Professional Documents
Culture Documents
(Ban hành kèm theo Quyết định số: 3671/QĐ-BYT ngày 27 tháng 9 năm 2012 của Bộ Y tế)
implant technique)
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Introduction
1.2. The situation and consequences of wound infection
- Wound infection has serious consequences for the patient due to prolonged hospitalization,
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Introduction
1.3. The situation and consequences of wound infection
Measures have been found to be highly effective in preventing wound infections, including:
(1) Bathe with antiseptic soap for the patient before 5) Strictly follow the aseptic procedure in the operating
surgery; room and when taking care of the incision, etc.
(2) Remove hair and prepare skin incision properly 6) Control blood sugar, warm the patient during surgery
(3) Surgical and routine hand disinfection with an (7) Maintain aseptic conditions in the operating area such
alcohol-based hand sanitizer as tools, surgical fabrics that are properly sterilized, sterile
water for surgical hand hygiene and clean air in the
(4) Correctly apply prophylactic antibiotic therapy
operating room.
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Introduction
1.4. Scope of application
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Pathogenesis and risk factors
2.1. Pathogens
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Pathogenesis and risk factors
2.2. Pathogen sources and genetic mechanisms
There are 2 sources of causes , including:
Microorganisms in the patient (endogenous)
Microbiological environmental (exogenous)
Is the main source of the cause of viral infections,
The microorganisms outside the environment enter
including microorganisms that are present on the
incision during surgery or while caring for the incision.
patient's body. These microorganisms often reside
The exogenous pathogens often originate from:
in the epidermal cells of the skin, mucous
+ The operating environment
membranes or in the hollow organs / organs of the
+ Tools, materials to stop bleeding, surgical
body. Endogenous pathogens often originate from
fabrics polluted.
the hospital environment and are highly resistant to
+ Surgery staff
drugs. . 12
Pathogenesis and risk factors
2.3. Risk factors for wound infection
There are 4 groups of risk factors for infections, including:
patient, environment, surgery, and pathogens.
• - Patient factors: The worse the patient's condition before surgery, the higher the risk
• - Environmental factors: Surgical hand hygiene, surgical conditions (operating room,
tools ...) are not sterile, medical staff, ...
• - Surgical factors: surgical timing and operations; type of surgery, ...
• - Microbiological factors: The higher the pollution, virulence and antibiotic resistance of
bacteria, the weaker the resistance of the surgical patient, the greater the risk.
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Preventive measures
3.1. General rules
All medical staff, patient's family members and patients should
conform to the rules and procedures before, during and after
surgery.
Use antibiotic prophylaxis suitable for the pathogen, the right dose,
time and route of administration.
Regularly and periodically monitoring; communicate the results to
the relevant people.
Equipment, conditions, facilities, consumables and chemicals
essential for aseptic practice of patient care. 14
Preventive measures
3.2.1: Prepare the patient for surgery
- Quantitative blood glucose and quantitative tests of serum albumin for all patients
undergoing session surgery.
- Detect and treat any infected
- Shorten preoperative hospital stay for prepared surgeries.
- The patient must be showered with a disinfectant soap containing iodine or chlorhexidine
the night before the surgery and / or the morning of the surgery. The patient can dry bath in
a way to disinfect the entire skin of the body, especially the skin of the surgical area
- No hair removal before surgery, except for cranial surgery patients or patients with hairs at
the incision site. The skin affects operations during surgery. For patients with an indication
for hair removal, it is necessary to remove hair in the operating area, performed by the
health worker within 1 hour before surgery. Use shears or an electric razor to remove hair,
do not use a razor. 15
Preventive measures
3.2.2: Use of prophylactic antibiotics in surgery
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Preventive measures
3.2.3. Preventive measures in surgery
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Preventive measures
3.2.4. Post-operative care
- Cover the incision with sterile gauze continuously from 24-48 hours after surgery.
- Change the dressing according to the aseptic procedure.
- Instruct the patient and the patient's family to follow up, detect and immediately notify the health
worker when the incision shows unusual signs / symptoms.
- Take care of the drain legs in accordance with the technical process and need to drain the drain as
soon as possible.
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Preventive measures
3.2.5. Supervision to detect incision bacteria
3 điểm Người bệnh có bệnh toàn thân nặng nhưng vẫn hoạt động bình thường
4 điểm Người bệnh có bệnh toàn thân nặng, đe dọa tính mạng
5 điểm Người bệnh trong tình trạng bệnh nặng, có nguy cơ tử vong cao cho dù được phẫu
thuật
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Preventive measures
Bảng phân loại vết mổ và nguy cơ NKVM
Loại vết mổ Định nghĩa Nguy cơ NKVM (%)
Sạch Là những phẫu thuật không có nhiễm khuẩn, không mở vào đường hô hấp, tiêu hóa, sinh dục và tiết niệu. Các vết thương sạch 1-5
được đóng kín kỳ đầu hoặc được dẫn lưu kín. Các phẫu thuật sau chấn thương kín.
Sạch nhiễm Là các phẫu thuật mở vào đường hô hấp, tiêu hoá, sinh dục và tiết niệu trong điều kiện có kiểm soát và không bị ô nhiễm bất 5-10
thường. Trong trường hợp đặc biệt, các phẫu thuật đường mật, ruột thừa, âm đạo và hầu họng được xếp vào loại vết mổ sạch
nhiễm nếu không thấy có bằng chứng nhiễm khuẩn/ không phạm phải lỗi vô khuẩn trong khi mổ.
Nhiễm Các vết thương hở, chấn thương có kèm vết thương mới hoặc những phẫu thuật để xảy ra lỗi vô khuẩn lớn hoặc phẫu thuật để 10-15
thoát lượng lớn dịch từ đường tiêu hoá. Những phẫu thuật mở vào đường sinh dục tiết niệu, đường mật có nhiễm khuẩn, phẫu
thuật tại những vị trí có nhiễm khuẩn cấp tính nhưng chưa hóa mủ.
Bẩn Các chấn thương cũ kèm theo mô chết, dị vật hoặc ô nhiễm phân. Các phẫu thuật có nhiễm khuẩn rõ hoặc có mủ. >25
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Preventive measures
3.2.5. Supervision to detect incision bacteria
- Use the uniform surveillance of vascular infection during the monitoring sessions.
- The monitoring group should calculate the rate of ARI according to each type of
surgery and according to the variables to determine the risk factors.
- The Department / Team is responsible for coordinating with relevant departments
and departments to develop intervention plans, submit to hospital leaders for
approval, and organize the implementation of improving the shortcomings obtained
from monitoring activities.
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Preventive measures
3.2.6. Check and monitor compliance with sterile procedures in health workers
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Preventive measures
3.2.7. Ensure essential equipment and equipment conditions and chemicals for the prevention of malaria
- Surgical area design must comply with regulations of the Ministry of Health.
- Ventilation of the operating room.
- Temperature and humidity in the operating room.
- Arranging and disinfecting the surface of the operating room environment.
- Always have personal protective equipment available at the entrance to the sterile area
of the operating area.
- Fully equipped facilities for surgical and routine hand hygiene.
- Sterilize tools, hemostatic materials and surgical fabrics.
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Preventive measures
Bảng tiêu chuẩn vi khuẩn cho không khí buồng phẫu thuật
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Preventive measures
3.2.8. Several other measures to prevent wound infections