BUAC DAU DANH GIA THUC TRANG 00 $0 VAT CHAT KY THUAT CHAN DOAN VA DIEU TRI CUM A TAI 6 BENH VIEN TUYIN HUYEN TINH QUANG NINH TOM TAT Kiim soat mdt each hieu qui cum dai dich khdng nhi/ng ddi hdi viec hiiu biet sau vi cum dai dich mi cdn can cd day dCi ca sd vat chat trang thiit bi. Nghien cifu xac dinh tht/c trang ca sd vat chat ky thuat chan doan va diiu tn cum A tai cac bdnh vien huyen thugc tinh Quing Ninh td dd lam ca ?5 ciio cac nghien eifu can thiep nhim ting cadng ca sd vat chat ky thuat can thiit eho vide chan doan va diiu tri cum dai dich. Kit qui: Thac trang ca sd vat chai ky thuat va thudc thiit yiu cho vide chan doan va diiu tri cum dai dich cCia cac benh vien tuyin huyen tinh Quing Ninh edn nhiiu thiiu thdn va bat cap, can daac bo sung va cung cap day dQ. TUkhoa: cum dai dich, tinh Quang Ninh. SUMMARY Effective influenza pandemic management requires not only understanding of the factors influencing behavious changes but also have enough instruments. To determine the real instruments and essentlons drugs for diagnosing and treating Influenza pandemic In some district- hospital in Quang Ninh province thereby to make basements to interfere for the purposes of Improving the ability for diagnosing and treating patients with influenza A. Results; The two group district-hospitals in Quang Ninh province do not have enough basic Instruments and essentlons drugs for diagnosing and treating influenza pandemic A and there Is a need to supply. Keywords: pandemic influenza, district hospital, Quangninh province. OAT VAN OE Hien nay tinh hinh djch cum A(H1N1) dang diln bien phirc tap va trd thanh dai djch tren toan the gidi, nhieu nude djch da lay lan ra cpng ddng, trong dd cd Vtet Nam. Tai tinh Quang Ninh tinh hinh cung diln ra tUPng tu. De phdng, chdng dai dich eiim A, ben canh viec nang cao kien thifc, thuc hanh phdng, chdng benh cua can bd y te, viec trang bj co sd vat chat ky thuat chan doan va dieu tri cum A la rat can thiet. Chinh vi the, de ed dupe nhiimg giai phap cu the, hieu qua, thich img trong viee tang cudng kiem soat lay nhilm ciim A la viec lam vd ciing can thiet. Xua't phat tif ly do tren, chimg tdi tien hanh nghien cufu nay nham muc tieu: "Budc dau danh gia thUc trang co sd vat chat ky thuat chan doan va dieu trj ciim A tai mdt sd benh vien tuyen huyen eiia tinh Quang Ninh". OOI TUONG vA PHUONG PHAP NGHIEN CLfU 1. Ddi tuong nghien cufu. - 6 benh vien tuyen huyen gdm: khu vUc thanh thj: Benh vien da khoa khu vUc Bai Chay, Benh vien da khoa thj xa Cam Pha; khu vUc ndng thdn; Benh vien da khoa huyen Ddng Trieu, Benh vien da khoa huyen Yen Hung, khu vUc mien nui, hai dao: Benh vien da khoa huyen Van Don, Benh vien da khoa khu vuc Tien Yen. VU TH! THU THUV - Bac sy va dieu dudng vien true tiep dieu trj ciim A tai 06 khoa cOa benh vien: Khoa Hdi sii'C c^p eifu, Khoa Npi nhi, Khoa truyen nhilm, Khoa Kham benh, Khoa Xet nghiem, Khoa Chdng nhilm khuan. 2. Phuong phap nghien cufu. 2.1. Thiet ke nghien CUV La thiet ke nghien cufu md ta cat ngang cd phan tich. 2.2. Cic ky thuit dp dung trong nghiin cuu: Md ta thuc trang co sd vat chat bao gdm: - Phdng dieu tri: so dd kien true, khu each ly, dOn vi each ly. - Dung cu, trang thiet bj: may mde xet nghiem, dung cu trang bj can thiet cho viec dieu tri tich cifc, dieu tri benh nhan cum. - Thude thiet yeu: cae thudc dieu trj cum hien tai va thude can thiet cho dieu tri bd trp cho benh nhan. - Nhan luc ciia cae khoa, phdng ban trong benh vien cd lien quan oen chan doan va dieu trj ciim A. Viec dieu tra dupe uen l^anh theo bang hoi diroc thiet ke sin, diing cho toan benh vien va cac khoa rieng biet ve kha nang dap umg vdi yeu cau chan doan va dieu tri eiim A. 2.3. Xuly sd lieu - Sd lieu dupe nhap va xuf ly bang SPSS 16.0 KET QuA vA BAN LUAN 1. Thirc trang cO sd vat chait, nhan lUc phuc vu chan doan va dieu tri cum A Bang 1. Co sd ha tang ciia 2 nhdm benh vien tuyen huyen. Co sd ha tang cua Bdnh vien So dd kien true Khu each ly ridng bidt Budng/don vi each ly didu tri cum Sd giodng Tinh trang dp lire dm cua budng each ly Hd thdng thdng khi Budng each ly nay cd budng ddm Budng cdch ly cd nhd tam & vd sinh ridng bidt NhOng budng each ly hoan toan each bidt vdi cdc budng khac Budng each ly cd didu hda khdng khi Budng each ly nay cd d§ ddng lam vd sinh/khir khuan Nhdm A (n = 3! 10-12 NhdmB (n = 3) 3 9-10 3 Chung tdi nhan thay: tuy hau het cac benh vien thudc ca 2 nhdm deu cd so dd kien tnic, deu cd khu each ly vdi phdng dieu trj ciim vdi sd phdng tif 3 phdng va sd giudng tir 9-li2 giudng, dl dang lam v^ sinh khii khuan, each biet vdi cac budng khac, deu c6 nha tam va nha ve sinh rieng biet nhung nhifng khu vUc each ly va cac phdng chUa dat tieu chuin ptiii hop cho cdng tac chan doan va dieu tri cum nhiT cac 54 Y HOC TH'JC HANH (751) - S6 2/2011 tieu chuan ve xii ly chat thai, he thdng thdng khi va dieu hda khdng khi, khdng cd khu vuc xii ly chat thai rieng, tinh trang ap lUc am ciia budng each ly deu cdn nhieu dieu can bo xung hoan chinh. Dac biet khoa hdi sifc cap cufu cua ca 2 nhdm benh vien deu thieu budng each ly. HPn ntifa khi xem xet viec bd tri khu vUc each ly chua thuc sif hpp ly trong benh vien nhU khu vuc each ly cdn d sau trong benh vien, khi di vao khu vUc each ly can phai di qua nhieu khu vUc khac. ThUe te dd cho tha'y, tuy cd khu vUc each ly nhUng yeu cau thUc te xay ra tiii benh vien se bj dpng, lung tuing trong viec bd tri khu vUe each ly va khdng dap Cmg dupe yeu eau, khdng dam bao dung dupc chirc nang va yeu cau ciia khu vUc each ly. Bang 2. Kha nang dap umg vdi eiim dai djch ciia 2 nhdm benh vien tuyen huyen Kha nang dap Ong Ndu cd dodi 10 b6nh nhdn cung nhap vidn Ndu cd to 10-50 bdnh nhdn cung nhap vidn Ndu cd nhidu hon 50 bdnh nhan cung nhap vi6n Nhdm A 3/3 2/3* 0/3 NhdmB 3/3 2/3' 0/3 Qua bang tren ta thay, khi dupe hdi ve kha nang dap img vdi cum dai djch trong thUc trang co sd vat chat eua ddn vi nhU tren, ea 2 nhdm benh vien deu chi dap umg dUde mdt phan rat nhd khi ed xay ra cum dai djch vdi sd lupng khdng qua 10 benh nhan. Khi ed 10-50 benh nhan thi phai huy dpng tdi cac khoa khac hoac la suf dung dien tich d khu vUc xung quanh. ThUe te eho tha'y khi cum dai djch xay ra thi sd lUpng benh nhan se rat nhieu, nhu vay cac benh vien tuyen thudc 2 nhdm tren deu khdng dap img dupc yeu cau khi xay ra cum dai djch. Vi vay viec bd tri khu vUc dieu trj cum se khdng dam bao, khdng dap umg dupe yeu cau, se khien cho djch ciim ed the lay lan trong benh vien khd cd the kiem soat dupc. Bang 3. Trang thiet bi can tiiiet cho viec chan doan ciim dai dich d 2 nhdm benh vien. Trang thidt bi Mdy thd Hd thdng d xy trung tdm ddn cdc khoa phdng Mdy tao d xy Binh d xy Monitor theo ddi Mdy do bao hod d xy Bom truydn dich Bom tidm didn Mdy chup X quang lou ddng Mdy sidu dm xdch tay Mdy sidu dm cd xe day Nhom A 2,6,2 2/3 2,3,8 2,13,0 4,9,2 1,7,2 1,14,2 1,18,2 1,1.1 0,1,1 0,0,0 NhdmB 1,1,2 1/3 1,3,3 1,10,0 1,10,5 3,0,0 1,17,3 2,17,3 1,1,0 1,2,0 0,0,0 Ca 2 nhdm benh vien deu cd cac loai may mde trang thiet bi can thiet cho viec chan doan va dieu trj cum nhu may thd, he thd'ng oxy trung tam, may tao oxy va binh oxy, cac loai monitor theo ddi, tuy nhien sd lupng cdn It. Cac thiet bi dUdc cung ca'p nhung cac dung eu hd trp de sir dung gap khd khan, vi du cd benh vien cd may thd ntiung he thd'ng oxy trung tam kiidng cd. May tao oxy hoac binh oxy deu khdng cd thudng xuyen tai cac phdng dieu trj cum, cd benh vien cdn khdng cd may do dp bao hda oxy. Oac biet nhiimg may mde nhu may chup X- quang luu ddng, may sieu am xach tay, may sieu am cd xe day la nhifng may moc hien dai, thich hpp cho viee eo ddng, thuan tien eho viec hd trp trong chan doan va dieu trj benh niian cum dai djch thi ed benh vien edn khdng cd. Nhu the, thuc trang trang thiet bj cO sd vat chat ciia cac benh vien tuyen huyen tai tinh Quang Ninh cdn thieu thdn rat nhieu, dae biet la trang thiet bi hd trd cho viee chan doan va dieu trj ciim dai djch, va nhu nhau d ca 2 nhdm benh vien. Khdng nhufng the, khi dieu tra cac khoa can lam sang trong viec hd trp va chan doan cum dai djch, chiing tdi xem xet cac khoanhu xet nghiem, huyet hpe, sinh hda, vi sinh, giai phlu benh/te bao, tham dd ciiufc nang, chan doan hinh anh, chiing tdi nhan tha'y da sd cac benh vien d nhdm A deu thieu cac khoa tren, cdn cac benh vien d nhdm B deu cd day du cae khoa, nhu the d nhdm B da hon nhdm A ve sd eae khoa can lam sang hd trp cho chan doan va dieu tri cum dai djch hdn. Tuy nhiien, khi dieu tra sau hdn mdt sd xet nghiem cu the ma benh vien cd the thuc hien duoc trong dieu kien eO sd vat chat tren de hd trp va chan doan cum A, chiing tdi dieu tra cac xet nghiem FCR, Realtime PCR, nudi cay vi khuan, ndng dp khi mau ddng mach tai khoa xet nghiem, hau het cae benh vien trong ca 2 nhdm deu khdng cd cae xet nghiem tren, nhu vay mac dii nhdm B cd cae khoa xet npliiem tren hdn han nhdm A nhUng thUe te kha nang hd trp chan doan ciia ca 2 nhdm benh vien trong phdng chdng cum dai djch deu nhu nhau. Ca 2 nhdm benh vien deu cd 2 benh vien ed may X- quang va sieu am tai giudng benh. NliU vay, thuc trang cd sd vat chat cua cac benh vien tuyen huyen tinti Quang Ninh cdn rat thieu thdn, dac biet la viec thuc hien cac xet nghiem ho trd chan doan eiim dai dich. Ve td dpi chdng nhilm khuan cua benh vien, khi dieu tra chung tdi tha'y ca 2 nhdm benh vien deu cd hdi ddng hoac ban chdng nhilm khuan, deu cd khoa hoac td dpi chdng nhiem khuan. Khdng nhiimg the, ca 2 benh vien deu cd xay dung ke hoach kiem soat nhilm ktiuan djnh ky va xay dung cac quy djnh, quy trinh kiem soat nhiem khuan, cd thiet lap va duy tri tie thdng giam sat va bao cao djch theo quy dinh, tuy nhien viec phdi hpp vdi khoa vi sinh, khoa Duoc, viec kiem tra, ddn dd'c thUe hien dung quy trinh thuc hanh kiem soat nhilm khuan cdn han che, cd ndi cdn chUa trien khai diing quy dinh. NhU vay mac dii cd day dii td dpi chdng nhilm khuan vdi ke hoach va quy dinh xong hoat ddng ciia td dpi chdng nhilm khuan cdn nhieu han che, ehua phat huy dupc vai trd, va dac biet se cang khd khan khi ddi phd vdi cum dai djch xay ra. Va dieu nay la gidng nhau d ca 2 nhdm benli vien. Ve khu vUc luu giiif chat thai y te ca 6 benh vien thupc 2 nhdm deu cd, vdi noi lifu giiif chat thai y te, dupe bd tri xa noi chuan bj dd an, xa Idi di chung, cd noi luu giOr cha't thai y te nguy hai rieng biet, va tieu chuan ve xuf ly chat thai y te deu theo quy djnh phii hop vdi he thdng cung cap nUdc, rufa tay chdng nhilm ktiuan, he thdng thoat nUde phii hpp. Cimg vdi dd cac benh vien deu cd quy djnh ve quan ly chat thai y te, eae quy trinh phan loai, xuf ly chat thai y te day du. Tuy nhien, khi kiem tra thUc dja mdt each sau sat va Y HOC THl/C HANH (751) - SO 2/2011 55 ty my, chumg tdi nhan tha'y thuc te cac benh vien ciia ca 2 nhdm deu chUa lam diing quy djnh ve luu giuf va xuf ly chat thai y te, deu mac thieu sdt trong qua trinh cdng tac, ehua thUc sU dam bao phii hop vdi quy djnh chung. Oieu nay thudng xay ra d cac benh vien tuyen huyen khi su quan tam, chi dao cua cac cap lanh dao ddi liic cdn lo la, can bp nhan vien y te chii quan, coi thudng benh dich, hoac lam qua loa dai khai, y thufc trach nhiem ehua eao. Vdi cac khoa Dinh dudng, bd phan giat la cung cap dien nude cua cac benh vien thi chimg tdi nhan tha'y da sd cac benh vien thude ca 2 nhdm deu thieu thdn trong van de thUe hien chirc nang cua cac khoa tren, cae benh vien cdn thudng xuyen bj ma't dien. Day cung la thuc trang chung ciia cac benh vien tuyen huyen khi dieu kien trang thiet bi cho cae khoa cdn han che, trang bi chUa ddng bd hoac khdng dupc chii trpng. Khi dieu tra cac thiet bj chuyen dung cho dieu trj benh nhan ciim A, dac biet ia cae loai may thd da nang ehufe nang cao, may thd xach tay, va cac loai may thd cao cap khac cuing vdi cac loai may chuyen dung khac dimg cho hdi sifc ca'p cufU benh nhan benh ly phdi, da sd cac benh vien deu khdng cd, hoac cd it, hoac khdng ddng bp, dae biet la he thd'ng oxy trung tam, tidm tiem dien, may truyen dich tU dpng, cac loai may hut, khi dung deu khdng cd d nhdm A, hoac it hon so vdi nhdm B, dii nhdm B cd mpt sd benh vien cd cac dung cu dd nhung khdng khdng hoan toan day dii. Oa sd benh vien deu cd may thd trong chUOng trinh SARS, cac thiet bj bao hp nhU trang phuc bao hp ca nhan, gang tay, kinh bao hd, ao choang, mu, bpc giay, (ing bao hd. Cac thiet bj nay dupc cung cap cho cae benh vien tuyen huyen cua tinh Quang Ninh trong chuong trinh phdng chdng ciim dai djch. Hdn the, khi dieu tra ve cac loai hda chat khuf khuan, cae benh vien deu cd cac loai hda chat nhu hda chat khuf khuan be mat, hda chat khuf khuan tay, hda chat khuf khua'n khdng khi, hda cha't khuf khuan dd vai, hda chat khuf khuan dung cu, thiet bj y te. Trong dd chii yeu la cloramin B, cidex, dung djch khii khuan nhanh SDS. Day la dieu dang ghi nhan tai cac benh vien d tuyen huyen, noi ma dieu kien co sd vat chat edn nhieu khd khan han che. 2. Thirc trang thudc thiet yeu trong dieu trj cum A Thudc dieu tri cum A Tamiflu Thudc thiet yeu Nhdm A 2/3 3/3 NhdmB 2/3 3/3 Ca 2 nhdm benh vien chi cd 2/3 sd benh vien cd Tamiflu, vdi sd lupng khdng nhieu. Theo khuyen cao cua Bd y te, Tamiflu la loai thudc cd ban nha't cho viec phdng chdng va dieu tri ciim dai djch, la loai thudc khdng the thieu. Cac loai thudj; thiet yeu trong hdi sire cap ciJli nhu trp tim mach, hd trp hd hap, cac loai djch truyen va khang sinh thi cac benh vien deu cd, nhung thudng chi cd sin tai cac khoa hdi sufc cap cufu va khoa DUOc. Tai cac khoa npi, khoa truyen nhilm, khoa nhi cac loai thudc tren thudng thieu hoac cd nhung sd lUdng khdng nhieu, khdng du dap umg vdi mpt sd lupng benh nhan nhieu nhap vien trong mdt liic. Day cung la mat cdn han che cua cac benh vien tuyen huyen, cung vdi trang thiet bj la viec cung cap cac loai thudc men chUa dupc day dii, kjp thdi tdi tat ca cac khoa trong benh vien. Khi duoc phong van true tiep nhan vien cua benh vien, dac biet la tai phdng kham benh, khoa xet nghiem, khoa truyen nhilm, khoa npi, khoa hdi sifc cap cifu dac biet chu trpng vao cac cau hoi ve co sd vat chat lien quan tdi chan doan va dieu trj ciim A, chung tdi deu nhan dUdc cau tra Idi chung cQa ea 2 nhdm benh vien dd la tliUc trang cd sd vat chat cdn nhieu thieu thdn, ngudn kinh phi cdn han hep, dac biet la ngudn nhan lUc cdn thieu, trong do phai ke den ngudn nhan lUc cd trinh dp chuyen mdn cao, cd trinh dp trong chan doan va dieu trj cum A. Thirc trang nay xay ra d hau het cac benh vien tuyen huyen trong ca nUdc. KET LUAN 1. Cd sd vat chat va trang thiet bj trong cac benh vien tuyen huyen thupc 2 nhdm ciia tinh Quarig Ninh cdn nhieu thieu thdn, duoc trang bj chua ddng bp, chua dat tieu chuan, da sd deu khdng dap img difOc khi cd cum dai djch xay ra tren dien rdng, vdi sd lupng benh nhan Idn. Day cung la thUc trang chung cua cac benh vien tuyen huyen trong ca nUdc. 2. Ben canh viec thieu thdn ve trang thiet bi, ngudn thudc thiet yeu cho dieu tri ciim A va cac thudc can thiet diing trong cap cufu hdi sinh tim phdi cOa cac benh vien cung rat thieu thdn, tuy cd sin nhung cap va du tru cho cac khoa lam sang chUa hop ly, chifa day du. Viec tranp bj co sd vat cha't, ky thuat, thudc thiet yeu giuip chan doan va dieu trj ciim dai djch cho cac benh vien tuyen huyen ciia tinh Quang Ninh ndi rieng va cac tinh khac trong ca nUdc ndi chung la rat can thiet, nham tang cUdng cO sd vat chat ky thuat, nang eao nang lUc chan doan, dieu tri va dU phdng cum dai djch trong thdi gian tdi mdt each tdt hOn. TAI LIEU THAM KHAO 1. Vien Ve sinh Dich tl Trung UOng, Tinh hinh cum A/H5N1 tai Viet Nam. 2003-2005. 2005, Vien Ve sinh Djch te Trung Udng: Ha Npi. 2. Tran HiTu Bich, La Ngpc Quang, and B.V. TrUdng, Dinh gii tdng hgp eie nghien cifu v§ thdng tin giio due, truyen thdng vi kiin thac, thii dd, thac hinh trong phdng ngda cum gia cim tai Viet nam td 2003 tdi 2006. 2007, Trudng Dai hpe Y te Cdng cpng. 3. CARE International in Vietnam, Knowledge - Attidutes - Practices Study of SmaH Holder Poultry Raising Farmers in Response to Avian Influenza. 2005: Hanoi, p. 16-25. 4. R. Fielding et al., Avian Influenza Risk Perception, Hong Kong. Emergency Infectious Disease, 2004. 11(2005): p. 677-682. 5. Ban chi dao qudc gia phdng chdng dioh cum gia cam, Bdnh cum gia cim vi bidn phap plidng chong. 2005, Ha Npi: Nha xuat ban Ndng nghiep. 6. The Academy of Education Development, Avian Flu Baseline Sun/ey Backyard Poultry Farmers of Viel Nam. 2005, The Academy of Education Development: Hanoi. 56 Y HOC THUC HANH (751) - SO 2/2011 . tra ve cac loai hda chat khuf khuan, cae benh vien deu cd cac loai hda chat nhu hda chat khuf khuan be mat, hda chat khuf khuan tay, hda chat khuf khua'n khdng khi, hda cha't. nang ehufe nang cao, may thd xach tay, va cac loai may thd cao cap khac cuing vdi cac loai may chuyen dung khac dimg cho hdi sifc ca'p cufU benh nhan benh ly phdi, da sd cac benh vien. Quing Ninh td dd lam ca ?5 ciio cac nghien eifu can thiep nhim ting cadng ca sd vat chat ky thuat can thiit eho vide chan doan va diiu tri cum dai dich. Kit qui: Thac trang ca sd vat chai ky