Vô khuẩn và Khử khuẩn trong Nha khoa

8/7/2019 V khun v Kh khun trong Nha khoa

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V Trng Nh Ngc B mn Rng Tr Em Vin o To Rng Hm Mt

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V KHUN V KH KHUN TRONG NHA KHOATS. V Trng Nh Ngc

A.t vn .Ngy nay him ha HIV, HBV, HCV, lao ngy cng gia tng v

tr thnh mt mi him ho chung cho ton nhn loi, tt c chng ta ai

cng u l i tng c nguy c b ly nhim cc virus trn nu nh

chng ta khng bit cch phng.

c bit trong hnh ngh nha khoa hng ngy chng ta thng xuyn

tip xc vi cc bnh nhn trn, lun lun phi x dng cc dng c cm

tay sc nhn rt d gy ra cc s c ngoi mun, lun lun tip xc trc

tip vi mu, nc bt ..nn nguy c ly nhim l rt cao. Mi can thip

ca nh thc hnh u c th lm ly nhim cho ngi khc v cho chnh

bn thn mnh nu khng tun th nghim ngt theo cc nguyn tc v

khun. Chnh v th, hn lc no ht chng ta cn phi tn trng cc

nguyn tc v khun v c cc bin php phng ly nhim trnh

ly lan ngun bnh t bnh nhn ny sang bnh nhn khc, bo v tnh

mng cho bnh nhn, cho ngi iu tr v cho c ph t.

Cc thy thuc, c bit l cc sinh vin phi to cho mnh mt thi

quen v mt phn x v khun tt trong cng tc thc hnh ngay t

nhng bui thc tp u tin

B. Mt s nh ngha

1. V khun (Asepsie)V khun l loi b hon ton cc vi khun gy bnh l, trn thc

hnh l loi b s lan truyn ca mi vi sinh vt.


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2. Kh khun (Sterilisation)Kh khun l dit hoc loi b mi dng vi sinh gm virus, vi khun v

bo t. Mt vt c kh khun th khng cn c th pht hin ra c

cc vi sinh vt trn cng nh sau mt thi gian bao bc cn nguyn vn..3. Ty trng (desinfection)Ty trng l dng cc ho cht ph hu, tiu dit cc vi sinh vt gy

bnh trn cc vt v cc b mt. Trn m sng, khi nim ny cng ging

vi khi nim st khun (antisepsie). Sau khi c ty trng cc dng c

hoc cc m c ty trng khng ch c kh khun mt cch cn

thit m cn m bo an ton s dng cho nhng ca sau. V mt gi

thuyt, tt c cc vi khun v phn ln cc nm b git cht. Mt s virus

c th cn sng st sau khi ty trng. Chng hn nh cc Mycobacterium

tuberculosis c sc khng mnh vi cc cht ty trng ho hc.

4. Lau chiMc ch ca lau chi l loi b cc vt bn. Phn ln cc mm bnh

c loi b giai on ny. Lau ra bng cc loi my t ng c hiu qu

hn lau ra bng tay.

5. Chng nhim (decontamination)Gm cc bin php khc nhau kim sot, ch ng nhim trng, t

bin php n gin nh lau chi cho n ty trng v kh trng.

Trong thc hnh, phn ln cc dng c, my mc v cc trang thit b

nha khoa khc c s dng tr li cho nn n cn phi c x l sao cho

khng cn c mt nguy c ly bnh no.Tuy nhin, khng th x l cc dng c theo cng mt phng thc bi

v mi loi c nhng tnh cht c bit ring v mc i hi ring.


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Trn lm sng d p dng ngi ta thng theo phn loi dng c ca

Spaulding kh khun. Theo ng c ba nhm dng c vi cc mc x

l khc nhau nh sau:

- Cc dng c i hi kh khun tuyt i: gm cc dng c ca vo vng v trng nht ca c th, c ngha l cc dng c c

tip xc trc tip n ng mu nh: dao m, km nh rng,

by, c, mi khoan, cc dng c nong tu, ly tu... Cc dng c

ny cn phi c kh khun tuyt i.

- Dng c cn kh khun trung bnh: l cc dng c tip xc vinim mc nhng khng i su vo bn trong m. Cc dng c

ny c kh khun hoc t nht l phi c ty trng (iu ny

c ngha l cc bo t c th c sng st). V d nh gng

khm, gp, thm trm... nu khng c kh khun th c th un

trong nc si 10 pht hoc ngm trong cc dung dch ty trng

cho n 10h.

- Dng c cn kh khun tng i: gm cc dng c ch tip xcvi da lnh, nhng dng c ny phi c lau ra v ty trng

nhng khng phi c kh khun

C. Ly nhim, nhim trng v cc ng ly truyn bnh

Mc ch ca vic v sinh l nhm ngn chn s lan truyn mm

bnh t ngi ny sang ngi khc theo kiu gin tip hoc trc tip.

kim sot c s ly nhim chng ta cn phi bit r v ngun bnh v

ng ly truyn bnh.1. Ngun bnhMi mt bnh nhn khi n cha rng u c th l mt ngun bnh mc

d ngi c hay khng c biu hin ca bnh nhim trng. Bnh nhn


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1/5 nu ch th mang HBV

1/30 nu ch th mang HCV

1/300 nu ch th mang HIV

Nu khng bit ch th c mang mm bnh hay khng, tnh ton theodn s B, kh nng gp cc ch th mang cc virus trn l:

HBV: 0,6%

HCV: 0,7%.

HIV: 0,1%

Do nguy c huyt thanh s b thay i sau khi b ly nhim trc

tip l:

1/800 i vi HBV

1/4000 i vi HCV

1/300000 i vi HIV

Do vn nguy him nht l cc HBV, cho nn cc nha s nn

tim vaccin phng nga cc bnh ny, tr khi chng ta cha tm ra vaccin.

3. Cc vi sinh vt gy bnh

3.1. Cc vi sinh vt gy bnh

V mt l thuyt, tt c cc vi sinh vt u c th ly nhim sang cho

ngi khc v u c th gy bnh thm ch i vi cc chng vi khun

cng sinh ngi nh: Pseudomonas aeruginosa, Candida albicans,

Legionella

Nhng vi khun thng gy bnh l:

y Staphylocoques: ch yu l Staphylococcus aureusy Mycobacterium Tuberculosisy Streptococcus pyogenes

3.2. Virus


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Phn ln cc loi virus u c th b ly truyn. y chng ta ch

ch n mt s virus c nguy c gy bnh cao v mc nhim trng

nguy him l:

y HBV: virus gy bnh vim gan B.y HCV: virus gy bnh vim gan C (cn gi l type non A-

non B)

y Herpex simplex type 1 v 2, mt s Enterovirus c trong ccvt thng ca ming v mi

y Cc virus trong dch bi tit ca ng h hp hoc ncbt+ Cc virus gy bnh ng h hp: Influenza,

Parinluenza..

+ virus Oreillon

y Cc virus gy bnh nhim trng c hi cho cc ngi bnhsuy gim min dch, ph n c thai nh: Cytomegaloviruys,

virus rubole, Parvovirus B19

C. Cc bin php d phng c bn

C 3 nhm d phng c bn sau:

- Bin php chun nhm chng li cc bnh ly truyn theo ngmu.

- Bin php cch ly ngun bnh: thng c p dng trong bnhvin.

- Bin php can thip vo ng ly truyn bng cch lau ra, tytrng v kh khun

1. Bin php chun


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Bin php ny nhm chng li cc bnh ly truyn theo ng mu

m khng cn bit bnh nhn c mang mm bnh hay khng

Trong thc hnh cn ch nhng vn sau:

* Mi mt bnh nhn c xem nh l ch th tim tng cc tc nhn gybnh, ngi chm sc bnh nhn cn phi bo v an ton cho ton b bnh

nhn, cc cng s v cho chnh bn thn ngi chm sc. thc hin c

iu ny tt c nhng dng c tip xc vi mu, nim mc, nc bt v cc

git nc bn ln v tt c cc dng c b ly nhim hoc c s

dng phi c x l nh sau:

+ Cc phng tin c tip xc vi nim mc bnh nhn phi c ty

trng mc cao hoc kh khun. Mt iu ch l cn phi lm sch

trc khi ty trng.

+ Ngi chm sc cn bo v nim mc ca h bng cch eo khu trang v

knh bo v, lun lun mang gng tay khi lm vic v phi ra tay ngay sau

khi tho b gng. Nu qun o c nguy c b vn bn th cn phi mc o

blouse v tp d.

+ Bng bt c gi no cng khng c cc dng c gy tn thng, cc

dng c sc nhn cn phi c tp trung vo cc dng c t bit x l.

+ Cc mu, hm gi trc khi gi v labo cn c lau ra v ty trng

trc.

+ Cc loi rc nha khoa cn phi c ng kn v x l theo ng qui trnh.

2. Lau ra, ty trng, kh khun

D. Cc phng php kh khun dng c:1. Chun b dng c:

- Dng c lm xong phi ngm ngay vo dung dch ty trng sau lau ra cn thn vi x phng, bn chi v nc hoc my siu


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y un si 30 pht k t lc si.y Nc phi ngp tt c dng c.y C th cho thm vo 1-2gram Natri Carbonate tng hiu

qu.

y Nc dng un si nn s dng cc loi nc cun si ngui trnh hin tng cc cn bn lng ng

lm nh hng n cht lng ca kh khun.

Nhc im ca phng php ny l khng dit c cc

bo t (bo t c th sng c trong 48h).

Cch ny thch hp trong nhng trng hp khn cp,nhng ni t dng c v nhanh v gn nh l c dng ngay.

- Kh khun bng t sy kh: c s dng kh khun nhng dng c,

bt, du v nhng th khng th hp c hoc un si c.

y u im:+ Kh khun c dng c l knh, thu tinh m khng b

hng

+ Khng lm r st v n mn.

+ Kh khun c cc loi du hu hiu.

+ Gi thnh r.

y Nhit , thi gian kh khun tt nht l 160C trong 120pht, 180C trong vng 60 pht v 180C trong vng 30

pht.

y Nhc im: lm h hi cc vi v cao su nhit cnthit, phng php ny ch s dng c cho cc dng c c

th chu c nhit cao; cc tay khoan, mt s dung dch

khng th c kh khun bng cch ny.


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- Kh khun bng autoclave: y l phng php chc chn nht tiu

dit tt c vi khun v cc bo t trong mt thi gian ngn nht. Phng

php ny cn gip chng ta c th kh khun c nhiu dng c trong

cng mt lc.Nguyn l: s dng hi nc di sc nn 1 Atmospher, nhit s tng

ln 120C v tt c cc vi sinh vt u cht trong khong 15-20 pht. C

nhng my c kh nng ty trng c dng c nhit > 90 C ch trong

vng 3-10 pht hoc kh khun nhit 1340 v nn 2 atmosphere

(200kPa) trong 3 pht, 121C (100kPa) trong 15 pht. Khi s dng cn ch

cng thm thi gian lm nng, lm ngui v lm kh dng c.

Dng c phi c bao bc trong giy xp c ghi ngy tit trng, loi

dng c c bn l, khp phi c m ra, nu bao mt ln sau khi kh

khun khng dng th sau 30 ngy phi kh khun li, nu bao 2 lp th c

th dng c trong vng 6 thng. Nu dng c b trong hp kim loi th

phi m np hp ra. Cc dng c, vi, gng phi xp cho nhau sao cho hi

nc c th thm vo c.

Ngy nay trn th trng c rt nhiu loi autoclave, c loi c th t

lm kh, c loi khng th t lm kh c do vy khi s dng cn phi ch

n tnh nng ca my v tun th theo qui trnh s dng ca nh sn xut.

i vi cc loi Chemiclave, chng ta c th trn hi nng vi mt

hn hp cc cht Formaldehyde, acetone v cn, nhit s dng l 132 C,

thi gian cn thit l 20 pht.

Nhc im ca Autoclave:+ Gi thnh cao.

+ Lm mm cc bng nha v cao su, cc dng c bng kim

loi c cht lng km nhanh b soi mn. khc phc nhc


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im ny ngi ta khuyn nn ngm cc mi khoan vo trong

dung dch Natri nitrite trc khi cho vo autoclave.

2.2. Kh khun lnh:

y l phng php dng cc cht ty trng kh khun. Tc dng caphng php ny ph thuc vo loi thuc s dng, nng ca thuc,

nhit , thi gian tip xc, cng ca nc v mc ly nhim. Cho

n ngy nay th vn cha c mt ho cht no hon ho v tin li.

2.3. Tia t ngoi

- Tia t ngoi c bc sng khong 0,39m 10-2m.

- Tia t ngoi mt tri nh hng ln hu nh tt c qu trnh trao i cht

v sinh l chc nng ca mi sinh vt, trong mt vi trng hp n c kh

nng quyt nh n hot ng sng ca mt c th no . Nghin cu tc

dng ca bc x t ngoi ngi ta c th chia ph ca n ra thnh 3 vng:

+ Vng c bc sng t 180-275nm gi l vng sng ngn lm thay

i cu trc ca proteine, lipit v c tc dng dit trng.

+ Vng c bc sng t 275-320nm gi l vng sng trung, c tc

dng chng ci xng, to sc t, thc y s to thnh biu m, lm

tt hn qu trnh ti sinh.

+ Vng c bc sng t 320-400nm gi l vng t ngoi sng di, c

tc dng ln sinh vt yu, gy pht quang mt s cht hu c

- Tia t ngoi liu lng ln c tc dng dit khun cao l do tia c tc dng

khng ch kh nng sinh sn ca vi khun. Tc dng ny ch yul do tia

lm tn thng ADN ca virus v vi khun.- Ngy nay tia t ngoi c s dng nhiu ty trng phng m, phng

nha sau khi kt thc bui lm vic. Cc nh sn xut cng sn xut ra cc

loi t tia t ngoi ct gi v bo qun dng c rt tin li


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E. Cc cht ty trng (desinfectant)

L cc cht ho hc c th c ch hoc tiu dit vi sinh vt gy bnh

c dng x l dng c, mi trng v trang thit b. Cn phn bit vi

thuc st trng (antiseptique) dng x l trn m sng: vt thng, vngda trc khi m...

1. Cc tiu chun cho mt thuc st khun l tng

Mt cht st khun l tng cn c cc tiu chun sau:

- Tc dng nng long.- Khng c vi m hoc lm hng dng c.- n nh.- Khng lm mt mu hoc nhum mu.- Khng mi.- Tc dng nhanh ngay c khi c mt proteine l, dch r vim.- R tin.Hin nay vn cha c mt cht st khun no t tiu chun trn.

#Phn loi cc cht st khun theo c ch tc dng:

y Oxy ho: H2O2, ozon, phc hp c Chlor, KMnO4y Alkyl ho: Ethylenoxyd, Formaldehyde, Glutaraldehyd.y Lm bin cht proteine: cn, phc hp phenol, iod, kim loi

nng nh Hg, Ag.

y Cht din hot: cc phc hp Amino bt 4.y Ion ho cation: cht nhum.y Cht gy tn thng mng: chlohexidine

2. Cc cht ty trng chnh

2.1 Nhm Alcool

Thng dng Ethanol dung dch 70% v cc isopropylique.


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Tc dng: dit c vi khun, nm, virus v vi khun lao nhng

khng c vi bo t ca vi khun. Tc dng ca cn gim i nu nng

ca n < 600 v > 900. C tc dng tt hn i vi vng da lnh. N

cng c th c s dng ty trng cc b mt v cc dng c sch.Nhc im: Ethanol d bc hi lm gim nng v d chy.

Nhm Aldehyde

Thng dng Formaldehyde (Formalin) v Glutaraldehyde (Glutaral)

Formalin c nhc im l gy kch ng v c do vy ngy nay hu

nh n khng cn c s dng. Tuy nhin, c th dng ty trng b

mt khi n c dng phi hp vi mt s aldehyde khc v hoc vi cc

Amonium bc 4. Nhng sn phm ny thng t c dng ty trng

dng c v n n mn dng c.

Glutaraldhyde c s dng dng dung dch 2% phi c hot

ho bng cht bt hoc dch m km km theo. Cht ny cng c th

c dng kh khun nu chng ta ngm dng c trong thi gian di

ti thiu l 3h. Ty trng c tc dng sau khi ngm dng c c 10

pht, sau 30 pht i vi HBV, HCV v BK.

Tc dng ca Glutaraldhyde ph thuc nhiu vo cht lng ca

cng vic lau ra trc . Nu nh dng c vn cn bn th n khng c

tc dng v cn phi thay th li.

c tnh v kh nng gy kch ng ca sn phm ch yu l cho mt,

da v ng h hp. Chnh v vy sau khi ngm vi dung dch cn phi

ra sch bng nc sch loi b ht nhng phn cn li. Khi thao tcvi cc sn phm ny cn phi mang knh bo v, khu trang, gng v

qun o bo v.

Biguanide


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- Cc Digluconate chlohexidine t c v do vy c s dng st

khun m sng. N thng c s dng vi Alcool hoc vi nhng

ammonium bc 4.

- Dung dch cn Chlohexidine 0,5% rt c tc dng st khun da.- Cc sn phm c dc cht chnh l Chlohexidine v Cetrimide th

tin li st khun da v vi nng cao hn th c dng lau

ra dng c. Tc dng chnh ca n l dit khun.

- Trc khi bt u iu tr cho bnh nhn nn cho bnh nhn sc

ming bng dung dch Chlohexidine 0,2% trong vng 1 pht

2.4 Nhm Ammonium bc 4

Hp cht ny bao gm:

- Cetrimide.- Ctylperidinium.- Benzalkonium chlorure- Didcyldimthylammonium

c tnh yu.

Khng c th dit c BK, bo t v virus, khng dit c tt c

cc vi khun Gr v mt tc dng bi x phng, nc cng v cc mnh

vn hu c. y l l do gii thch ti lm sao m n ch c dng kt

hp vi cc loi khc.

2.5 Nhm hp cht gii phng Chlor

y Dung dch Natrihypochloride (v d: nc Javel 1% dng ngmdng c trc khi ra 15 pht v ty trng nn nh, ng nh,Household Bleach, hoc nc Dakin 0,43% dng ra vt thng

hoc ra tay trc khi phu thut).

y Dung dch Canxihypochloride.


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y Dung dch Natri dichloroisocyamurate (NaDCC)y Chloraminey Benzakonium chlorure (Zephiran 1%) c nhiu u im nhng phi

ngm lu trong 18h.Nhm ny tc dng chm trn bo t.

Nhm Hypochloride khng c dng cho dng c kim loi v gy

r st.

NaDCC v Chloramin bn vng hn so vi Natrihypochloride( nc

Javel, Household Bleach) v Canxihypochloride Chloramin khng b cc

cht sinh hc nh prrotein, mu kh hot nhng gii phng ra Chlorchm hn so vi Hypochloride.

2.6Nhm cc cht oxy hoThng dng l Hydro Peroxyde 3-6% ngm dng c ra vo dung

dch 30 pht - khng dng vi dng c: ng, nhm, km, thau v oxy ho

mnh.Vi nng cao hn 10-25% n c th dit c bo t.

Thuc tm (KMno4) vi nng 1:10000 c tc dng dit nhiu loi vi

khun trong 1h. Nng cao hn d kch ng da.

Ngy nay trn th trng c rt nhiu sn phm c tc dng tt. Sau y

l mt s sn phm thng ang c s dng Vit nam.

Cc sn phm dng ty dng c:

** Ampholysine plus

Cng thc gm:

y 3 cht dit khun l cht lng tnh Amphotere,y Dn cht Biguanide, cht Amoni bc 4,y Mt s cht ty ra khng ion ho phn hu mu, m, huyt tng.y Cc cht c ch s n mn khng lm r st dng c.


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Tc dng: dit c c vi khun, virus v nm, k c HIV v HBV

trc khi hp

- t c, khng kch ng vi ngi.- ng trong can, l, gi ch cn pha long vi nc my theo ch

dn ca nh sn xut

- ng gi: mt gi 25ml pha vi 5l nc, ngm dng c 15ph rira nc lau kh, hp l Poupinel.

Endosporine:

Thnh phn gm;

- Glutaraldehyde 2%- Cht in hot khng ion ho.- Cht c ch s n mn.Tc dng:

Dit vi khun, virus HIV, HBV, nm v c bo t.

Tit trng dng c ni soi, dng c cao su.

Qui trnh u tin ngm Ampholysine plus sau ngm

Endosporine (ch sn khng cn pha ch)

Cc cht ty u mi trng:

y BactylysineThnh phn:

- Polyalkylamine.- Amoni bc 4.- Cht in hot khng ion ho.- Cht c ch s n mn.Dung dch m c khi dng pha long vi nc my

S dng: ra nh, bn, gh, xe y


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y Biospray.Ty u theo phng php khuych tn kh, phun bng bm tay hoc

bm in, s dng cho khng kh phng hay my nha khoa.

Bactilysine v Boispray dit vi khun k c BK, nm virus HIV, HBV.Ngy nay khng dng Formaldehyde v c v gy kch ng, thay cho

chiu tia UV v khng tc dng i vi HIV

y Savon dit khun.- Trc y dng Savon trn Hexachlorophen ch phm l Phisohex

nhng c c tnh.

-

Ngy nay dng Savon Doux Usage Frequent. Thnh phn: chtBacteriostatique, Vitamine F dng da, cht ph tr ty u virus,

nm, vi khun, k c HBV v HIV

Cc ch phm trn c b y t Vit Nam cho php s dng rng ri

F. phng ly nhim trong phng rng

Cn phi ch n nhng vn sau:

1. Chm sc tay phu thut vin

- y l mt ng tc ht sc cn thit bo v cho phu thutvin v cho c bnh nhn

- Trn da tay lun c hai nhm vi sinh vt: cc vi sinh vt cng sinhv cc vi sinh vt tm thi (nht thi). Cc vi sinh vt cng sinh

sng v pht trin trong cc np gp ca da, ng tuyn b v cc

nang lng, t chng pht trin ra b mt v ln ln vo cc vi

sinh vt nht thi. Kh nng gy bnh ca cc vi sinh vt cng sinhkhng cao v thng thng khng phi l tc nhn gy ly nhim

chnh tr khi c nhng can thip nng. Cc vi sinh vt nht thi rt


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phc tp v thnh phn v thng thng l nguyn nhn chnh gy

ly nhim cho.

. Cc ch chung

- Mng tay cn phi ct ngn.- Cc trang sc cn phi tho b.- Cn phi ra tay sch trc v sau khi can thip.

1.1.Khi nim v ra tay v st khun tay.

1.1.1.Ra tay

- Ra tay c ngha l chi ra tay loi b tt c cc vt bn c thnhn thy v khng nhn thy nh vo cc bin php c hc.

- Ra tay v sinh l loi b cc vt bn v mt phn ln cc visinh vt nht thi.

- Mc d dng phng php no ra tay i chng na th cngkhng th loi b ton b ht cc vi khun c.

1.1.2.St khun tay

Mc ch l dit khun bng cc cht ho hc. Chng ta phn bit

ra hai loi st khun tay:

**St khun v sinh

- c thc hin trc khi tin hnh can thip v sau khi b lynhim.

- St khun v sinh phi tiu dit c ht ton b cc vi sinh vtnht thi cn tc dng trn cc vi sinh vt cng sinh th c th

nhng khng cn thit.** St khun phu thut:

- c thc hin trc khi can thip phu thut.


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- St khun phu thut ngoi vic loi b cc vi sinh vt nht thicn km hm s hot ng ca cc vi sinh vt cng sinh, tc dng

ny c th ko di 2-6h.

1.2.Nguyn tc v phng php ra tay, st khun tay1.2.1.Gng tay

- Ra tay v st khun tay khng th thay th cho vic i gng vngc li.

- Lun lun phi i gng tay khi iu tr cho bnh nhn. Sau mibnh nhn phi thay gng v ra tay.

- Gng tay phi p ng c cc iu kin sau :o Ph hp vi kch c ca tay, c tay ca gng phi di v

cht.

o Gi c cm gic xc gic cho tay.o chu lc cao khng b rch v thng.o Khng thm.o Khng b n mn bi cc cht ho hc v phi tng hp vi

mt s sn phm nh Alginate, Silicon.

o Gi thnh r.- Ngy nay, trnh hin tng d ng vi cc loi gng Latex c

bt tan chng ta nn s dng cc loi gng Vinyl, Nitrile hoc cc

loi Latex khng c bt tan.

- C 2 loi gng tay:+ Gng tay non- sterile: c dng bo v cho ngi lm victrnh ly nhim khi chm sc

+ Gng tay sterile c dng bo v cho bnh nhn trong khi

lm cc can thip nng nh m mng xng.


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1.2.2.Cc thit b cn thit km theo

1.2.2.1.Bn ra tay

- Bn ra tay phi c hai ngun nc: nc nng v nc lnh, ltng l nc c iu khin chy bng ci ch, u gi hocchn ca phu thut vin. Bn ra tay phi c thit k sao cho

khi ra nc khng b bn ln.

- Cc thuc, x phng, v dng c lm kh phi c gn ngay trn tng. Nn s dng cc loi dng mt ln hoc l cc loi

bnh cha thuc ra tay c vch nh lng sn cho mi ln dng.

- Bn cnh cc bn ra tay cn c cc ti ng rc dng mt ln duynht v kch c phi ln.

1.2.2.2.Nc ra tay

- Cn phi c dng nc chy ra sch v loi b cc vi sinh vt.- Nc cn phi trung tnh khng nh hng n cht lng ca

cc dung dch v x phng ra tay.

- Khng cn thit phi dng cc nc v khun ra tay.1.2.2.3. Cc sn phm dng ra tay v st khun

- Bn chi mm chi tay. Nn dng bn chi dng mt ln nukhng phi ra sch v v khun trc khi dng.

- Nc x phng: sch v mt sinh hc, pH trung tnh hoc hiacide, c ng gi theo liu thng nht, gi c tc dng trong

sut thi gian s dng.

- C th dng cn 700 hoc cc dung dch c cht c bn l cn 700 st khun. Nn cho thm vo cn cc cht bi trn hoc

Glycerol 1% hoc du Silicon (2 git /lt) trnh lm kh da tay.


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- Nn s dng cc loi x phng c cha cc thuc st khun nhChlohexidine, Iodophore ra tay phu thut.

- Dng c lm kh tay:+ Cc dng c lm kh tay phi sch, ring cho mi c nhn, mmv c chun b sn.

+ C th dng khn giy hoc vi.

+ i vi cc h thng kh nn khng nn s dng v mt thi

gian, kch ng da v gy ly nhim khng kh.

+ Sau khi ra tay phu thut c th dng vi lau kh hoc

nhng tay vo cn.

1.3.Qui trnh ra tay phu thut

Gm c 6 giai on chnh:

- Nhng tay vo nc m t bn tay n khuu.- Ly dung dch x phng.- Dng bn chi chi t ngn bn tay ri n cng tay trong vng ba

pht (ch chi k ngn tay, mng tay v da quanh mng).

- Di nc m cho chy t ngn tay n khuu cho n khi sch htx phng.

- Xoa v ra li bng x phng m khng cn phi dng bn chi- Lau kh.

2. Trang phc

Trang phc ca nha s, ph t v cc cng s phi tun theo mt

vi tiu chun sau:- V sinh hon ho.- An ton cho ngi chm sc.- Thm m v ngn np.


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- c trng cho ngh nghip.3.Qun o

- Qun o phi c thay u n khi b vy bn.- Qun o phi che kn thng phc. Nn mc o ngn tay d

dng ra tay. Cht liu phi d dng git sch, khng b hng bi

cc cht git ty, chu c nhit , khng d chy. Trong thc t

chng ta nn chn cc o blouse hoc Veste c tay ngn bng

coton hoc polyester- coton, c ng kn.

- Khng c trang tr cc trang sc trn qun o.4.M

- Vic i m th khng cn thit khi chm sc rng thng thng.Tuy nhin nn tc ngn hoc bi thnh tng bi. Nu tc di

c th gy kh chu cho bnh nhn v c th gy ly nhim cho

dng c lm vic v ngc li.

5.Khu trang

- eo khu trang va c tc dng bo v cho nh thc hnh v choc bnh nhn.

- eo khu trang trnh ht phi cc ht nc bn ln v cc ht phnt nh nht l khi ly cao rng, mi rng , nh bng khng c li

cho nh thc hnh.

- Khi ngi chm sc b cc bnh nhim khun ng h hp nhvim mi, cm hoc nhim trng da v d nh do Herpes th bnh

nhn cng phi cn c eo khu trang.- Khu trang cn phi che kn mi v ming, c kh nng lc > 95%

v chng m. Cn phi thay khu trang ngay khi n b bn, b m


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v ngay sau khi s dng. Cn phi ra tay li ngay sau khi s vo

khu trang.

- Ngy nay c rt nhiu loi khu trang c kh nng lc cao, kn khttt bo v cho nha s nht l trnh cc BK.

6. Knh- Cn nn eo knh trnh cc ht nc hoc cc ht bi nh do

mi rng hoc nh bng bn vo mt gy tn thng mt hoc

gy ly nhim. Knh phi rng bo v v khng lm nh

hng n tm nhn ca mt.

7. Gh my

7.1.B mt

- B mt gh phi trn nhn, ty ra c vi cc cht ty ra,khng c cc ch ni hoc cc khe lm lau ra kh khn. Mu gh

phi sng d lau chi cc vt bn. Yn gh khng c cc np

gp hoc cc ng khu.

7.2. ng nh

- ng nh c kch thc , trn nhn, d bo qun, b thot, vira phi trn ng nh trnh ly nhim, ng nh c th c

tho ra v ty trng.

- Cn gii thch cho nha s v bnh nhn l gh my rt b ly nhim,trnh s tay vo m khng c bo v.

- Nn ty trng ng nh v b mt gh sau khi chm sc cho mimt bnh nhn

7.3.My ht.

- y l mt phng tin rt cn thit ht b cc cht dch, ccmnh vn trnh ly nhim ra mi trng xung quanh.


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- Nn chn h thng my c h thng ht c d dng lau ra vty trng. ng ht cn trn nhn pha ngoi, khng c cc im

ni thm ch c th ty trng bng nhit.

7.4.Cc nt iu khin v tay y.- Nn s dng cc nt iu khin chn trnh ly nhim. Mm

my v tay y nn bc bng cc loi nha hoc cellophan, nhm

mi khi dng cho mt bnh nhn.

7.5.My nn hi v cung cp nc

- Nc v hi s dng khoan hoc cho bnh nhn sc ming cnphi i qua mt h thng ty trng ho hc hoc i qua mt bnh

lc.

- Cc gh my c khi tc moteur v my phun nc s c hin tnght ngc dng tr li lm cho cc mm bnh b ht ngc tr li

vo trong ng ht v thm ch ra c bn ngoi. Ngy nay, cc gh

my hin i trnh hin tng ny ngi ta thay th van co tht

bng mt van chn hoc s dng mt dng c thi kh lm thng

ng ng

- Hng ngy trc khi bt u lm vic v sau khi lm cho mi bnhnhn chng ta nn vn hnh moteur v cc turbine vi giy trc

khi s dng.

- Trong cc phng mch c cc can thip phu thut nh phu thutnha chu, cy ghp implant cn lp thm cc h thng ht v bm

ra huyt thanh.7.6. Cc embout

- L cc b phn nh u tay xt hi, xt nc, u quang trng hp,u siu m...


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- Cc b phn ny thng xuyn a vo trong ming bnh nhnnn rt b ly nhim. Khi mua nn mua cc loi c th kh khun

v tt nht l dng mt ln.

- Trc y cc my quang trng hp, siu m, ni soi.. thngc ri ngoi my nhng by gi thng c lp gn lin

trn gh my lun nn nguy c b ly nhim l rt cao. Chng ta

cn phi st khun chng theo hng dn ca nh sn xut khi s

dng.

7.7.Cc t ng dng c

- Cc t ng dng c cn phng c b mt nhn, khng c cc khe,d lau ra v ty trng.

- Tt nht nn s dng cc khay dng c c chun b snkhng nn lp t nhiu t trong phng mch v dng c

trong s nhanh chng b ly nhim v do chng ta thng xuyn

chm vo nn n cng tr thnh mt ngun ly nhim.

7.8.My tnh

- Ngy nay my tnh ngy cng xut hin nhiu hn trong phng

mch qun l bnh nhn v phc v nhiu mc ch khc nn

y cng l mt vn cn quan tm n v nha s hoc tr th

phi lin tc thao tc trn bn phm hoc trn chut. Chng ta c

th dng cc giy cellophane mng che v thay th cho mi

bnh nhn.

8. X l dng c8.1.V sinh cc dng c nh

- Cc dng c nh file nong ty, mi khoan, que trm ... sau khidng xong cn phi ngm vo dung dch ty trng, ra sch, ng


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gi ri tin hnh kh khun theo cc phng php trnh by

trn. Tu theo tng loi dng c v theo hng dn ca cc nh

sn xut m chn mt phng php thch hp nht

8.2.V sinh cc tay khoan khuu, dng c cm tay, cc tay khoan siutc

- Cc dng c ny thng xuyn b ly nhim bi cc ngun khcnhau nh nc bt, mu, m..., n b ly nhim khng ch pha

bn ngoi m cn c bn trong nn i hi phi ty trng v kh

khun c bn trong ln bn ngoi. Tuy nhin vic kh khun

cc tay khoan l rt phc tp, ngoi ra n cn lm nhanh hng cc

thit b bn trong nn chi ph mua cc tay khoan l rt cao.

Chnh v vy m rt nhiu nha s ngi kh khun cc tay khoan

theo ng qui trnh.

- C hai cch v sinh nh sau:8.2.1. Qui trnh v sinh chun

Cng nh tt c cc dng c khc, cc dng c quay cng cn phi

c ty trng v kh khun theo mt qui trnh chnh xc hn:

- Dng tay xt hi lm sch ng du trong khong 10s.- Ra mt ngoi hoc bng bn chi hoc bng x phng hoc my

ra. Khng c dng my siu m ra tay khoan v n lm

hng cc b phn bn trong.

- Bm du bi trn theo ch dn ca nh sn xut (mt s nh snxut khuyn bm cht bi trn sau khi kh khun tay khoan).t bit i vi cc tay khoan vn hnh bng kh nn cn loi b

ht cc phn cht bi trn tha bng kh nn.

- Lau b cc vt du v loi b cc si nhn thy bng cn.


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- Bao bc.- Kh khun. S dng cc ni hp m kh khun, khng c

dng cc l hp kh.

- Trc khi s dng li dng c cn vn hnh trc bng tay xt hitrong vng vi giy.

Cc phng tin b sung.

- Vic ty trng v bi trn dng c quay c th c ci thin nhvo cc my t ng. Cc my ny cho php:

+ Lm cho tay khoan quay trong khi bm cc cht bi trn.

+ Bm cc cht ty trng trc khi bm cht bi trn.

+ Phun cc cht ty trng bn ngoi tay khoan.

+ Phun kh loi b ht cc cht ty trng v cht bi trn.

+ Dng c quay sau khi dng cho bnh nhn cn phi c kh

khun li.

- Ngy nay c nhng autoclave chuyn dng kh khun cc taykhoan.

8.2.2. Qui trnh ti thiu.

- C nhiu nh thc hnh khng p dng qui trnh chun khkhun tay khoan v gi thnh qu cao. Trong trng hp ny vn

y php b t ra.

- Nu chng ta khng thc hin theo qui trnh chun th phi thchin theo qui trnh sau:

y Thi b ht du trong ng bng tay hi trong 10s.y Lau ra mt ngoi hoc vi bn chi, cht ty trng hoc my ra t

ng

y Bm cht bi trn.(nn s dng my t ng bm)


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y Lau b cc vt du v loi b cc si nhn thy bng cn.y Ty trng bn ngoi bng cc cht ty trng.y Trc khi s dng li dng c cn vn hnh trc bng tay xt hi

trong vng vi giy.H Ni 24/12/2004

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