dung cu de bi
htf hai.
- Khti khuan bing may cung dtfdc thtfc hien vdi cac dung cu (vai v6c, vai
gitfdng, bo, chen bat, cac ong may thd, kinh deo m lt trong phong x6t
nghiem va cac dung cu phlu thuat trtfdc khi hap). 6 cac may nay, cac
btfdc lam sach, khti khuln ntfdc nong, lam khd dtfdc phoi hdp, hoa hdp vdi
nhau, giup cung cap nhanh cac dmig cu (day may thd), hoSc dam bao an
toan trong viec stf dung (dung cu phau thuat) va viec sue riia ky cang
trtfdc khi dung may co the lam cho thdi gian khtf khuan cua may ngan
hdn (70°C trdng vong 3 phut va 80UC trong vong 1 phut).
Chu y: can phai kiem tra may thtfdng xuyen va mtfc do khtf khuan cao
hay thap dat dtfdc tuy loai may va tinh phtfc tap cua dung cu dtfdc khii khuan.
4.3. Khuf khuan bang hoa hoc
4.3.1. Phan loai mite do khvC khuan
- Khii khuan mile do cao: la qua trinh khii khuan doi hoi phai diet dtfdc
hau het cac ldai vi khuan, nam, virus, trtfc khuan lao, ke ca bao tii vi
khuan. San pham hoa hoc dap tfng dtfdc nhu cau nay la cac loai hoa chat
glutaraldehyde d nong do 2%, hypochlorite, acide Pevicetic.
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+ Mot so" dung cu doi hoi khii khuan mtic do cao (ong noi soi ho hap. tieu
hoa tren) ta co the dung glutaraldehyde 2% (Cidex) trong 20 phut.
Neu can tiet khuan (diet ca bao tii vi khuan) co the ngam ngap dung
cu vao glutaraldehyde 2% trong it nhat 3 gid (Neu ngam trong 10 gid
thi se dam bao vo khuan tuyet doi).
+ Dung cu sau khi khii khuan d mtic do cao phai dtfdc trang riia bang
nUdc tiet khuan hoac ntfdc chin, sau do phai dtfdc lam kho va dong goi
hoac bao quan trong moi trtfdng kho, sach de khoi tai nhiem....
- Khii khuan miic do trung binh: la qua trinh khu khuan doi hoi phai diet
dtfdc cac loai vi khuan, nam, virus va trtfc khuan lao, nhtfng khong diet
bao ttf. Cac loai hoa chat thtfdng dtfdc stf dung nhom Iodine, formol,
phenolic, con.
- Khii khuan m iic do thap: la qua trinh khtf khuan doi hoi phai diet dtfdc
cac loai vi khuan sinh dtfdng, mot so virus co kich thtfdc trung binh va co
vo lipid. Cac loai hoa chat thtfdng dtfdc stf dung: amoni bac 4, amphoteres,
aminoacide, chlorhexidine.
4.3.2. Nguyen tac ltfa chon hoa chat dung trong khii khuan benh vien
Hoa chat khu! khuan phai dam bao mot so tieu chuan sau:
- Pho khang khuan rong.
- Tac dung nhanh.
- Khong bi anh htfdng bdi cac chat nhtf chat htfu cd, xa phong, chat tay riia
hoac cac hoa chat khac.
- Khong gay doc cho benh nhan, nhan vien y te va moi trtfdng.
- Khong anh htfdng len cac dung cu y khoa bang kim loai cung nhtf cac vat
dung bang vai, cao su, chat deo khac.
- Phai co hieu qua lau dai tren be mat dtfdc xii ly: de lai mot ldp mang
trang chong vi khuan (antimicrobial film) tren be mat dung cu sau khi
xii ly.
- De sii dung, mui vi phai de chiu, hoac khong mui.
- Re tien.
- Phai hoa tan de dang trong ntfdc va on dinh khi pha loang.
- Phai co tac dung lam sach.
4.3.3. Mot so hoa chat khii khuan hay dtfdc sti dung
* MICROSHIELD.
- Thanh phan va cac dang trinh bay:
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