B Y T

K HOCH HNH NG QUC GIA

V CHNG KHNG THUC
Giai on t nm 2013 n nm 2020
(Ph duyt km theo Quyt nh s 2174/Q-BYT
ngy 21 thn 6 nm 2013 ca B trng B Y t)

H Ni, thng 06/2013

MC LC
Trang
Phn th nht: S CN THIT XY DNG K HOCH
T VN .............................................................................................5
I. C S THC TIN................................................................................6
1. Thc trng khng thuc ..........................................................................6
.....................................................................................................................1.
1.Tnh hnh khng thuc trn th gii.................................................................6
.....................................................................................................................1. 2.
Tnh hnh s dng khng sinh v s khng thuc ti Vit Nam..........................8
2. Nguyn nhn khng thuc ......................................................................13
3. Hu qu v gnh nng do khng thuc ...................................................14
.....................................................................................................................II.
C S PHP L ...............................................................................................15
Phn th hai: NI DUNG K HOCH
I. MC TIU .............................................................................................15
.....................................................................................................................1.
Mc tiu chung ...................................................................................................15
.....................................................................................................................2.
Mc tiu c th ...................................................................................................15
.....................................................................................................................II.
NI DUNG HOT NG.................................................................................16
1. Nng cao nhn thc ca cng ng v cn b y t v khng thuc .......16
.....................................................................................................................2.
Tng cng, hon thin, nng cao nng lc h thng gim st quc gia v s dng
khng sinh v khng thuc .................................................................................17
3. Bo m cung ng cc thuc thit yu c cht lng........................18
4. Tng cng s dng thuc an ton, hp l ............................................19
5. Tng cng kim sot nhim khun .......................................................20
6. Tng cng s dng khng sinh hp l, an ton trong trng trt v chn
nui gia sc, gia cm, thy sn............................................................................21
Phn th ba: CC GII PHP
I. C ch chnh sch v qun l...................................................................22
II. Thng tin, truyn thng, gio dc...........................................................22
.....................................................................................................................III.
Chuyn mn, k thut v o to........................................................................23
2

IV. Ti chnh................................................................................................23
V. Nghin cu khoa hc v hp tc quc t ...............................................24
Phn th t: T CHC THC HIN
I.Thnh lp Ban Ch o .....................................................24
II.Phn cng trch nhim thc hin ............................................................25
CC T VIT TT

T vit tt

Ting Vit

Ting Anh

AFB

Trc khun khng cn khng

toan

Acid - Fast Bacilli

ANSORP

Mng li gim st ca chu

v s khng thuc ca vi khun
gy bnh thng gp

Asian Network for Surveillance

of Resistant Pathogens

AMR

Khng thuc

Antimicrobial resistance

ARV

Khng retro vi rt

Antiretrovirus

AZT - ZDV

Zidovudine

DDD

Liu xc nh trung bnh trong

ngy

Defined Daily Dose

ESBL

Men Beta - Lactamase ph rng

Extended - Spectrum Beta

-Lactamase

HAART

Liu php khng retro vi rt hot

tnh cao

HIV/AIDS

Vi rt suy gim min dch

ngi/Hi chng suy gim min
dch mc phi

Human Immunodeficiency
Virus/Acquired Immune
Deficiency Syndrome
3

KONSAR

Mng li gim st quc gia v

khng thuc ca Hn Quc

Korean Nationwide Surveillance

of Antimicrobial Resistance

KSNK

Kim sot nhim khun

Infection Control

NDM1

Men lm cho vi khun khng vi New Delhi metallo - beta

cc khng sinh nhm beta-lactam lactamase 1

NKBV

Nhim khun bnh vin

NNRTI

c ch men sao chp ngc

khng nucleosid

NRTI

c ch men sao chp ngc

nucleosid v nucleotid

NVP

Nevirapine

MDR-TB

Bnh lao a khng thuc

Multidrug - resistant tuberculosis

MIC

Nng c ch ti thiu

Minimum Inhibitor
Concentration

MRSA

Staphylococcus aureus khng

methicillin

Methicillin Resistance
Staphylococcus aureus

3TC

Lamivudine

d4T

Stavudine

PLTMC

Phng ly truyn m con

TCYTTG

T chc Y t Th gii

World Health Organization

XDR-TB

Bnh lao siu khng thuc

Extensively Extremely Drug

Resistance - TB

Hospital Infection

Phn th nht
S CN THIT XY DNG K HOCH
T VN

T khi pht hin ra khng sinh penicilline n nay, hng trm loi khng
sinh v cc thuc tng t c pht minh v a vo s dng. S ra i ca
khng sinh nh du k nguyn pht trin mi ca y hc v iu tr cc bnh
nhim khun.
Ngoi vai tr trong y hc i vi loi ngi, thuc chng vi khun cn c
s dng rng ri trong chn nui gia sc, gia cm, thy sn v trng trt iu tr,
phng chng dch bnh trn ng vt, cng nh cho mc ch sn xut. Kt qu
ca vic tip xc lin tc vi thuc chng vi khun, t l vi khun khng trong
phn ca cc ng vt tng i cao.
S dng khng sinh c li ch to ln trong iu tr, chm sc ngi bnh v
c th y khi c k n v iu tr ng. Tuy nhin, nhng loi thuc ny
c s dng rng ri, ko di, lm dng, lm cho cc vi sinh vt thch nghi vi
thuc, to iu kin cho nhiu loi vi khun tr thnh khng thuc, lm cho thuc
km hiu qu hoc khng hiu qu. Tnh trng khng thuc khng ch l mi lo
ngi ca cc bc s lm sng trong iu tr m cn l mi quan tm chung ca ton
x hi i vi sc khe cng ng.
Khng thuc (AMR) l tnh trng cc vi sinh vt (nh vi khun, vi rt, nm
v k sinh trng) khng li cc thuc khng sinh nhy cm vi cc vi sinh vt
ny trc y. Sinh vt khng (vi khun, vi rt, k sinh trng) c th chu c
s tn cng ca cc thuc chng vi khun (nh thuc khng sinh, thuc khng vi
rt, thuc chng st rt) dn n vic p dng cc phng php, thuc iu tr c
hiu s tr nn khng hiu qu, nhim khun ko di (thm ch gy t vong) v c
th ly lan cho ngi khc. AMR l h qu tt yu ca qu trnh s dng thuc

trong iu tr v c bit gia tng khi vic lm dng thuc khng sinh ngy cng
ph bin hn.
Trn th gii xut hin cc vi khun khng vi hu ht khng sinh, cn
gi l vi khun siu khng thuc.
Vit Nam, hu ht cc c s khm, cha bnh ang phi i mt vi tc
lan rng cc vi khun khng vi nhiu loi khng sinh. Mc v tc khng
thuc ngy cng gia tng, ang mc bo ng. Gnh nng do khng thuc ngy
cng tng do chi ph iu tr tng ln, ngy iu tr ko di, nh hng n sc
khe ngi bnh, cng ng v s pht trin chung ca x hi. Trong tng lai,
cc quc gia c th phi i mt vi kh nng khng c thuc iu tr hiu qu
cc bnh truyn nhim nu khng c cc bin php can thip ph hp.
Hin nay, khng thuc khng phi l vn mi, nhng tr nn nguy
him, cp bch, i hi phi c s n lc tng hp nhm gip nhn loi trnh khi
nguy c quay tr li thi k cha c khng sinh. T chc Y t Th gii (TCYTTG)
nhn nh, chng ta ang sng trong k nguyn ph thuc khng sinh v yu cu
ton cu c trch nhim bo v ngun thuc khng sinh qu gi cho th h sau.
Ngy sc khe th gii nm 2011, TCYTTG ly khu hiu phng chng
khng thuc l Khng hnh ng ngy hm nay, ngy mai khng thuc cha v
ku gi cc quc gia phi c k hoch kp thi i ph vi tnh trng khng
thuc.
Do vic xy dng K hoch chng khng thuc mang tnh ton din, tng
th, di hn l ht sc cn thit i vi Vit Nam trong giai on hin nay.
I. C S THC TIN

1. Thc trng khng thuc

1.1.Tnh hnh khng thuc trn th gii
Trn th gii, c bit l cc nc ang pht trin, vn khng thuc tr
nn bo ng. Gnh nng v chi ph iu tr do cc bnh nhim khun gy ra kh
ln do vic thay th cc khng sinh c bng cc khng sinh mi, t tin.
Nm 2011, tnh hnh lao khng thuc ang xy ra hu ht cc quc gia.
Ton cu c khong 640.000 trng hp lao a khng thuc (MDR - TB), trong s
khong 9% l siu khng thuc (XDR - TB) [1].
6

K sinh trng st rt Falciparum khng vi artemisinin ang ni ln ng

Nam . khng vi thuc chng st rt th h trc nh chloroquine v
sulfadoxine-pyrimethamine l ph bin hu ht cc nc lu hnh st rt [2].
Vic tip cn ton cu i vi cc thuc khng vi rt iu tr ngi bnh
HIV lm tng nguy c khng thuc. S khng ca vi rt i vi cc thuc ny
ang l mi e da i vi loi ngi. Khong 15% ngi bnh c iu tr
phi dng n cc thuc phc bc hai v bc ba. Chi ph cc thuc ny gp 100
ln so vi cc thuc phc bc mt. S khng thuc ca HIV tng ln t ra mt
thch thc cn phi duy tr chng trnh tip cn ton cu cc nc c thu nhp
thp. Cc nc ny cn phi tng cng cc dch v y t v ci tin cht lng
chm sc ngi nhim HIV gim ti thiu vic lan truyn vi rt khng.
S liu nghin cu gim st ANSORP t thng 1/2000 n thng 6/2001 ca
14 trung tm t 11 nc ng Nam cho thy t l khng cao ca vi khun S.
pneumoniae. Trong s 685 chng vi khun S. pneumoniae phn lp c t ngi
bnh, c 483 (52,4%) chng khng cn nhy cm vi penicillin, 23% mc trung
gian v 29,4% khng vi penicillin (MIC 2mg/l). Kt qu phn lp vi khun
cho thy t l khng penicillin Vit Nam cao nht (71,4%) tip theo l Hn Quc
(54,8%), Hng Kng (43,2%) v i Loan (38,6%). T l khng erythromycin
cng rt cao, Vit Nam l 92,1%, i Loan l 86%, Hn Quc l 80,6%, Hng
Kng l 76,8% v Trung Quc l 73,9%. S liu t nghin cu gim st a trung
tm chng minh r rng v tc v t l khng ca S. pneumoniae ti nhiu
nc chu , nhng ni c t l mc bnh nhiu nht th gii [3].
Theo s liu nghin cu KONSAR t 2005-2007 cc bnh vin Hn Quc
cho thy S. aureus khng Methicillin (MRSA) 64%; K. pneumoniae khng
cephalosporin th h 3 l 29%; E. coli khng fluoroquinolone 27%, P. aeruginosa
khng 33%, Acinetobacter spp. khng 48%; P. aeruginosa khng amikacin 19%,
Acinetobacter spp. khng 37%. E. faecium khng vancomycin v Acinetobacter
spp. khng imipenem tng ln dn. T l khng pht hin ti cc phng xt nghim
ca E. coli v K. pneumoniae i vi cephalosporin th h 3 v P. aeruginosa i
vi imipenem cao hn trong bnh vin [4].
Cc thuc khng sinh iu tr hiu qu bnh l do Shigella trc y b
khng, v vy hin nay TCYTTG ang khuyn co dng ciprofloxacin. Tuy nhin
t l khng ciprofloxacin tng ln nhanh chng lm gim c an ton v hiu
qu iu tr, c bit l i vi tr em.
7

AMR tr thnh mt vn nghim trng trong iu tr bnh lu (gy ra

bi N. gonorrhoeae), thm ch lin quan n c cephalosporin ung (phng thuc
cui trong iu tr) v ngy cng gia tng trn ton th gii. Nhim khun do lu
cu khng th iu tr c s dn n tng t l bnh v t vong, do lm o
ngc li cc thnh tu t c trong chng trnh kim sot cc bnh ly
truyn qua ng tnh dc. Vic kim sot cc loi bnh ny v ang chu s tc
ng bt li ca s pht trin v lan rng ca tnh trng khng thuc.
C ch khng mi, nh beta-lactamase NDM-1, ni ln trong s cc trc
khun gram m. iu ny c th lm mt hiu qu ca cc khng sinh mnh thng l ch nh cui cng chng li cc chng vi khun a khng.
1.2.Tnh hnh s dng khng sinh v s khng thuc ti Vit Nam
I.2.1. S dng khng sinh trong cng ng:
Theo kt qu kho st v vic bn thuc khng sinh cc hiu thuc vng
nng thn v thnh th cc tnh pha Bc cho thy nhn thc v khng sinh v
khng khng sinh ca ngi bn thuc v ngi dn cn thp c bit vng nng
thn. Trong tng s 2953 nh thuc c iu tra: c 499/2083 hiu thuc thnh
th (chim t l 24%) v 257/870 hiu thuc nng thn (chim t l 29,5%) c
bn n thuc k khng sinh. Khng sinh ng gp 13,4% ( thnh th) v 18,7%
( nng thn) trong tng doanh thu ca hiu thuc. Phn ln khng sinh c bn
m khng c n 88% (thnh th) v 91% (nng thn). Mua khng sinh iu tr
ho 31,6% (thnh th) v st 21,7% (nng thn). Ba loi khng sinh c bn nhiu
nht l ampicillin/amoxicillin (29.1%), cephalexin (12.2%) v azithromycin
(7.3%). Ngi dn thng yu cu c bn khng sinh m khng c n 49,7%
(thnh th) v 28,2% (nng thn) [5].
I.2.2. S dng khng sinh v tnh hnh khng khng sinh trong bnh
vin
im li kt qu bo co tnh nhy cm ca cc khng sinh c tin
hnh t nm 2003-2006 cho thy t l khng ca Klebsiella spp. i vi cc
khng sinh cephalosporins th h 3, th h 4, fluoroquinolon v aminosid tng
nhanh t >30% trong nm 2003 ln >40% trong nm 2006; i vi Pseudomonas
spp. t >40% trong nm 2004 ln >50% trong nm 2006 v i vi Acinetobacter
spp. t >50% trong nm 2004 ln >60% trong nm 2006. Trong khi
imipenem/cilastatin, carbapenem c a vo th trng Vit Nam mi gn c
10 nm, cng gim nhy cm i vi cc trc khun gram m khng sinh men.
8

T l khng imipenem/cilastatin ca Pseudomonas spp. tng dn qua cc nm

12,5% (2003), 15,5% (2005) v 18,4% (2006) [5].
Theo s liu bo co ca 15 bnh vin trc thuc B, bnh vin a khoa tnh
H Ni, Hi Phng, Hu, Nng, H Ch Minh, v s dng khng sinh v
khng khng sinh giai on 2008 - 2009 cho thy: nm 2009, 30 - 70% vi khun
gram m khng vi cephalosporin th h 3 v th h 4, gn 40-60% khng vi
aminoglycosid v fluoroquinolon. Gn 40% chng vi khun Acinetobacter gim
nhy cm vi imipenem.
S dng khng sinh trung bnh l 274,7 DDD/100 ngy-ging. T l ny
cao hn ng k so vi bo co ca H Lan cng k l 58,1 DDD/100 ngy-ging
v bo co t 139 bnh vin ca 30 nc chu u nm 2001 l 49,6 DDD/100
ngy-ging. S tng quan gia vic dng khng sinh v khng khng sinh th
hin r khi t l khng ca vi khun gram m i vi cephalosporin th h 4 cao
nhng ni vic tiu th khng sinh ln [6].
Theo kt qu Tm hiu thc trng s dng khng sinh trong nhim khun
bnh vin ti cc n v iu tr tch cc mt s c s khm, cha bnh cho thy
4 chng vi khun phn lp c nhiu nht l Acinetobacter spp, Pseudomonas
spp, E.coli, Klebsiella spp. Tn xut nhim Acinetobacter spp. hay Pseudomonas
spp. chim t l u th (>50%) trong vim phi bnh vin (th my hay khng th
my). 4 chng ny u l vi khun a khng khng sinh. S khng thuc cao c
bit nhm cephalosporin th h 3, 4 (khong t 66-83%) tip theo l nhm
aminosid v fluoroquinolon t l khng xp x trn 60%.
S khng thuc cao cn c phn nh qua vic s dng khng sinh theo
kinh nghim ban u khng ph hp vi kt qu khng sinh l 74% [7].
I.2.3. S dng thuc khng lao v lao khng thuc
Bo co ca TCYTTG nm 2012 c tnh, Vit Nam ng th 12 trong 22
nc c gnh nng bnh lao cao trn ton cu, ng hng th 14 trong s 27 quc
gia c gnh nng lao a khng thuc trn th gii.
T l lao khng a thuc l 2,7% trong s bnh nhn lao mi (khong 4800
bnh nhn), 19% trong s bnh nhn lao iu tr li (khong 3400 bnh nhn)
TCYTTG c tnh nm 2011 c khong 3.500 (95% CI: 2.600 - 4.700) bnh nhn
lao khng a thuc trong s bnh nhn lao phi c khm pht hin [8].

Tuy nhin, trong nhng nm gn y, tnh hnh bnh lao tr nn phc tp

hn do c tc ng ca i dch HIV/AIDS v khng thuc.
Theo TCYTTG hin nay bnh lao khng thuc l mt vn c bit
nghim trng. Kt qu iu tr vi ngi bnh khng thuc thng khng cao, nht
l i vi ngi bnh mc lao khng a thuc. Chi ph iu tr ngi bnh lao
khng a thuc tng ln hng trm ln so vi ngi bnh lao khng khng thuc v
thm ch khng th iu tr c mt s trng hp. Hin nay, t l khng a
thuc ngi bnh lao mi ti Vit Nam cn mc < 3%, song vi s lng
ngi bnh lao phi AFB (+) mi pht hin ti Vit Nam hng nm vn cao th s
lng ngi bnh mc lao khng a thuc khng phi l con s nh. Hn na mi
nm c khong 350 ngi bnh lao phi mn tnh v hu ht trong s l lao
phi khng a thuc lm nng hn tnh trng khng thuc hin nay.
Nguyn nhn vi khun lao khng thuc c th l do vi khun t bin i
tn ti; do ngi bnh khng tun th ng phc iu tr, t ngng thuc,
gim liu...; do mi trng nhim, do khc nh, x rc ba bi ni cng cng
y l nhng yu t khin Vit Nam c s ngi mc lao v b khng thuc cao.
I.2.4. S dng thuc iu tr HIV v tnh hnh khng HIV
T trng hp nhim u tin c pht hin vo nm 1990, tnh n ngy
31 thng 03 nm 2012, s ngi nhim HIV cn sng l 199.744 ngi, trong
49.369 ngi chuyn sang AIDS v 52.681 ngi t vong do AIDS. Tc dch
vn ang c chiu hng gia tng, tuy nhin c du hiu chng li trong nhng
nm gn y nh s trin khai cc chng trnh can thip.
Ti Vit Nam, t gia thp nin 1990, thuc ARV c s dng nhng
rt hn ch ti mt s tnh, thnh ph ln, c bit l H Ni v thnh ph H
Ch Minh vi phc mt hoc kt hp hai loi thuc ARV.
T nm 2005, phc kt hp ba thuc theo liu php khng retro vi rt
hot tnh cao (HAART) c cp trong hng dn quc gia chn on v
iu tr HIV/AIDS ca B Y t. Trong , vn tun th iu tr ARV c xem
nh l mt trong cc yu t tin quyt cho s thnh cng ca iu tr.
Vic s dng thuc ARV cng lm xut hin cc chng vi rt HIV khng
ARV v nguy c lm lan truyn cc chng khng thuc trong cng ng. nhng
nc m thuc ARV c a vo s dng nhiu nm, 5-27 % nhng ngi
mi nhim HIV mang cc chng vi rt HIV-1 c tnh khng vi mt hay nhiu loi
thuc ARV.
10

Trong mt nghin cu v tnh khng thuc c thc hin ti thnh ph H

Ch Minh, t l vi rt HIV khng thuc trn cc i tng l nhng ngi nghin
chch ma ty, gi mi dm v ngi bnh mc cc bnh ly truyn qua ng tnh
dc cha tng tip cn vi ARV l 6,5 %. Cc kt qu nghin cu ca Vin Pasteur
thnh ph H Ch Minh trn nhm thai ph cha tip cn ARV v trn nhng
ngi mi nhim HIV (tui di 30, s lng t bo lympho T CD4 +>500 t
bo/mm3 cha dng thuc ARV) u c t l HIV khng thuc thp <5%. Mt
nghin cu khc ti thnh ph H Ch Minh, t l HIV khng thuc trn thai ph
tham gia chng trnh PLTMC thi im trc khi ung thuc tng i thp
0,6 %. Hai tun sau khi sinh, t l thai ph c pht hin c mang vi rt HIV
khng thuc l 17,53 % v gim xung cn 3,06 % hai thng sau khi sinh. Cc t
bin khng 3TC thng pht hin trong nhm thai ph dng phc kt hp
AZT+3TC v t bin khng NVP nhng ph n mang thai dng sd-NVP. Cc
t bin khng 3TC thng pht hin trong nhm thai ph ung phc kt hp
AZT+3TC v t bin khng NVP nhng ph n mang thai dng sd-NVP. Mc
d sau khi ngng ung thuc d phng, t l vi rt mang t bin khng thuc
gim dn theo thi gian, nhng cc chng khng thuc c th vn tn ti mc
di ngng c pht hin v c th ti bng pht khi ngi m c iu tr vi
cc phc c cc loi thuc b khng.
Nm 2008, B Y t xy dng k hoch quc gia v d phng, theo di
HIV khng thuc theo khuyn co ca TCYTTG. K hoch quc gia bao gm
nhng ni dung lin quan n: (1) thu thp cc ch s cnh bo sm HIV khng
thuc; (2) theo di s xut hin ca HIV khng thuc trong s nhng ngi bnh
iu tr ARV phc bc 1; v (3) iu tra s xut hin ca HIV khng thuc trong
s ngi nhim HIV cha iu tr ARV.
K t nm 2008, hng nm Vit Nam tin hnh thu thp s liu lin quan
n kt qu iu tr ARV cng vi vic thu thp cc ch s cnh bo sm HIV
khng thuc ti cc c s iu tr ARV i din trn ton quc.
Vic gim st HIV khng thuc nhng ngi mi nhim HIV cha iu tr
ARV c mt s n v thc hin cho thy t l khng HIV di 5%.
I.2.5. S dng khng sinh v khng khng sinh trong trng trt, chn
nui
Trong chn nui, hn ch ri ro vi cc nguy c dch bnh, ngi chn
nui c thi quen dng nhiu loi khng sinh, thuc kch thch bao gm c cc hot
11

cht v thuc th y ngoi danh mc lu hnh c s dng nhm kch thch tng
trng hoc phng v iu tr cho vt nui. Nu khng c kim sot tt, vic s
dng cc loi hot cht, thuc th y trong chn nui s gy ra mt nguy c ri ro
ln cho mi trng v sc khe con ngi nh hin tng khng thuc, khng
khng sinh ngi, do tn d khng sinh t phn, nc tiu sang cy trng v qua
ngun nc sang con ngi,... Trong chn nui cng nghip c hin tng lm
dng qu nhiu cc loi khng sinh tng hp, s h s dng thuc khng sinh c t
3 - 6 hot cht chim 27% s trang tri nui ln tht, 24% trang tri nui ln con v
10% s trang tri nui g tht (V nh Tn v cng s 2010). Vic s dng khng
sinh v ha cht th y ch yu da vo kinh nghim dn ti ngi chn nui
thng t tng liu v liu trnh iu tr. S dng khng sinh theo triu chng
bnh (44%), theo ch nh ca th vin l 33%, s dng khng sinh theo khuyn
co ca nh sn xut chim 17% v ch 6% trang tri s dng khng sinh theo kt
qu th nghim khng sinh (Nguyn Quc n, 2009) [5].
I.2.6. Nhim khun bnh vin v kim sot nhim khun trong bnh
vin
Nhim khun bnh vin (NKBV) l mt trong nhng thch thc v l mi
quan tm hng u ti Vit Nam cng nh trn ton th gii. Nhiu nghin cu cho
thy NKBV lm tng t l t vong, ko di thi gian nm vin, tng thi gian s
dng khng sinh, lm tng khng khng sinh v tng chi ph iu tr.
Thng k ca M cho thy: chi ph ca mt NKBV thng gp 2 n 4 ln
so vi nhng trng hp khng NKBV. Trong chi ph pht sinh do nhim khun
huyt c lin quan n dng c t trong lng mch l t 34.508 la ln n
56.000 la v do vim phi trn ngi bnh c thng kh h tr l t 5.800 la
ln n 40.000 la. Ti M, hng nm c tnh c 2 triu ngi bnh b NKBV,
lm 90.000 ngi t vong, lm tn thm 4,5 t la vin ph.
Tnh hnh NKBV ti Vit Nam cha c xc nh y . C t ti liu v
gim st v NKBV c cng b. Nhng tn ph v nhn lc v ti lc do NKBV
trong ton quc cng cha c xc nh. C ba iu tra ct ngang tm quc gia
c thc hin. iu tra nm 1998 trn 901 ngi bnh trong 12 bnh vin ton
quc cho thy t l NKBV l 11,5%, trong nhim khun vt m chim 51%
trong tng s cc ca NKBV. Nm 2001 t l NKBV l 6,8% trong 11 bnh vin v
vim phi bnh vin l nguyn nhn thng gp nht (41,8%). iu tra nm 2005
t l NKBV trong 19 bnh vin ton quc l 5,7% v vim phi bnh vin cng l
12

nguyn nhn thng gp nht (55,4%). Cha c nhng nghin cu quc gia nh
gi chi ph ca NKBV.
Cc bnh pht sinh do NKBV c mc a khng thuc khng sinh cao hn
cc bnh do nhim khun trong cng ng. NKBV do vi khun c s khng cao
nh S. aureus khng methicillin (MRSA) v Enterococci khng vancomycin, A.
baumanni, P. aeruginosa a khng khng sinh chim t l ng k.
Thc trng cng tc kim sot NKBV: H thng t chc KSNK cha hon
thin theo yu cu; i ng cn b qun l KSNK va thiu va cha nng lc,
phn ln cha c o to; C s h tng v phng tin thit yu phc v
KSNK cn thiu nht l cc bnh vin tuyn huyn; Nhiu nhim v chuyn
mn trng yu v KSNK cha c thc hin; cha c h thng c s d liu v
NKBV, dch bnh, vi sinh vt khng thuc,
2. Nguyn nhn khng thuc
2.1. S dng thuc khng khun khng thch hp
Vic s dng qu liu, di liu hoc lm dng thuc khng khun u gy
ra tnh trng khng thuc, to iu kin thun li cho cc vi sinh vt khng thuc
xut hin, bin i v ly lan. Thc t nhiu ngi bnh mua khng sinh t iu tr
khi khng c n ca thy thuc, s dng khng sinh iu tr i vi trng
hp khng do bnh l nhim khun gy ra, s dng khng sinh, thuc khng ph
hp vi loi, chng vi khun, vi rt, k sinh trng gy ra,.... s dng khng ng
liu lng, hm lng, thi gian s dng...
2.2. Cng tc kim nghim, kim tra cht lng thuc cn hn ch
H thng kim tra cht lng cha p ng c nhu cu thc t do cn
thiu nng lc kim nghim vi nhiu danh mc hot cht; cha bo m kim
sot c cht lng ca tt c cc l hng sn xut khc nhau ca tng loi sn
phm lu hnh trn th trng.
2.3. Phng v kim sot cc bnh truyn nhim cha hiu qu
Vic phng v kim sot cc bnh truyn nhim khng hiu qu lm tng s
lan truyn ca vi khun khng thuc. Ngi bnh c iu tr trong bnh vin l
mt ngun lan truyn chnh cc vi sinh vt khng t ngi ny ti nhng ngi
khc.
2.4.H thng gim st v khng thuc cha c thit lp
13

Hin ti, Vit Nam cha c mng li gim st quc gia v khng thuc.
Vic gim st v khng thuc ch c thit lp v trin khai mt s n v, nh
bnh vin Bnh nhit i trung ng, bnh vin Bch Mai, bnh vin Nhi ng 1...
Tuy nhin, nhng hot ng gim st cha c thc hin thng xuyn. Vic
thiu cc c s xt nghim c th xc nh chnh xc vi sinh vt khng dn n
kh khn trong vic pht hin cc vi sinh vt khng mi ni, nn khng th c
nhng hnh ng nhanh chng khng ch tnh trng khng thuc ny.
2.5. S dng thuc khng khun trong chn nui cha c kim sot
hp l
Khng sinh ngy cng c s dng rng ri trong chn nui thc y
tng trng v phng nga bnh tt. iu ny c th dn n cc vi sinh vt
khng v gy ra khng thuc ngi.
2.6. Cc quy nh chuyn mn v khm, cha bnh cha c cp nht
thng xuyn, lin tc
Nhiu bnh truyn nhim cha c cc hng dn chn on v iu tr
hoc hng dn cha c cp nht. Bn cnh , vic quy nh v s dng khng
sinh, lm khng sinh , xt nghim vi sinh cha hon thin, y ; vic kim tra,
gim st trong qu trnh thc hin ti cc a phng cha c thng xuyn.
2.7. Nhn thc ca cng ng, cn b y t v khng thuc cn hn ch.
Thi quen t cha tr v bt chc n thuc ca ngi dn dn n tnh
trng s dng khng sinh ty tin, gp phn lm gia tng s khng thuc. Bn cnh
, trnh cn b y t, trang thit b ca mt s c s y t, c bit cc tuyn
di, vng su, vng xa cn hn ch, cha c iu kin, kh nng lm khng sinh
nn ngi bnh khng c s dng khng sinh hp l.
3. Hu qu v gnh nng do khng thuc
Khng thuc khng phi l mt hin tng mi, tuy nhin mc ngy
cng trm trng v tc gia tng ca vn ny nh hng ln i vi sc khe
cng ng. Kt qu l ch sau 70 nm k t khi gii thiu thuc khng sinh, chng
ta ang phi i mt vi kh nng ca mt tng lai khng c thuc khng sinh
iu tr hiu qu i vi mt s bnh nhim khun, nht l i vi cc phu thut
v phng php iu tr nh ha tr liu ung th v cy ghp m, b phn c th
ngi.
14

Ngoi ra, khng thuc gy ra s khan him, thiu ht cc thuc khng khun
mi, c bit ngi bnh b nhim khun do sinh vt a khng (MDR).
Cc chi ph x hi v ti chnh trong iu tr cc bnh nhim khun khng
thuc t gnh nng ng k ln mi c nhn, gia nh v x hi: do thi gian iu
tr ko di, tin lng xu v lng ph nhiu chi ph tin thuc do s dng thuc
khng ph hp.
II. C S PHP L

1. Lut Khm bnh, cha bnh s 40/2009/QH12 ngy 23 thng 11 nm

2009
2. Lut Dc s 34/2005/QH11 ngy 14 thng 6 nm 2005
3. Lut Phng, chng bnh truyn nhim s 03/2007/QH12 ngy 21 thng
11 nm 2007.
4. Lut Phng, chng nhim vi rt gy ra hi chng suy gim min dch
mc phi ngi (HIV/AIDS) s 64/2006/QH11 ngy 29 thng 6 nm 2006.
5. Ngh nh s 63/2012/N-CP ngy 31 thng 8 nm 2012 ca Chnh ph
quy nh chc nng, nhim v, quyn hn v c cu t chc ca B Y t.
6. Quyt nh s 1208/Q-TTg ngy 04 thng 9 nm 2012 v vic ph
duyt chng trnh mc tiu quc gia y t giai on 2012-2015 ca Th tng
chnh ph.
Phn th hai
NI DUNG K HOCH
I. MC TIU
1. Mc tiu chung
y mnh cc hot ng phng, chng khng thuc, gp phn nng cao cht
lng, hiu qu ca cng tc phng, chng dch bnh, khm bnh, cha bnh
bo v, chm sc v nng cao sc khe nhn dn.
2. Mc tiu c th
2.1. Nng cao nhn thc ca cng ng v cn b y t v khng thuc.
2.2.Tng cng, hon thin h thng gim st quc gia v s dng khng
sinh v khng thuc
15

2.3.Bo m cung ng y cc thuc c cht lng p ng nhu cu

chm sc sc khe nhn dn.
2.4.Tng cng s dng thuc an ton, hp l
2.5.Tng cng kim sot nhim khun.
2.6.Tng cng s dng khng sinh hp l, an ton trong trng trt v chn
nui gia sc, gia cm, thy sn
II. NI DUNG HOT NG
1. Nng cao nhn thc ca cng ng v cn b y t v khng thuc
1.1.Hot ng
a) Bin son ti liu cho o to lin tc v pht trin cc ti liu truyn
thng.
b) T chc cc hot ng truyn thng, gm: truyn thng trc tip (ta
m, ni chuyn, t vn,) v truyn thng gin tip trn cc phng tin thng
tin i chng (tivi spot, radio spot, ph bin kin thc, bi vit trn bo,).
1.2.Thi gian v l trnh thc hin
Giai on 1 (t 2013 n 2016):
a) Xy dng cc ti liu truyn thng: t ri, pano, p phch, tranh lt, video
spot, tivi spot v tuyn truyn, ph bin nguyn nhn v hu qu, cc bin php
phng khng thuc.
b) Xy dng cc ti liu hng dn cho cn b y t, cng ng v vic
phng, chng khng thuc.
c) T chc cc bui ta m, ni chuyn v t vn gii p thc mc v
phng, chng khng thuc trn cc phng tin thng tin i chng.
d) T chc cc hot ng truyn thng gio dc sc khe v phng, chng
khng thuc trn cc phng tin thng tin i chng t trung ng n a
phng.
) T chc pht ng thng phng, chng khng thuc trn ton quc.
e) T chc hi ngh tp hun, ph bin, gio dc php lut v phng, chng
khng thuc

16

g) T chc cc kha o to lin tc, tp hun v k nng truyn thng,

gim st, nh gi phng, chng khng thuc.
Giai on 2 (t 2016 2020):
Tip tc duy tr cc hot ng truyn thng bn cnh vic kho st, nh gi
kin thc ca cng ng v khng thuc.
2. Tng cng, hon thin, nng cao nng lc h thng gim st quc
gia v s dng khng sinh v khng thuc
2.1.Hot ng
a) Xy dng v hon thin cc vn bn quy nh v xt nghim vi sinh lm
sng; quy trnh xt nghim chun, xy dng phng xt nghim vi sinh chun v
phng xt nghim tham chiu;
b) Thit lp h thng gim st khng thuc;
c) Tham gia xy dng khung chng trnh, gio trnh o to v vi sinh,
khng sinh trong cc trng i hc, trung cp y - dc;
d) o to lin tc, tp hun nhm nng cao nng lc xt nghim vi sinh
lm sng, nng lc nghin cu khoa hc ca cn b v s khng thuc;
) Xy dng cc chng trnh hp tc o to lin tc v chng khng thuc
gia cc trng Y, Dc trong v ngoi nc;
e) Xy dng c s d liu v s dng khng sinh v khng thuc.
2.2.Thi gian v l trnh thc hin
2.2.1.Giai on 1
a) Xy dng v hon thin cc quy trnh xt nghim chun, hng dn v
xt nghim vi sinh lm sng.
b) Thnh lp Trung tm quc gia v xt nghim vi sinh lm sng.
c) Tp hun, o to lin tc chuyn mn k thut v vi sinh lm sng cho
cc cn b lm xt nghim ti Trung tm chun quc gia v 30 xt nghim trong
ton quc.
d) Xy dng chc nng, nhim v, c cu t chc, nhn lc, trang thit b
cho cc phng xt nghim vi sinh lm sng.
17

) T chc kha hc tp ti nc ngoi v h thng gim st khng thuc.

e) Thit lp mng li gim st v s dng khng sinh v khng thuc ti 30
phng xt nghim trong ton quc.
g) Xy dng cc biu mu, phn mm theo di v bo co s dng khng
sinh, bo co tnh hnh khng thuc.
h) Trin khai cc ti nghin cu khoa hc v khng thuc.
i) Tham gia cc hi ngh khoa hc trong nc v nc ngoi v khng thuc.
2.2.2.Giai on 2
a) Xy dng c c s d liu v s dng khng sinh v s khng thuc.
b) Xy dng b ch s nh gi, thit lp h thng thu thp x l thng tin,
xy dng trang web v theo di, gim st v nh gi v khng thuc.
c) T chc hi ngh khoa hc v chng khng thuc.
3. Bo m cung ng cc thuc thit yu c cht lng
3.1.Hot ng
a) Hon thin, cp nht h thng cc vn bn quy nh v danh mc thuc
thit yu, danh mc thuc ch yu s dng trong cc c s khm, cha bnh;
b) u t cho sn xut cung ng cho th trng cc loi thuc c cht
lng tt, gi c ph hp;
c) Qun l cht lng thuc ton din trong sut c qu trnh sn xut, xut
khu, nhp khu, lu hnh v s dng thuc.
3.2.Thi gian v l trnh thc hin
3.2.1.Giai on 1
a) Cp nht danh mc thuc thit yu, danh mc thuc ch yu sao cho ph
hp vi m hnh bnh tt v iu kin kinh t, x hi ca Vit Nam; ph hp vi
tin b v khoa hc, k thut trong y t trong tng giai on c th v kh nng
chuyn mn k thut ca tng tuyn.
b) Theo di, gim st thuc gi lu hnh trn th trng.
c) Tip tc y mnh trin khai n Ngi Vit Nam u tin dng thuc
Vit Nam.
18

d) Xy dng, xut c ch, gii php u tin sn xut thuc generic cho
cc doanh nghip dc trong nc.
) u t cho sn xut cung ng cho th trng cc loi thuc c cht
lng tt, gi c hp l.
3.2.2.Giai on 2
Tip tc mt s hot ng ca giai on trc nm 2015 kt hp vi Hi
tho khoa hc chuyn v tng cng kh nng tip cn cc thuc thit yu ca
ngi bnh.
4. Tng cng s dng thuc an ton, hp l
4.1.Hot ng
a) Xy dng v hon chnh, cp nht cc vn bn quy nh, hng dn s
dng thuc hp l, Hng dn s dng khng sinh, Hng dn iu tr;
b) Hi tho, hi ngh, tp hun, o to lin tc v thc hnh k n thuc
tt, thc hnh dc lm sng.
c) Nng cao nng lc hot ng ca Hi ng Thuc v iu tr;
d) Hi tho, hi ngh nh gi vic s dng thuc an ton, hp l, nh gi
hot ng ca Hi ng Thuc v iu tr.
) Theo di, kim tra, gim st vic s dng thuc an ton, hp l trong cc
c s khm, cha bnh.
e) Xy dng, hon chnh chng trnh o to, o to lin tc v thc hnh
dc lm sng.
4.2.Thi gian v l trnh thc hin
4.2.1.Giai on 1
a) Xy dng, cp nht v ban hnh cc Hng dn iu tr.
b) Xy dng ti liu Hng dn s dng khng sinh cho cn b y t v
cng ng.
c) Tp hun, o to lin tc v thc hnh dc lm sng, k n thuc tt.
d) Xy dng quy nh v hot ng ca Hi ng Thuc v iu tr.
) o to lin tc, tp hun v Hng dn iu tr cho cn b y t.
19

e) nh gi s tun th Hng dn iu tr ti cc c s y t.
g) Xy dng vn bn quy nh vic nh gi s dng thuc.
h) Xy dng b ch s nh gi s dng thuc trong bnh vin, ngoi cng
ng
i) Gim st, nh gi v s dng thuc, gim st tun th iu tr, hot ng
ca Hi ng Thuc v iu tr ti cc c s khm, cha bnh.
k) Hi tho nh gi v s dng thuc, hot ng ca Hi ng Thuc v
iu tr trong cc c s y t.
4.2.2.Giai on 2
a) Hp tc nghin cu v s dng thuc, c bit l khng sinh
b) o to lin tc, tp hun trong nc v quc t v thng tin thuc, s
dng thuc, thc hnh dc lm sng
c) Qun l, thu thp thng tin, nh gi cc ch s s dng thuc
d) Hi tho khoa hc v khng sinh v khng khng sinh.
5. Tng cng kim sot nhim khun.
5.1.Hot ng
a) Hon thin, cp nht cc vn bn quy nh v kim sot nhim khun;
b) o to lin tc, tp hun, kim tra, gim st, nh gi vic thc hin
kim sot nhim khun cho cn b y t.
c) Thc y h thng gim st v bo co s liu hnh thnh c s d
liu v kim sot nhim khun ca quc gia.
5.2.Thi gian v l trnh thc hin
5.2.1. Giai on 1
a) B sung, cp nht v ban hnh cc vn bn quy phm php lut, chnh
sch, quy chun k thut quc gia v cc ti liu hng dn KSNK bnh vin.
b) Hon thin t chc kim sot nhim khun theo quy nh ti Thng t s
18/2009/TT-BYT ngy 14/10/2009 v hng dn t chc thc hin cng tc
KSNK trong cc c s khm, cha bnh.
c) o to lin tc, tp hun nng cao kin thc, k nng thc hnh kim
sot nhim khun cho cn b y t v cn b chuyn trch KSNK ti cc c s y t.
20

d) Xy dng cc ch s gim st kim sot nhim khun.

) Hnh thnh h thng gim st v bo co s liu v nhim khun bnh
vin t cc bnh vin trc thuc B Y t v bnh vin a khoa tnh, thnh ph trc
thuc trung ng.
5.2.2.Giai on 2
a) y mnh cng tc nghin cu khoa hc thuc lnh vc KSNK.
b) Thng k t chc Hi tho khoa hc quc gia 2 nm/ln v Hi tho
khoa hc quc t v kim sot nhim khun 5 nm/ln.
6. Tng cng s dng khng sinh hp l, an ton trong trng trt v
chn nui gia sc, gia cm, thy sn
6.1.Hot ng
a) Xy dng cc vn bn quy nh v hng dn s dng khng sinh, thuc
tng trng trong trng trt v chn nui gia sc, gia cm, thy sn.
b) Xy dng danh mc khng sinh c php s dng v quy nh gii hn
d lng khng sinh trong trng trt v chn nui gia sc, gia cm, thy sn
c) Thit lp h thng gim st s dng khng sinh an ton, hp l trong
trng trt v chn nui gia sc, gia cm, thy sn.
6.2.Thi gian v l trnh thc hin
6.2.1.Giai on 1
a) Xy dng cc vn bn quy nh vic s dng khng sinh trong nui
trng v chn nui gia sc, gia cm, thy sn
b) Quy nh danh mc khng sinh v gii hn d lng khng sinh s dng
trong trng trt v chn nui gia sc, gia cm, thy sn.
c) Thit lp h thng gim st vic s dng khng sinh trong trng trt v
chn nui gia sc, gia cm, thy sn.
6.2.2.Giai on 2
a) Hp tc nghin cu, nh gi vic s dng khng sinh v s khng thuc
trong trng trt v chn nui gia sc, gia cm, thy sn.

21

b) nh gi vic s dng khng sinh v s khng thuc trong trng trt v

chn nui gia sc, gia cm, thy sn.
c) Tip tc trin khai cc hot ng nhm ngn chn tnh trng khng thuc.
Phn th ba
CC GII PHP
I.

C CH CHNH SCH V QUN L

1. Tng bc hon thin h thng vn bn php quy v xy dng cc

hng dn chuyn mn k thut v kim sot bnh truyn nhim, kim sot nhim
khun, gim st v khng thuc, tng cng s dng thuc hp l.
2. Hon thin h thng vn bn v s dng khng sinh trong nui trng v
chn nui gia sc, gia cm, thy sn.
3. Tng cng cng tc thanh tra, kim tra, gim st vic thc hin cc quy
nh chuyn mn nghip v lin quan n hng dn iu tr, s dng thuc, nh
thuc bnh vin, chng nhim khun trong cc c s y t.
4. Tng cng nh gi tnh hnh dch t bnh lao, thuc v trang thit b,
tnh hnh bnh lao nhim HIV/AIDS, tnh hnh khng thuc ca vi khun lao.
5. Tng cng gim st cht ch cht lng thuc, khng thuc km
cht lng, thuc gi lu hnh trn th trng.
6. Nng cao nng lc qun l cc chng trnh: phng chng lao, phng
chng HIV/AIDS, phng chng khng thuc, kim sot nhim khun.
II. THNG TIN, TRUYN THNG, GIO DC
1. y mnh cng tc ph bin, tuyn truyn, gio dc php lut v s
dng thuc an ton, hp l.
2. Nng cao nhn thc ca cng ng, cn b y t, ngi nui trng v
chn nui gia sc, gia cm, thy sn v khng sinh v s khng thuc.
3. Tin hnh vn ng thng phng, chng khng thuc
4. Tng cng cng tc gio dc truyn thng trong ton dn, tng bc x
hi ha cng tc phng, chng lao: vn ng, yu cu, s dng cc thnh phn ca
22

x hi, ngi thn trong gia nh ngi bnh vo cng tc phng, chng lao mi
cp v hnh thc khc nhau.
III.CHUYN MN K THUT V O TO
1. Hon thin cc hng dn chuyn mn, quy trnh k thut trong khm,
cha bnh, xt nghim vi sinh, gim st khng thuc lm c s cho cc n v trin
khai thc hin.
2. Tng cng o to, nng cao trnh cn b y t, a dng ha cc loi
hnh o to, o to lin tc, o to b sung, o to trong nc, nc ngoi v
chn on, iu tr bnh, c bit l bnh truyn nhim; xt nghim vi sinh; kim
sot nhim khun, gim st khng thuc trong cc c s y t.
3. Hon thin khung chng trnh, gio trnh o to v vi sinh, khng sinh
trong cc trng i hc, trung cp y.
4. Tng cng u t c s h tng, h tr phng tin, trang thit b nhm
p ng nhu cu kim sot nhim khun, xt nghim vi sinh, gim st khng thuc,
kim nghim cht lng thuc.
5. Nng cp cc phng xt nghim, trung tm nghin cu v vi sinh ti cc
bnh vin Trung ng, trng i hc Y trong nc
6. Khng ngng nng cao cht lng thuc v nh gi tng ng sinh
hc.
7. m bo cung ng thuc trong Danh mc thuc ch yu s dng ti
cc c s khm, cha bnh.
8. Hon thin h thng thu thp s liu v thng k bo co, dn tng bc
hin i ha, ng dng cng ngh tin hc c th qun l thng tin trn mng
trong ton quc.
9. Phi hp hot ng chng lao quc gia vi cc chng trnh y t quc
gia khc ti cc tuyn qun, huyn, phng x v thn bn.
IV. TI CHNH
u t t ngun ngn sch nh nc, cc ngun vn h tr pht trin chnh
thc ODA v cc ngun vn hp php khc trin khai thc hin K hoch hnh
ng quc gia v chng khng thuc giai on t nm 2013 n nm2020:

23

1. Trong nc: Cc n v bo m ngun kinh ph trin khai hot ng

trong phm vi c phn cng v ngun ngn sch nh nc cp theo k hoch
hng nm v 5 nm.
2. Huy ng ngun lc t cc t chc quc t, t chc phi chnh ph:
WHO, qu nng lm lin hip quc, GARP - Vit Nam, UNAIDS, World bank,...

V. NGHIN CU KHOA HC V HP TC QUC T

1. Tng cng nghin cu v chuyn giao k thut mi trong chn on v
iu tr bnh truyn nhim, xt nghim vi sinh, kim nh cht lng xt nghim vi
sinh.
2. Nng cao nng lc nghin cu v nh gi s dng thuc, nghin cu
khng thuc c bit l nghin cu v cc vi khun a khng thuc.
3. y mnh nghin cu v nhim khun bnh vin.
4. Phi hp vi cc n v lin quan y mnh hp tc nghin cu: nh
gi s dng khng sinh, khng virt, k sinh trng; nghin cu v khng thuc c
bit l nghin cu v cc vi khun a khng thuc.
5. Tng cng hp tc quc t, trao i, chia s kinh nghim, tham gia cc
hi tho, hi ngh khoa hc chuyn ngnh, cc din n v phng, kim sot bnh
truyn nhim, s dng thuc hp l, nhim khun bnh vin, kim nh cht lng
xt nghim vi sinh, khng thuc.
6. Hp tc quc t v o to lin tc, nghin cu s dng thuc, thc hnh
dc lm sng.
Phn th t
T CHC THC HIN
I. THNH LP BAN CH O
1. Trng ban: B trng B Y t
2. Cc Ph Trng ban: Th trng B Y t, B Nng nghip v Pht trin
Nng thn
24

3. Cc y vin: Lnh o Cc Qun l khm, cha bnh, Cc An ton thc

phm, Cc Y t d phng, Cc Phng, chng HIV/AIDS, Cc Qun l Dc, Cc
Qun l mi trng y t, Cc Khoa hc cng ngh v o to, Lnh o V K
hoch - Ti chnh, V Trang thit b v Cng trnh y t, V Bo him y t, Thanh
tra B ca B Y t; Cc V, Cc lin quan thuc B Nng nghip v Pht trin
Nng thn.
4. Cc th k: i din cc V, Cc lin quan ca B Y t, B Nng nghip
v Pht trin nng thn.
5. Cc tiu ban chuyn mn:
a) Tiu ban kim sot nhim khun
b) Tiu ban iu tr (Truyn nhim, Hi sc tch cc, HIV/AIDS, Lao)
c) Tiu ban gim st, thanh tra, kim tra vic s dng khng sinh:
- D phng,chn on, iu tr trong cc c s y t v cng ng
- Trng trt v chn nui gia sc, gia cm, thy sn
d) Tiu ban hu cn
) Tiu ban truyn thng, gio dc
6. B phn thng trc: Cc Qun l Khm, cha bnh
II. PHN CNG TRCH NHIM THC HIN
1. Cc n v thuc B Y t
I.1. Cc Qun l Khm, cha bnh:
a) Lm u mi phi hp vi cc n v lin quan trin khai ch o, hng
dn thc hin; tng hp cc kt qu hot ng trong K hoch bo co Lnh o
B Y t;
b) Xy dng cc hng dn chuyn mn k thut v kim sot bnh truyn
nhim, phc iu tr, gim st khng thuc, s dng thuc;
c) T chc kim tra, gim st vic thc hin cc quy nh chuyn mn
nghip v lin quan n hng dn iu tr, s dng thuc, kim sot nhim khun
trong cc c s y t;
d) Thit lp h thng gim st khng thuc quc gia; theo di, qun l, gim
st, cnh bo s khng thuc v s nguy him ca khng thuc; xy dng c s d
liu v s dng khng sinh v khng thuc; tp hun, o to lin tc chuyn mn
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k thut v vi sinh lm sng cho cc cn b lm xt nghim ti Trung tm chun

quc gia v 30 phng xt nghim trong ton quc;
) Hnh thnh h thng gim st v bo co s liu v nhim khun bnh vin
t cc bnh vin trc thuc B Y t v bnh vin a khoa tnh, thnh ph trc
thuc trung ng;
e) Gim st, nh gi v s dng thuc, gim st tun th iu tr, y mnh
hot ng ca Hi ng Thuc v iu tr ti cc c s khm, cha bnh;
g) T chc nh gi tnh hnh dch t bnh lao, thuc v trang thit b, tnh
hnh bnh lao nhim HIV/AIDS, tnh hnh khng thuc ca vi khun lao.
1.2. Cc Qun l Dc
a) Thc hin cc bin php nhm nng cao cht lng thuc v nh gi
tng ng sinh hc.
b) Cung ng thuc trong Danh mc thuc ch yu s dng ti cc c s
khm, cha bnh.
c) Theo di, gim st thuc gi lu hnh trn th trng.
1.3. Cc Phng, chng HIV/AIDS
a) u mi thu thp s liu lin quan n kt qu iu tr ARV; thu thp
cc ch s cnh bo sm HIV khng thuc ti cc c s iu tr HIV/AIDS i din
trn ton quc.
b) Theo di, gim st, nh gi HIV khng thuc trn ngi bnh ang
iu tr v nhng ngi mi nhim HIV cha iu tr ARV.
c) Trin khai cc bin php nhm nng cao nng lc cho cc labo xt
nghim khng HIV.
1.4. Cc Y t d phng
Theo di, gim st, nghin cu, nh gi s dng khng sinh v khng
khng sinh trong cng ng
1.5. Cc An ton thc phm
Theo di, gim st d lng khng sinh trong thc phm nh hng trc
tip n sc khe ngi dn.
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1.6. Thanh tra B

T chc thanh tra, kim tra vic bn thuc khng sinh khng theo n.
1.7. V K hoch - Ti chnh
a) Hng dn cc n v lin quan lp d tr kinh ph hng nm theo ni
dung k hoch c phn cng.
b) u t t ngun ngn sch nh nc, cc ngun vn h tr pht trin
chnh thc v cc ngun vn hp php khc trin khai thc hin K hoch hnh
ng quc gia v chng khng thuc giai on 2013-2020.
c) B tr, phn b ngn sch thng xuyn cho cc bnh vin thc hin cc
gii php phng, chng khng thuc.
1.8. V Bo him y t, Cc Qun l mi trng y t
Phi hp vi cc n v lin quan trin khai K hoch hnh ng ph hp
vi chc nng, nhim v c giao.
1.9. Cc Khoa hc cng ngh v o to
a) xut, h tr, u tin cho cc nghin cu v chuyn giao k thut mi
trong chn on bnh truyn nhim, xt nghim vi sinh.
b) o to nng cao nng lc nghin cu v nh gi s dng thuc,
nghin cu khng thuc c bit l nghin cu v cc vi khun a khng thuc,
nghin cu v nhim khun bnh vin.
c) Tng cng o to lin tc vi cc hnh thc ph hp trong v ngoi
nc nhm nng cao trnh ca cn b y t.
d) Hon thin khung chng trnh, gio trnh o to v vi sinh, khng sinh
trong cc c s o to y v dc.
1.10. V Truyn thng v Thi ua, khen thng
Ch tr, phi hp vi cc n v lin quan trong vic ph bin, tuyn truyn
gio dc, nng cao nhn thc ca cng ng v cn b y t v phng chng khng
thuc, vn ng thc hin thng hnh ng chng khng thuc.
1.11. S Y t cc tnh/thnh ph trc thuc trung ng

27

Ch o cc n v thuc tnh xy dng k hoch, trin khai thc hin, b tr

ngun lc thc hin k hoch hnh ng quc gia chng khng thuc giai on
2013-2020 ph hp vi hon cnh c th ca tng a phng.
1.12. Bnh vin
a) Xy dng k hoch c th ph hp vi iu kin ca tng n v
trin khai thc hin K hoch hnh ng quc gia v chng khng thuc giai on
2013-2020.
b) B tr ngun lc cho cc hot ng phng chng khng thuc: nng cp
cc phng xt nghim vi sinh, tng cng kim sot nhim khun; gim st, kim
tra vic s dng khng sinh khng hp l,
2. B Nng nghip v Pht trin Nng thn
B Nng nghip v Pht trin Nng thn phn cng cc n v phi hp vi
B Y t ch o, hng dn cc n v lin quan xy dng quy nh v s dng
khng sinh, danh mc khng sinh, gii hn d lng khng sinh s dng trong
trng trt v chn nui gia sc, gia cm, thy sn. Thanh tra, kim tra, gim st
vic s dng khng sinh trong trng trt v chn nui gia sc, gia cm, thy sn.

TI LIU THAM KHO

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1. Global tuberculosis control 2012- WHO

2. Transatlantic Taskforce on Antimicrobial Resistance, U.S & E.U, 2011.
3. Nghin cu gim st ANSORP t 1/2000 n 6/2001 (Song JH & ANSORP.
Antimicrobial Agents And Chemotherapy, June 2004, p. 21012107).
4. Nghin cu KONSAR t 2005-2007 cc bnh vin Korea (Yonsei Med J. 2010
Nov;51(6):901-11)
5. Phn tch thc trng s dng khng sinh v khng khng sinh ti Vit Nam, 2010
(Situation Analysis on Antibiotic Use and Resistance in Vietnam, 2010, GARP Vit Nam)
6. Bo co s dng khng sinh v khng khng sinh ti 15 bnh vin Vit Nam nm
2008-2009 (Report on AB use and resistance in 15 hospitals in Vietnam 2008-2009).
7. L Ngc Knh, Ng Th Bch H v cng s, tm hiu thc trng s dng khng sinh
trong nhim khun bnh vin ti cc n v iu tr tch cc mt s c s khm, cha bnh
nm 2009-2010.

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