BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ Y TẾ VIỆN SỨC KHỎE NGHỀ NGHIỆP VÀ MÔI TRƯỜNG ---*--- LÊ ANH THƯ NGHIÊN CỨU THỰC TRẠNG PHÒNG NGỪA CHUẨN TẠI CÁC BỆNH VIỆN ĐA KHOA THUỘC SỞ Y TẾ HÀ NỘI VÀ HI
TỔNG QUAN
Nguy cơ lây nhiễm nghề nghiệp của nhân viên y tế
Sơ đồ 1: Chủ trình lây nhiễm
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Môi trường Vệ sinh môi trường, bề mặt
(Vi khuẩn, vi rút, ký sinh trùng…) Đối tượng bị ảnh hưởng
Nguồn chứa Đường ra Đường xâm nhập
Rác thải lây nhiêm, sắc nhọn
Dụng cụ y tế sắc nhọn
Da NVYT bị tổn thương
Bệnh nhân Dụng cụ y tế
Máu, dịch, chất tiết Đã sử dụng
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Nguồn chứa gián tiếp chủ yếu: có thể tồn tại và lưu trú dưới nhiều hình thức khác nhau, trong đó có một số nguồn chứa chủ yếu như:
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NVYT, ống nghe, máy tính, điện thoại di động…
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Ba Lan từ năm 2007 đến năm 2016 có tổng số 1849 BN thì có với tỷ lệ
Thực trạng phơi nhiễm và lây nhiễm nghề nghiệp của NVYT
Sơ đồ 2: Yếu tố nguy cơ và yếu tố phòng ngừa lây nhiễm
Yếu tố nguy cơ phát sinh
Yếu tố nguy cơ lây nhiễm
+ Trực tiếp: máu dịch, chất thải, chất tiết…
+ Giản tiếp: Bàn tay nhân viên y tế, bề mặt môi trường, không khí
- Điều kiện lao động đặc thù
+Dụng cụ y tế sắc nhọn
Yếu tố phòng ngừa và kiểm soát lây nhiễm
- Cung cấp điều kiện hoạt động phòng ngừa chuẩn :
+Hệ thống kiểm soát nhiễm khuẩn
- Hoạt động của hệ thống kiểm soát nhiễm khuẩn
(giám sát, đào tạo, quản lý sức khỏe…)
- Hoạt động của nhân viên y tế (KAP)
1.2.1 Các yếu tố bất lợi trong môi trường làm việc của NVYT
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19,3%); tỷ lệ hành hung chiếm 2,4 % trong đó lần lượt là KTV (2,8%); y tá (2,7%) và bác sỹ là 2,6% [44]
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1.2.2 Phơi nhiễm, lây nhiễm của nhân viên y tế
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DALY: năm sống tàn tật hiệu chỉnh (Disability adjusted life years) YLL: số năm mất đi do tử vong sớm (Years of life lost)
YLD: Số năm sống bệnh tật (Years lived with Disability)
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0,53% và ở các NVYT khác là 0,23% [54] Đặc điểm lây qua đường máu:
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Theo báo cáo của WHO số lượng NVYT bị nhiễm Ebola tại 3 nước Guinea, Liberia và Sierra Leone từ tháng 1 năm 2014 đến ngày 31 tháng 3 năm
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Lây nhiễm mạn tính (điển hình là bệnh lao), hiện nay lao nghề nghiệp được công nhận là bệnh nghề nghiệp theo thông tư hướng dẫn của Bộ Y tế
Các biện pháp phòng ngừa và kiểm soát lây nhiễm
1.3.1 Khái niệm và quá trình phát triển hoạt động phòng ngừa
Năm 2012, BYT đã ban hành tài liệu “Hướng dẫn phòng ngừa chuẩn trong các cơ sở khám, chữa bệnh” tại Việt Nam [8]
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Năm 1985 do sự bùng phát của dịch HIV/AIDS, CDC ban hành hướng dẫn phòng ngừa mới gọi là Phòng ngừa phổ cập (Universal Precautions)
Theo hướng dẫn này, máu được xem như là nguồn lây truyền quan trọng nhất và dự phòng phơi nhiễm qua đường máu là cần thiết [8]
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1.3.2 Một số biện pháp phòng ngừa chuẩn
Sơ đồ 3: Các biện pháp phòng ngừa chuẩn và kiểm soát
Môi trường Vệ sinh môi trường, bề mặt
(Vi khuẩn, vi rút, ký sinh trùng…) Đối tượng bị ảnh hưởng
Nguồn chứa Đường ra Đường xâm nhập
Quản lý các loại chất thải y tế
Sử dụng phương tiện phòng hộ cá nhân, quản lý chất thải y tế sắc nhọn
Bệnh nhân Dụng cụ y tế
Quản lý chất thải,đồ vải của BN
Khử khuẩn tiệt khuẩn VST
Kiếm soát hoạt động PNC
Giám sát +Tuân thủ PNC +NKBV Đào tạo
Cơ cấu tổ chức + Hội đồng + Khoa + Mạng lưới
Khái niệm: là làm sạch tay bằng nước và xà phòng có hay không có chất sát khuẩn và sát khuẩn tay với dung dịch có chứa cồn [8]
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Phương tiện thiết yếu vệ sinh tay:
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+ Chỉ định vệ sinh tay: là lý do cần VST tại thời điểm xác định liên quan tới loại thao tác chăm sóc, điều trị đã thực hiện
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Tỷ lệ tuân thủ vệ sinh tay: được xác định bằng số cơ hội có vệ sinh tay
(hành động VST) x 100/số cơ hội cần vệ sinh tay Theo báo cáo kết quả, trong
9900 cơ hội VST quan sát được, chỉ có 7,4% tuân thủ VST (BV tuyến tỉnh đạt