B Y T

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

S: 1127/Q-BYT
H Ni, ngy 06 thng 4 nm 2013
QUYT NH
V vic ban hnh Hng dn k thut ly mu, bo qun v vn chuyn
mu bnh phm cm A(H7N9)
B TRNG B Y T
Cn c 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;
Theo ngh ca Cc trng Cc Y t d phng- B Y t,
QUYT NH:
iu 1. Ban hnh km theo Quyt nh ny Hng dn k thut ly
mu, bo qun v vn chuyn mu bnh phm cm A(H7N9).
iu 2. Hng dn k thut ly mu, bo qun v vn chuyn mu
bnh phm cm A(H7N9) l ti liu hng dn c p dng trong cc c
s y t d phng v cc c s khm, cha bnh Nh nc, bn cng v t
nhn trn ton quc.
iu 3. Quyt nh ny c hiu lc k t ngy k ban hnh.
iu 4. Cc ng, b: Chnh Vn phng B, Chnh Thanh tra B, Cc
trng cc Cc: Y t d phng, Qun l khm cha bnh, cc n v trc
thuc B Y t; Gim c S Y t, Trung tm Y t d phng, Bnh vin a
khoa cc tnh, thnh ph trc thuc trung ng v Th trng cc n v lin
quan chu trch nhim thi hnh Quyt nh ny./.
Ni nhn:
- Nh iu 4;
- BT. Nguyn Th Kim Tin ( bo co);
- B NN v PTNT ( phi hp);
- Cc /c Th trng B Y t ( phi hp);
- Cc thnh vin BC PCD nguy him v mi ni;
- Cc KCB, ATTP, QLMTYT;
- V KHTC, TT-TKT ( thc hin);
- Cc Vin V sinh dch t/Pasteur ( thc hin);
- Cc Bnh vin trc thuc B Y t ( thc hin);
- S Y t cc tnh, thnh ph ( thc hin);
- Trung tm YTDP, KDYTQT, Bnh vin cc tnh, thnh
ph ( thc hin);
- Trung tm Y t cc B/ngnh ( thc hin);
- Lu: VT, DP.

KT. B TRNG
TH TRNG
TH TRNG
( k)
Nguyn Thanh Long

B Y t

Cng ho x hi ch ngha
Vit Nam
c lp - T do - Hnh phc
HNG DN K THUT LY MU, BO QUN,
VN CHUYN BNH PHM CM A(H7N9)

(Ban hnh km theo Quyt nh s 1127./Q-BYT ngy 06 thng 4 nm

2013
ca B trng B Y t)
1. MU BNH PHM
- Bnh vim ng h hp cp tnh do vi rt cm A(H7N9) l bnh truyn nhim
nhm A. Tc nhn gy bnh l vi rt cm A(H7N9) c ngun gc t gia cm, vi rt ny t
trc ti nay cha tng gy bnh cho ngi.
- Xt nghim chn on nhim vi rt cm A(H7N9) ph thuc rt nhiu vo cht
lng ca bnh phm, v vy cng tc thu thp v bo qun mu bnh phm phi m bo:
+ ng chng loi
+ ng thi im
+ ng thao tc
+ Bo qun v vn chuyn bnh phm ng cch.
- Virut cm A(H7N9) c pht hin tt nht khi trong bnh phm c cha t bo
biu m ng h hp nhim vi rt, dch tit ng h hp. Bnh phm s dng cho chn
on sm nhim vi rt thng qua nhn din vt liu di truyn (ARN) thu thp trong vng 3
ngy u sau khi khi bnh.
- m bo an ton cho ngi ly mu cng nh m bo cht lng bnh phm l
iu kin bt buc trnh ly lan trong cng ng c th dn ti nguy c xut hin i dch.
Cc loi bnh phm
1.1. Bnh phm ng h hp trn:
- Dch hng
- Dch mi
- Dch t hu
1.2. Bnh phm ng h hp di:
- Dch ni kh qun
- Dch ph nang
1.3. Huyt thanh:
- Huyt thanh giai on cp.
- Huyt thanh giai on hi phc (10 -14 ngy sau khi khi bnh).

2. QUY TRNH THU TP, BO QUN VN CHUYN BNH PHM

2.1. Dng c, mi trng:
2.1.1. Mu bnh phm ng h hp
- Dy nha mm (Catheter) c ng knh 10 FG ly dch t hu hoc ht dch
ng h hp di.
- Tm bng cn mm v cn cng v trng.
- li.
- ng ly tm hnh chp 15ml (cha 2-3ml mi trng vn chuyn)
- Ti nylon ng gi bnh phm.
- Bng, gc c tm cht st trng.
- Qun o bo h.
- Bnh lnh bo qun mu.
- Bm tim 5 ml, v trng.
- Tube ly mu v trng (khng c cht chng ng).
- Dy garo, bng, cn
- Gng tay, khu trang (N95).
- Cn st trng, bt ghi...
- Tube bo qun mu
2.1.2. Mu huyt thanh
- Bm kim tim 10 ml, v trng.
- ng nghim tit trng.
- Dy garo, bng, cn.
2.2. Chun b thu thp bnh phm:
- Dng c thu thp bnh phm.
- Phiu thu thp mu bao gm thng tin chung v bnh nhn, loi bnh phm, ngy thu
thp v mt s thng tin v dch t.
- S dng trang phc bo h c nhn theo theo Ph lc 1 ban hnh km theo hng dn
ny.
2.3. Cch ly bnh phm v bo qun ti ch:
2.3.1. Dch mi

- Yu cu bnh nhn nga mt khong 45o.

- a tm bng vo dc theo sn mi ti khoang mi hng. tm bng
cho thm t dch mi sau xoay trn, mit mnh vo thnh mi v rt ra
t t.
- Sau khi ngoy mi xong, tm bng c chuyn vo mi trng bo
qun bnh phm (u tm bng phi nm ngp trong mi trng vn chuyn).
Ct b cn tm bng cho ph hp vi di ca ng cha mi trng vn
chuyn vi rt.
- ng np, xit cht, bc ngoi bng giy parafilm (nu c).
2.3.2. Dch hng

- Yu cu bnh nhn h to ming.

- Dng dng c li c nh li bnh nhn xung sn di vm hng.

- a tm bng vo vng hu hng cho dch hng thm t u tm

bng, sau mit mnh v xoay trn tm bng ta khu vc 2 a-mi-an v
thnh sau hng thu thp t bo nhim.
- Sau khi ngoy hng xong, tm bng c chuyn vo mi trng bo
qun bnh phm (u tm bng phi nm ngp trong mi trng vn chuyn).
Ct b cn tm bng cho ph hp vi di ca ng cha mi trng vn
chuyn vi rt.
- ng np, xit cht, bc ngoi bng giy parafilm (nu c).
2.3.3. Dch ni kh qun, ph nang
- Phi c s h tr ca bc s lm sng.
- Bnh nhn khi ang th my, c t ni kh qun: Dng 1 ng ht dch, t theo
ng ni kh qun v dng bm tim ht dch ni kh qun theo ng ng t t 1 2ml.
- Cho dch ni kh qun vo tube cha mi trng vn chuyn.
2.3.4. Huyt thanh

- S dng bm kim tim v trng ly 3-5 ml mu tnh mch, tho kim

tim, ta u bm tim vo thnh ng nghim bm mu vo ng mt cch t
t trnh to bt kh v tan huyt, chuyn vo tube cha, ng np, bo
qun 4oC trong vng 24 gi.
- Tch huyt thanh theo cc bc sau:
+ ng cht np tube cha mu, ly tm tc thp 2000 vng/pht
trong 8 pht trnh v hng cu. Khng lm ng lnh mu mu khi cha
tch huyt thanh.
+ Dng pipet v trng, nh nhng ht huyt thanh phn trn ca tube,
chia u vo cc tube bo qun nh (1,8ml).
- Bo qun huyt thanh 4-8oC khng qu 10 ngy, nu lu hn phi
c bo qun m 70oC hoc m 20oC.
2.4. Cch ghi nhn v phiu xt nghim:
- Ghi nhn trn mi ng ng mu bnh phm v nhn trn bao b vn chuyn bao
gm cc thng tin sau, ghi m s, h tn, tui bnh nhn, loi bnh phm, ngy ly bnh
phm trn tube thu thp bnh phm.... theo quy nh ti Khon 1, Khon 2 iu 7 Thng
t s 43/2011/TT- BYT ngy 5/12/2011 ca B trng B Y t Quy nh ch qun l
mu bnh phm bnh truyn nhim.
- in y thng tin vo phiu xt nghim theo quy nh ti Ph lc 6 Thng t
s 43/2011/TT- BYT ngy 5/12/2011 ca B trng B Y t. Cc phiu xt nghim bnh
phm phi c gi km theo mu bnh phm.

- Trn cc bao b bnh phm phi ghi tn loi bnh phm (BNH
PHM CHN ON hoc BNH PHM LM SNG)
2.5. Vn chuyn bnh phm ti phng xt nghim:
2.5.1. Yu cu v bo qun, thi gian vn chuyn bnh phm
Tt c cc bnh phm cn phi c bo qun trong mi trng thch hp, nhit
0
4 C v chuyn n ni xt nghim trong vng 48 gi. Trong trng hp khng th

chuyn bnh phm n ni xt nghim trong vng 48 gi, th bnh phm phi c bo
qun nhit m 700C hoc m 200C (nu khng c t m 700C). Trnh lm ng bng
v r ng nhiu ln phng nga vi sinh vt trong bnh phm mt hot tnh.
Khng c bo qun hoc vn chuyn trong kh (solid carbon dioxide) tr khi
c ng kn trong ng thu tinh hoc trong 2 lp ti nha
2.5.3. ng gi bnh phm
Bnh phm phi c ng gi trc khi vn chuyn, trnh , v, pht tn tc nhn
gy bnh trong qu trnh vn chuyn theo quy nh ti iu 6 Thng t s 43/2011/TTBYT ngy 5/12/2011 ca B trng B Y t.
2.5.4. Vn chuyn bnh phm
- Thng bo cho phng xt nghim ngy gi bnh phm, phng tin vn chuyn v
thi gian d kin s ti phng th nghim.
- La chn phng tin vn chuyn, m bo thi gian vn chuyn ngn nht.
- Nu vn chuyn qua ng hng khng: mt n v mu bnh phm khng vt qu
1 lt (cht lng) hoc 1kg (cht rn). Bnh phm sau khi ng gi khng c vt qu 4
lt (cht lng) hoc 4 kg (cht rn)/kin.
- Cc cht bo qun bnh phm trong qu trnh vn chuyn ( t, kh, nit lng)
cn c cn nhc cho ph hp vi yu cu v an ton khi vn chuyn cng nh m bo
cht lng bnh phm khi vn chuyn.
3. T CHC XT NGHIM V THNG BO KT QU XT NGHIM
3.1. n v xt nghim khng nh vi rt cm A (H7N9)
Vin V sinh dch t trung ng v Vin Pasteur TP. H Ch Minh l nhng ni tip
nhn v tin hnh xt nghim khng nh.

3.2. n v ly mu xt nghim:
- Trung tm Y t d phng cc tnh,thnh ph, cc bnh vin chu trch
nhim ly mu bnh phm cc trng hp nghi do vi rt cm A(H7N9) ti a
phng v n v mnh, ng thi ng gi v chuyn ngay v trung tm cm
thuc Vin V sinh dch t Trung ng v Vin Pasteur TP. H Ch Minh
theo ng quy nh ti Thng t s 43/2011/TT-BYT ngy 5/12/2011 ca B
trng B Y t Quy nh ch qun l mu bnh phm bnh truyn nhim.
- Cc Vin v sinh dch t, Pasteur c trch nhim ch o, h tr chuyn
mn k thut v phi hp vi cc tnh, thnh ph thuc khu vc ph trch
tin hnh iu tra, ly mu, bo qun v vn chuyn bnh phm kp thi, ng
quy nh v trc tip tin hnh ly mu bnh phm ti cc a phng, n v
thuc a bn ph trch.
- Cc cn b tham gia ly mu bnh phm, lm xt nghim phi c
trang b phng h c nhn, phi m bo an ton tuyt i khi tip xc vi
mm bnh ti nguy him.
3.3. Xt nghim:

- Vin V sinh Dch t Trung ng chu trch nhim tip nhn v xt nghim khng
nh i vi cc mu gi t cc tnh t Qung Ngi tr ra pha Bc;
- Vin Pasteur TP.H Ch Minh chu trch nhim tip nhn v xt nghim khng nh
i vi cc mu gi t cc tnh t Bnh nh tr vo k c cc tnh Ty Nguyn
- Vic nui cy phn lp vi rt ch c tin hnh ti phng xt nghim an ton sinh
hc cp 3 (BSL3).

3.4. Thng bo kt qu xt nghim cm A(H7N9):

Vin V sinh Dch t trung ng v Vin Pasteur TP. H Ch Minh c
trch nhim bo co kt qu xt nghim v Cc Y t d phng, B Y t v
thng bo kt qu xt nghim cho n v gi mu bnh phm. Vic thng bo
tnh hnh dch bnh, ca bnh truyn nhim nguy him gy dch thc hin theo
Thng t s 48/2010/TT-BYT ngy 31/12/2010 ca B trng B Y t hng
dn ch khai bo, thng tin, bo co bnh truyn nhim.
KT. B TRNG
TH TRNG
( k)

Nguyn Thanh Long

Ph lc 1: S dng trang phc bo h c nhn

Trc khi ly mu (mc)

Sau khi ly mu (ci)

Gng tay - lp th hai

Khu trang N95

Knh bo h

Qun

Qun

ng

Knh bo h

ng

Gng tay - lp th nht

Khu trang N95

Gng tay - lp th hai

Gng Tay - lp th nht

- Trc khi ly mu
+ Gng tay - lp th nht: lun gi lp gng th nht sch, trnh khng tip
xc vi dng c bn.
+ Gng tay lp th hai: dng cho ly mu v c th thay th nu b rch.
Ch : trc khi tho lp gng th 2, cn phi phun kh trng cn ton b b
mt gng.
- Sau khi ly mu
+ Trc khi ci b trang phc bo h, phi phun kh trng cn 70 0 ln ton b
b mt trang phc bo h v ng.
+ Ra tay bng x phng v st trng li tay bng cn 700
Khu trang N95 loi c
van v khng van

Khu trang phu thut

B quno kn c km
o ni lng pha trc,
ph hp cho ly mu
gia cm ti thc a.