Y HQC V | | T NAM THANG S • SO 1/2011
DIEU TRA TINH HINH NHIEM KHUAN VET MO
TAI BENH VIEN BACH MAI
T 6 M TAT
Tien hanh dieu tra tinh hinh nhiem khuHn vet mo
(NKVM) ciia 911 benh nhan dupe phau thuat t^i cic
phong mo thupc hai khu mo cu va mdi tai benh vi?n
Bach Mai, ket qua cho thay. Ty le NKVM tai b?nh
vien Bach Mai trong thdi gian nghien CLTU la 6,45%. Ty
le NKVM d nhdm benh nhan phau thuat tai khu md cu
la 10,5%, cao hdn han so vdl ty le NKVM d nhom b^nh
nhan phau thuat tai khu mo mdi la 2,4%. Sy" khac bi?t
nay hoan toan cd y nghTa thong Vk, p < 0.001. Ooi vdi
cac benh nhan mo phien, ty le NKVM tai khu md cu
cao hdn ro ret (19,2%) so vdi khu md nidi (4 4%) (p
< 0.01). NhiJng benh nhan dUdc tien hanh phau thuat
trong vong 120 phut cd ty le mac NKVM tai khu mo cij
(10,8%) cao hdn so vdi khu md mdi (4,2%) (p <0.01).
Cac vi khuan gay NKVM thudng gap la Enterococci
(30,17o), E. coll (20,6%), S. aureus va P. aeruginosa
deu diiem 4,8%.
SUMMARY
THE SURVEY ON SURGICAL SHE INFECTIONS
I N BACH MAI HOSPITAL
The survey on surgical site infections (SSI) in
911 patients operated on in both the old and the new
operating theatres of Bach Mai Hospital showed that
the SSI rate at Bach Mai Hospital during the survey
was 6.45% on average. SSI rate with 10.5% at the old
theatre was much higher than just 2.4 % at the new
one, this difference had full statistical significance, p
<0.001. Among the regular operation patients, the
rate of SSI at the old theatres were distinctively higher
(19.2%), compared with 4.4% at the new theatres (p
<0.01). Among those patients whose operations lasted
for about 120 minutes the SSI was 10.8% at the old
theatre, compared with 4.2% at the new one (p
<0.01) The bacteria causing SSI that were often found
,vtere Enteirococo {'^0.\P/o), E a3//(20.6%) then came
S^ aureus and P. aeruginosa- both making up 4.8%.
I. D/^T VAN OE
Mac dii da cd nhtfng cai tien ve cac phUdng
phap phau thuat, nhuhg hieu b i ^ ve tac nhan gay benh
va viec sir dung phd bien lieu phap khang sinh dU phdng
nhul^ nhiem khuan vet md (NKVM) van tiep tuc xay ra
lam bam bong them tinh bang benh tat va tang ty le tir
vong d cac b&ih nhan ngoai khoa. Tai t^, qua giam sat
lean qua: cho thay NKVM l^ mdt loai nhiem khuan benh
vien pho bi&i, quan trong, diihg hang thir 2 sau nhiem
* Benh vien Bach l^ai
Phan bien khoa hoc: GS.TS. Le Bach Quang
Nguyen Quoc A n h * , fioan Mai Phu'dng*
khuan tiet nieu, chiem 24% nhilm khuan benh vien.
Cijng tai My, ty le NKVM chian tir 2% - 5% trong sd 16
tneu benh nhan phau thuat hang n3m. NKVM cdn deu
ton 42% tdng chi phi phat sinh do nhiem khuan benh
vien gay ra (1).
Trong nhiJng nam gan day, chdng nhiem
khuan benh vien da dUde Bd Y te nudc ta dac
biet quan tam. Kiem soat nhiem khuan trong
benh vien la thUe hien tdt cdng tac cham sdc va
dieu trj chdng lay cheo trong benh vien theo
nhuYig quy djnh, quy trinh ky thuat chuyen mdn
da de ra, la mdt chUdng trinh quan ly chat lUdng
cham sdc va dieu trj benh nhan. Bat dau mdt
chUdng trinh kiem soat nhiem khuan cung ed
nghTa la bat dau mpt chuyen bien mdi ve chat ludng
thUe hanh cham sdc ngUdi benh d moi benh vien.
Vi vay, chiing tdi thUc hien de tai nghien culi
nay vdi mue di'ch:
1. Danh gia tinh trang nhiem Ichuan vet mo
cua benh nhan sau phau thuat tai Ichu mo cu va
khu mo mdi.
2. Tim cac can nguyen vi khuan thu'dng gay
nhiem khuan vet md, giiip cho viec de ra cac
bien phap thfch hdp di' kiem soat nhiem khuan
benh vien dac biet la NKVM.
II. D d l n / p N G VA PHUONG PHAP NGHIEN COU
2 . 1 . Benh nhan:
Bao gom 911 benh nhan dUde phau thuat tai
cae phdng md thudc hai khu nha md cu va mdi
ciia benh vien Bach Mai.
2.2. V a t lieu nghien cu'u:
Cac mdi trudng, sinh pham de nudi cay,
phan lap va xac dmh vi khuan do hang Bio - Rad
(Phap), Bio - Merieux (Phap) va Becton Dickinson
(Hoa ky) cung cap.
2.3. Tieu chuan xac dinh NKVM theo CDC:
Nhiem khuan vet mo la nhii'ng nhiem khuan
tai vet md" trong thdi gian tir khi mo eho den 30
ngay sau mo vdi phau thuat khong ed cay ghep.
Nhiem khuan vet mo ndng la nhiem khuan
ciia da va t d chirc dUdi da (ap xe chi khau khdng
dUde coi la nhiem khuan):
+ Cd dau hieu viem tai cho (sUng, ndng,
dd, dau).
 Y HQC VlgT NAM THANG 5 - s 6 1/2011

+ Chay mil ti!r vet mo.
+ Cay phan lap dUdc vi khuan tgi vet md.
- Nhiem khuan vet mo sau la nhiem khuan
Idp can va cd phia ddi:
+ Chay mil vet md tir Idp cd (khong phai
tCrcae cd quan hoac khoang cd the).
+ Sdt, dau t u nhien tai vet md vci to^c vet
md t u nhien.
+ 6 ap xe d Idp cd thSy dUdc qua thSm
kham, chan doan hinh anh hoSc khi mo lai.
• Nhiem khuan cac ed quan hoac khoang
ed the gom cac tang hay khoang giu^ eae tang
da sir ly trong phau thuat:
+ Chay mil td ong dan lUu ndi tang.
+ C^y djch dng dan lUu phan lap dutfc vi khuan.
+ 6 ap xe trong cd quan ngi tang (qua
thSm kham, phau thuat lai, X quang hoac giai
phau benh).

III. KET Q u A NGHIEN CCTU

3 . 1 . Ket qua phSn bd NKVM t h e o khu vi/c ph§u t h u a t :
Bang 1 . Ty le NKVM theo khu vUc phau thuat
Khu vyc Ty 1$ o/o NKVM t^i Ty 1$ o/o NKVM tai Ty 1$ o/o NKVM
phSu thuat khu md cQ khu m d mdj chung
Khoi ngoai 10,5 (22/ 209) 2,4(17/702) 6,45(39/911)
Khoa ngoai 11,2 (22/ 196) 4,4(16/366) 6,8(38/562)
Nghien eUu 911 benh nhan dUdc phau thuat d eac khu md eu va mdi tai benh vien Bach mai, ket
qua cho thay ty le NKVM chung cho toan khdi ngoai la 6,45%, rieng khoa ngoai la 6 , 8 % (bang 1).
Ket qua d bang 1 cdn cho thay cd sU khac biet rd ret ve ty le NKVM, b^nh nhan phau thuat tai
khu md cu mac NKVM eao hdn han so vdi khu mo mdi. SU khac biet nay hoan toan cd y nghla thdng
ke vdi p < 0.001 va p < 0.01.
3.2. Ket qua phSn bo NKVM t h e o hinh thu'c phau t h u a t :
Bang 2. J'^ le NKVM theo hinh thirc o h l u thuat
Hinh thu'c phau Ty le »/o NKVM tai Ty le % NKVM tai Ty le % P
thuat k h u mo cu khu mo mdi NKVM
Mo cap CLTU 8,7 (a/ !•«) VCV 93) 7,0(17/ 242) >0.05
Mo phien 19^(9/47) 4,4(12/ 273) 6,6(21/ 320) <0.01
Tien hanh dieu tra nhij'ng benh nhan dUdc phau thuat theo hinh thirc md cap cUu va mo phien tai
khu md cu va mdi cho thay khdng ed sU khac biet mang y nghla thdng ke g i u ^ benh nhan mo cap CLTU
tai hai khu md nay (p > 0.05)(bang 2).
Tuy nhien doi vdi cac benh nhan mo phien, ty le NKVM tai khu mo cu eao hdn rd ret (19,2%) so
vdi khu md mdi (4,4%), vdi sU khac biet ed y nghia thdng ke, p < 0.01.

3.3. Ket qua phan bo NKVM t h e o thdi gian p h l u t h u a t :

Bang 3. Ty le NKVM theo thdi qian phau thuat
Thdi gian phau Ty le o/o NKVM Ty ti °/o NKVM Ty 1$ % N K V M
thuat tai k h u mo cu tai khu m o mdi P
< 120 phut 10,8(20/186) 4,2(14/332) 6,56(34/518) <0.01
> 120 phut 20,0(2/10) 5,9(2(34) 9,1(4/4*) > 0 .05
Oieu tra nhutig benh nhan du'cfc tien hanh phau thuat trong vong 120 phut tai 2 l<hu mo cu va
mdi, l<et qua d bang 3 cho thay co sir khac biet mang y nghla thong ke ve ty le mac NKVM tai khu mo
cu (10,8%) cao hdn so vdi khu mo mdi (4,2%) (P < 0.01).
Trong khi dd khong co sir khac biet (P > C.05) giDS khu mo cu va mdi ve ty le NKVM doi vdl
nhffng benh nhan cd thdi gian phau thuat keo dai tren 120 phut.

3.4. Ket qua phan lap vi k h u a n tir N K V M :

Bang 4. Ket qua phan lap vi khuan tCr NKVM
Nhiem khuan vet mo So lu'Ong PKan tram
So li/dnq mau thiy nqhiem 92 100.0
So mau CO vi khuan: 51 56,0
 Y HQC Vl|T NAM THANG 5 - sg 1/2011

55mau col loai VKqavbenh 41 80,4

So msj. CO 2 loai VK qav benh 8 15,7
.5(5 mau CO J toai i/K qay benh 2 3,9
Cd 92 benh nhan sau phau thuat tai benh vien B?ch mai du'dc chi djnh cay mil tim tac nhan gay
NI<VM. Ket qua trong nghien ciJu nay cho thay cd 51 mau (56%) phan lap du'dc vi khuan. Trong dd so
mau cd 1 loai vi khuan la 80,4%, cd 2 loai vi khuan chiem 15,7% va so mau co 3 loai vi khuan chiem
3,9%^ Nhu' vay ket qua d bang 6 da cho thay tai vet mo khdng nhiilig chi cd 1 loai vi khuan ma cdn
fd the cd 2 den 3 loai vi khuan cung gay benh tren ciing mot benh nhan.
Bangs, Tv le phan lap vi khuan tCr NKVM
Vi khuan So lu'dng Ph'an trSm
1. Vi khuan Gram (+): 26 41,3
2.1. Staphylococcus aureus 3 4,8
Enterococci 19 30,1
Streptococci 4 6,3
2. Vi khuan Gram (-): 29 46,0
2.2. Escherichia coli 13 20,6
EntetobactersDO. 7 11,1
Klebsiella spp. 2 3,2
Proteus spu. 2 3,2
Pseudomonas aeniqinosa 3 4,8
A. baumannii 2 3,2
3. Nam men: 8 12,7
2.3. Candida spp. 8 12,7
Tonq so 63 100,0
Co 63 tac nhan gay nhiem khuan vet md da dUdc phan lap. Ty le cau khuan Gram dUdng chiem
41,3%, b-Uc khuan Gram am chiem 46,0% va nam men chiem 12,7%. Trong sd dd cac vi khuan gay
nhiem khuan vet mo dutig dau la Enterococci (31,1%), E.coli (20.6%), sau dd la S.aureus va
P.aeruginosa 6e\j chiem 4,8%.

IV. BAN LUAN
4.1. Ban lu|in ve sd phan bo NKVM theo
khu vu'c phau thuat:
Tai Viet Nam, mot so eae nghien ciru cat
ngang trong nhulng nam gan day cho thay ty le
NKVM tUdng ddi cao. Mdt giam sat toan qudc do
Vu Oieu tn - Bp Y te thUc hien d 11 benh vien
trong toan quoc nam 2001 cho thay NKVM chiem
17,6%. Qua giam sat 558 ea phau thuat tai benh
vien Bach mai vao nam 1999, ty le NKVM la
9,6%. Nghien cu'u dieu tra cat ngang 1 ngay
(7/11/2001) d tat cae khoa lam sang trong benh
vien Bach mai, ket qua cho thay ty le NKBV
chung trong toan benh vien la 6,75%, trong dd
NKVM la 14,3%. Mdt nghien cdu khac tai b#nh
vien Viet - Du'c cung tien hanh khao sat thi diem
d hai khoa la khoa Hoi sut sau md va khoa Phau
thuat gan mat da cho thay ty ie NKVM la 6,75%.
Tien hanh nghidn CU\J theo nganh dpc 911
benh nhan dUdc phau thuat ngoai khoa tai cac
kfiu md cu va mdi cua benh vien Bach mai td
thang 3/12/1001 den 2/3/2002, ket qua trong
nghien cu'u nay cho thay ty le NKVM chung cho
toan khol ngoai la 6,45%, rieng khoa ngoai la
6,8% (bang 8).
Mac du viec so sanh nhu'ng ty le NKVM d cac
benh vien khac nhau thudng khdng chinh xac do
phUdng phap xac djnh chUa dddc thdng nhat.
Mat khac do cd nhu'ng khd khan ve kinh te va
dae diem mdi sinh nen nhin chung ty le NKVM d
Viet Nam ta qua nghien cUu nay la cao hdn nhieu
so vdi cae dieu tra d eac nUde Chau Au va Hoa ky
(5 - 6%). Tuy nhien ty le nay lai tUdng dUdng vdi
mdt sd ket qua nghien culi d eac nUde dang phat
then cung nhU eae nUde Odng Nam A. Patlr va
cpng sU ghi nhan nhiem khuan sau phau thuat
tlian kinh la 15% tai New Delhi, An Dp.
Oac biet khi so sanh ve ty le NKVM glQ^ khu
mo eu va khu md mdi, cac ket qua trong nghien
eulj nay da cho thay (bang 1) cd sU khac biet rd
ret, benh nhan phau thuat tai khu mo cu mac
NKVM (10,5%) eao hdn han so vdi khu md mdi
(2,4%). SU khac biet nay vdi P < 0.001 hoan
toan cd y nghTa thong ke. Oieu nay cd the ly giai
do benh vien Bach mai vdi 1400 giUdng benh, la
mdt trung tam y te chuyen sau Idn nhat Viet
 Y HQC VrgT NAM T H A N G S - Sd 1/2011
nam, la ed sd dao tao ciia trUdng Dai hpc Y Ha
npi, ed nhiem vu thu dung eae benh nhan khu
vUe Ha npi va cac benh nhan nSng chuyen den
tCr cae benh vien khu vUc phi'a BSC. Benh vien cd
180 giUdng benh ngoai khoa, trong dd khoa
jj Ngoai 100 glUdng, khoa San 50 giUdng v^ 30
giUdng eho lien khoa RSng h^m mSt-MSt-Tai miji
hpng (RHM-M-TMH). Tir cudi nSm 2000 benh
vien Bach mai dUa them 6 phdng md mdi, hi?n
dai vao sir dyng, nang sd phdng md len 9 phdng.
Qua giam sat cho thay dieu kien v$ sinh vd
khuan eiia 2 khu phau thuat tUdng doi khac
nhau. Khu phau thuat mdi dUdc thiet ke mpt
ehieu, cd thdng khi ap lUc dUdng va thiet bj ri^a
tay hien dai cung nUdc rira tay da dUdc tiet
khuan. Trong khi dd khu phdng md cu dUde xay
dUng tir nhutig n3m 1960 nen he thdng thdng
khi phdng mo kem, thiet bi rira tay da xudng
cap, nude rira tay dUdc cung cap tLf cac be chira
nude lUu cii'u, rat it khi dUdc thau be nen khdng
dam bao tieu chuan su* dung.
4.2. Ban luan ve sd phan bo NKVM theo
hinh thuTc phau thuat:
Cae nhiem khuan vet md hau het phat sinh
do d nhiem ti!r nguon vi khuan ndi sinh cua benh
nhan thdng qua tiep xuc trUc tiep. Vi vay chuan
bj benh nhan trUde mo can phai dUdc tien hanh
k9 ludng nham giam bdt tdi da so lUdng vi khuan
cd mat d rudt, da, dudng hd hap, dUdng tiet nieu
ciia benh nhan tiJy theo tirng loai phau thuat.
Vi vay trong nghien ciru nay chung tdi da
thong ke, so sanh ty ie NKVM cua benh nhan md
cap ciru va benh nhan md phien dUde phau thuat
tai hai khu md cu va mdi. Ket qua cho thay rang
ddi vdi benh nhan mo cap cdu khdng thay cd sU
khac biet mang y nghTa thdng ke ve ty le NKVM
tai hai khu mo nay vdi P > 0.05 (bang 2). Cd le
do khi benh nhan mo cap cu'u, sU chuan bi benh
nhan trUde mo khdng dUde tien hanh ky luSng
nen m3e du cae dieu ki?n ve mdi trUdng ed hien
dai, dam bao ve sinh thi cung khd tranh khdi
nhien khuan sau md hdn so vdi nhthig benh
nhan dUdc mo trong phdng mo tUdng tu va cd
dUdc chuan bj ky cang trUdc khi md.
Tuy nhien ddi vdi cac benh nhan md phien,
ty le NKVM tai khu md cu cao hdn ro ret (19,2%)
so vdi khu md mdi (4,4%), vdi sU khac biet cd y
nghTa thong ke, P < 0.01. Dieu nay eho thay ro
khi benh nhanid ca hai khu md deu da dUde
chuan bj ky ludng trUdc md thi moi trUdng phdng
mo lai la yeu td het sire quan trpng ddi vdi NKVM.
Khu md mdi dudc trang bi hien dai se la yeu 1^ lam
48
giam ty 1$ NKVM, dSc biet d nhCihg benh nhan dUcfc
phau thuat cd sU chuan bi trddc md.
4.3. Bdn Ju|in ve sd phan bo NKVM theo
thdi gian phSu thu^t:
Hau het cac nhilm khuan vetmd ngoai khoa
xay ra trong thdi gian phau thuat d trong phdng
md. Mpt sd It nhiem khuan vet mo xay ra sau
cu§c md khi vet md dUde ddng kin thdi ky dau.
Vi v^y thdi gian phau thuat la yeu td lien quan
true tiep den ty 1^ NKVM. Theo eae thdng ke eho
thBy, doi vdi loai phau thuat sach neu thdi gian
phau thuat la 1 gid thi ty le NKVM la 1,3%, 2 gid
la 2,7% va 3 gid la 3,6%. NhU vay thdi^gian mo
cang dai cang tang kha nang nhiem khuan, trong
dd nguyen nhan do phdi bay vung md lau la yeu
td quan trpng gSy NKVM.
Ket qua dieu tra trong nghien cu'u nay cung
cho thSy nhij'ng b#nh nhan dUdc tien hanh phau
thuat trong vdng 120 phiit ed nguy ed nhiem
khuan nhU nhau nhUtig ty le mSc NKVM tai khu
md cu (10,8%) cao hdn so vdi khu mo mdi
(4,2%) (P < 0.01). Nhu vay cung thdi gian phdi
bay viing md nhUng nhutig benh nhan md tai
khu md eu la ndi ed dieu kien ve sinh kem hdn
nen nguy ed nhiem khuan se cao hdn va nguUc
lai khu md mdi dieu kien ve sinh rat hien dai se
cd ty le NKVM thap hdn.
Tuy nhien ddi vdi nhutig benh nhan cd thdi
gian phau thuat keo dai tren 120 phut thi khdng
cd su khac biet (P > 0.05) ve ty te NKVM giiJa
khu md eu va mdi do thdi gian mo qua dai thi du
trong dieu kien ve sinh dam bao thi ty le NKVM
van cd the tSng. Lue nay thi ty le NKVM cdn phu
thudc vao eae yeu td khac nhU t3ng ton thUdng
td chu'c, tSng mat mau lam giam su'c de khang
ciia cd the benh nhan.
4.4. Bdn l u i n ve ket qua phan lap vi
khuSnttJrNKVM'
Tt le cac tac nhan gay nhiem khuan benh
vien cd sU thay ddl theo thdi gian, khac nhau d
mSi benh vien tham ehi moi khoa, dong thdi cd
cau vi sinh vat d tutig vj tri ton thUdng cung khac
nhau. Cac quan the vi khuan gay djch d benh
vien thay doi do sU sir dung khang sinh va chi
djnh y te. Cac vi khuan gay benh thudng i ^
khang khang sinh. Cac vi khuan khang thuoc do
lam dung khang sinh hoSc chi djnh khang sinh
khdng diing.
Ket qua trong nghien ciru nay eho thay co
51 mau benh pham mii (56%) phan lap dUde vi
khuan tir 92 benh nhan sau phau thuat tai khoa
Ngoai benh vien Bach mai. Trong dd sd mau cd 1
 Y HQC VIET NAM THANG 5 • SO 1/2011
loai vi khuan la 80,4%, cd 2 loai vi khuan chiem
15,7% va sd mau cd 3 lo^i vl khuan chiem 3,9%.
Nhu vay ket qua cho thay tai vet md khdng
nhu'ng chi ed 1 loai vi khuan gay benh ma eon cd
the ed 2 den 3 loai vi khuan cung gay nhiem
khuan vet md tren ciing mot benh nhan.
Cd 63 tac nhan gay nhiem khuan vet md da
dUde phan lap trong nghien cud nay. Ty le cau
khuan Gram dUdng chiem 41,3%, trUc khuan
Gram am chiem 46,0% va nam men chiem 12,7%.
Trong sd dd cae vi khuan gay nhiem khuan v ^ md
dimg d3u la Entenxxxri {31,1%), E coli [20.6%),
sau dd la 5. aureusva deu chiem 4,8%.
Cay mil ciia 23 benh nhan cd NKVM tai benh
vien Chd ray, ket qua cho tay ty le phan lap gom P.
aenj0nosa 33%, S. aureus 14%, Enb&obac^ 12%,
Adnet^:)acterX2%, E coli 9%, flTJteusehiem 7%.
Mdt nghien cuU eiia Ooan Mai PhUdng va
Nguyen Xuan Quang tien hanh khao sat nhiem
khuan benh vien tai khoa Hoi sii'c cap eiili - benh
vien Bach mai cho thay cd 5 benh nhan dude xac
djnh la nhiem khuan benh vien trong thdi diem ki&n
ba. Cac vi khuan phSn lap dUdc la 2 ehiing P.
aewginosa, 1 chung 5. aureus, 2 ehiing Carxiida
albk3ns NhU vay sU cd mat cua cae tac nhan gay
nhiem khuan benh vien trong cac nghien eulJ d Viet
Nam la tudng tU ket qua bx)ng nghien ciru nay.
a ngoai nude, theo cac ket qua nghien cu'u
ciia he thdng cham sdc nhiem khuan qudc gia -
Hoa ki", ty le phan lap vi khuan tU vet mo nhiem
triing trong cac giai doan 1986-1989 va 1990-
1992 cho thay cac eau khuan Gram dUdng chiem
ti le cao nhat 5 8 , 1 % , cac trUc khuan Gram am
chlem 38,8%, cdn lai la nam men 3 , 1 % . Trong
sd cac vi khuan Staphylococci dung hang dau
(38,7%), Enterococci ddng hang thir 2 chiem
15,6%, thir 3 la E. coliy&\ 11,2%, trong khi do A
aeruginosa la 1,0%. NhU vay cac vi khuan
thudng gay NKVM theo nhU cae nha khoa hpc
Hoa ky da cdng bd la tUdng tU vdi ket qua phan
lap vi khuan tiTvet md trong nghien cUu nay.
V. KET LU^N
1. TV le n h i i m khuan v e t mo ciia benh
nhan sau phau t h u a t t a i khu mo cu va khu
mo mdi:
Ty le NKVM tai Benh vien Bach Mai trong
thdi gian nghien ciru la 6,45%.
- Ty le NKVM d nhdm benh nhan phau
thuat tai khu mo cu la 10,5%, cao hdn han so vdi
ty le NKVM d nhdm benh nhan phau thuat tai
khu md mdi la 2,4%, SU khac biet nay hoan toan
ed y nghia thdng ke, p < 0.001.
- Doi vdi eae benh nhan mo phien, ty le
NKVM tai khu md cu cao hdn rd ret (19,2%) so
vdl khu md mdi (4,4%) (p < 0.01).
- Nhiitig benh nhan dUdc tien hanh phau
thuat trong vdng 120 phut cd ty le mac NKVM tai
khu md cu (10,8%) cao hdn so vdi khu mo mdi
(4,2%) (p < 0.01),
2. Cac can nguyen vi khuan thu'dng
gay nhiem khuan v&'t mo:
Cac VI khuan gay NKVM thudng gap la
Enterococci {ZQ,\%), E. coli {20,6%), S. aureus
4,8%, P. aeruginosa ^,^%.
TAI UEU THAM K H A O
1. Nguyen Ngpc Bich. Nhiem khuan vetmova cac
bien phap dW phong. Tai lieu tap huan kiem scat
nhiem khuan lan thLT nhat -11/2000; 79-86.
2. Do Khang Chien, Pham OuTc Mijc. Hddng dan
dian doan nhiem khuan ijSnh vien (khuyen cao
cua CDC). Hpi thao dieu tra nhiem khuan benh
vien - DU an chong nhiem khuan benh vien
10/2002; 16-24.
3. Nguyen Vi?t Hiing. Mot so diem cd ban ve giam
sat nhiem khuan vet mo ngoai khoa. Tai lieu dao
tao kiem soat nhiem khuan benh vien - 2001; 98-
110.
4. Nguyen Manh Nham. Tom tat ttnh hinh nhiem
khuan vet mo tai Benh vien Viet Dut (qua 1098
tn/dng hdp). Tom tat cac bao cao va tham luan
tai hpi thao "Nhiem khuan trong ngoai khoa". Ha
Noi -1991; 1
5. Nguyen Xuan Quang, Oo^n Mai PhUdng. Cac
tac nhan gay nhiem khuan thu'dng gap tai benh
vien Bach mai. Tai lieu dao tao kiem soat nhiem
khuan benh vien - 2001; 127-135.
5. Annete Sohn. MD, CE)C Atlanta Georgia USA.
Infection Qxitid h Viet Nam Challenges and new
Diredkm.
7 Anette H.Shon, MD; Farah M.Parver, MD; Tien
Vu,MS; Hoang H.Hai, MDetaL Prevalence ofsjrgicai
site mfectJons and patterns c^antirrvatitxal use in a larg
tentary-<3re hospital in hto Chi Minh Oty, Vietnam.
Infection oontrol and hospital epktemiotogy-Volume
23(7)-]uly 2002.