tiÊm an toÀn - benhviennhi.org.vnbenhviennhi.org.vn/upload/files/kimlien/tiem an toan 2...
TRANSCRIPT
-
11/24/2013
D Nguyn Th Kim Lin 1
TIM AN TOND Nguyn Th Kim Lin- PD
Thng 9- 2013
1
NH NGHA TIM
K thut a: Thuc, Dch Cht dinh dng Cht khcqua da vo c th chn on hociu tr
2
-
11/24/2013
D Nguyn Th Kim Lin 2
NH NGHA TIM AN TON
Khng gy nguy hi cho ngi nhnmi tim
Khng gy phi nhim cho ngi thchin mi tim.
Khng to cht thi nguy hi cho ngikhc v cng ng.
3
NH NGHA TIM AN TON
An ton cho:
Ngi bnh
Cng ng
Nhn vin y t
SIGN: Safe Injection Global Network -1999
4
-
11/24/2013
D Nguyn Th Kim Lin 3
TNH HNH
c khong 16 t mitim/ nm
95% iu tr 3% tim chng 1% k hoch ha gia nh1% truyn mu
& sn phm ca mu.
5
TNH HNH 70% mi tim khng cn
thit
B bt nhng mi tim
khng cn thit l cch tt
nht phng nga nhng
nhim trng lin quan n
mi tim.6
-
11/24/2013
D Nguyn Th Kim Lin 4
TC HI TIM KHNG AN TON Shock phn v Gy h hi thn kinh v nhng m khc
=> abces, bi lit, thng tch Ly truyn:VirusVi khunNmK sinh trng
7
i tng b tai nn vt sc nhn
8
-
11/24/2013
D Nguyn Th Kim Lin 5
NGUYN NHN: CHA TUN THNG QUY TRNH- K THUT TIM
Dng chung bm, kim tim cho thuc khc nhau, ngi bnh khc nhau.
Dng mt kim ly thuc pha thuc & rt thuc nhiu ln,
Lu kim trn l. Cha thng xuyn ra tay trc khi:Chun b thucTrc khi timKhi tim t Bn ny Bn khc.
9
NGUYN NHN: CHUA TUN THNG QUY TRNH- K THUT TIM
Ct gim cc quy trnh tim . i tim khng mang phng tin. Dng li kim tim tim cho ngi
bnh sau mi tim u khng thnh cng.
Thao tc cha tt: chm tay vo nhng vng v khun .
10
-
11/24/2013
D Nguyn Th Kim Lin 6
TIM KHNG AN TON
Trc tip: dngc ly nhim
Gin tip: qua lthuc b lynhim
ngly:
11
Thm ch 1 mi tim khng an ton l qu nhiu!
12
-
11/24/2013
D Nguyn Th Kim Lin 7
NGUY C KHI TIM- LY MU i vi BN: Mi tim khng cn thit S dng li dng c tim Kim & bm tim khng v khun Khng ra tay Ly nhim cho qua:V sinh tay kmng thuc b nhimK thut tim hoc v tr tim b nhim
13
NGUY C KHI TIM- LY MU i vi
nhn vin y t:
Mi timkhng cnthit
2 tay ynp kim
14
-
11/24/2013
D Nguyn Th Kim Lin 8
NGUY C KHI TIM- LY MU i vi nhn vin y t: Thiu hp ng vt sc nhn trong tm
tay. V tr ca Bn khng thun tin K thut ly mu km Vn chuyn mu khng an ton V sinh tay km
15
NGUY C KHI TIM- LY MU i vi cngng:
Gia tng rcthi t nhngmi tim khngcn thit
Hp ng vtsc nhn khngan ton
bn ngoihp
16
-
11/24/2013
D Nguyn Th Kim Lin 9
NGUY C KHI TIM- LY MU i vi cng ng:
Ln ln vi rc khc.
Khng c ni an ton
Thiu phng tin bo h cho ngi thu
gom
S dng li bm tim v kim
17
y nhng hp li khi y v trong
nhng khu vc c bo v
Nim phong hp nga ai
ly kim s dng li . i
khi cn thit phi kha ca
nu ngi ta bn ng tim
s dng li.
Tai nn vt sc nhn c th
xy ra nu hp y qu.
18
-
11/24/2013
D Nguyn Th Kim Lin 10
THC HNH TIM AN TON TT
Ra tay: Mang gant
Dng c bo h dng mt ln
Chun b da & st khun da
19
20
-
11/24/2013
D Nguyn Th Kim Lin 11
THC HNH TIM AN TON TT
Ch :
Bo m tay kh trc khi bt u bt k th
thut no.
Mang gant ( tay phi kh)
Khng dng dd ra tay nhanh khi thy
tay bn.
21
THC HNH TIM AN TON TT
Ch : Khng dng dd ra tay nhanh sau khi da
khng nguyn vn tip
xc vi mu/ dch c
th Ra tay vi x
phng di vi nc
ang chy, lau kh vi
khn tay dng 1 ln.
22
-
11/24/2013
D Nguyn Th Kim Lin 12
S DNG GANT- CHNH
Mang gant sch, va vn, dng mt ln:
Khi c kh nng tip xc vi mu ca
Bn, nhng cht c kh nng ly
nhim: dch tit c th
Khi tin hnh chm cu/ tim tnh
mch/ tip xc vi mu bi v kh
nng nhim mu ni v tr tim.
23
S DNG GANT- CHNH
Mang gant sch, va vn, dng mt
ln:
Khi da ca nhn vin y t khng
nguyn vn: chm, nt, da kh.
Khi da Bn khng nguyn vn: chm,
phng, nhim trng da.
24
-
11/24/2013
D Nguyn Th Kim Lin 13
S DUNG GANT- LU
Gant khng bo v
phng kim m hoc
nhng vt thng
khc do vt sc nhn
kim , dao m v
nhng dng c sc
nhn khc cn c
x l cn thn.25
S DUNG GANT- LU Khng dng gant khi :
Tim di da, trong da,
tim bp.
Da ca nhn vin y t
nguyn vn.
Da ca Bn nguyn vn.
26
-
11/24/2013
D Nguyn Th Kim Lin 14
THC HNH TIM AN TON TT-DNG PHNG TIN PHNG H C NHN
khu trang
knh mt
nhng vt dng phng h khc
khng ch nh cho tim ngoi tr
d kin c tip xc vi mu.
khi dng phng tin phng h
c nhn, b ngay sau khi s
dng. 27
CHUN B DA- ST KHUN DA
Dng alcohol swab 60-70O( isopropyl alcohol / ethanol) / gn c cn dng mt ln ( khng dng methanol/ methyl alcohol )
St khun vng tim t trung tm ra ngoi v tr tim , tr / thay gn sau 1 vng.
St khun 30s kh hon ton.
28
-
11/24/2013
D Nguyn Th Kim Lin 15
CHUN B DA- ST KHUN DA khng ngm/ lm t bng gn
trc - n s ly nhim cao do vi khun ni tay v t mi trng.
khng dng cht st khun da bng ru trong tim chng.
29
Che ph vng da trc khi tim l khng cn thit
Ra da da vi nc sch v lm kh vi bng/ vi sch
Nu da c bao li, dng mt
gi isopropyl alcohol hoc l
ethanol
NGUY HIM:
Hu ht nhng cht lm sch &
cht alcohol khc ( methy-
alcohol / methanol) khng an
ton s dng cho ngi
-
30
-
11/24/2013
D Nguyn Th Kim Lin 16
DNG C TIM & THUC- DNG C TIM
Nn chc rng c sndng c dng 1
ln , c th s dng mt b dng c
mi cho mi Bn.
S dng mt b dng c dng 1 ln
cho mi quy trnh (thuc / vaccine).
Kim tra bao b.
31
THC HNH KIM SOT NHIM KHUN
Khi thc hin thuc: Khng dng ng tim
cha thuc thc
hin thuc cho nhiu bn
- bo m 1 ng tim-1
kim- 1 bn.
32
-
11/24/2013
D Nguyn Th Kim Lin 17
THC HNH KIM SOT NHIM KHUN
Khi thc hin thuc: Khng thay kim s dng li bm tim.
Khng dng cng 1 ng tim pha
nhiu loi thuc.
khng trn thuc s dng cn s
dng cho ln sau.
33
THUC N LIU S dng
thuc n
liu cho mi
bn khi c th
trnh ly
nhim cho
34
-
11/24/2013
D Nguyn Th Kim Lin 18
THUC A LIU : CH DNG KHI KHNG THTHAY I C.
Ch m mt l thuc ring l cng vo 1 thi im cho mi khu vc chm sc bn.
Gi mt ng a liu cho mi bn & ct givi tn bn trn ng thuc phng iu tr /t phng thuc.
Khng gi l thuc a liu trong mt phng khng c ngi gim st, n c th v tnh b nhim bn vi bi nc hoc l vng vi.
35
THUC A LIU- QUNG B
Nu tnh v khun / thuc trong b xm phm.
Nu ht hn s dng/ hnbo qun ht ( mcd c cht bo qun).
Nu n khng c lugi thch hp sau khi s
dng.
36
-
11/24/2013
D Nguyn Th Kim Lin 19
THUC A LIU- QUNG B 24h sau khi m l. Sau khi ht thi
hn khuyn co ca nh sn xut, nu l thuc khng c cha cht bo qun khng khun.
37
THUC A LIU- QUNG B Khng c hn s
dng.
Khng c lu gi
thch hp.
V tnh b nhim hoc
xem nh l b
nhim bt k ngy
ht hn. 38
-
11/24/2013
D Nguyn Th Kim Lin 20
S DNG THUC NP BT
S dng thuc np bt hn l l thuc cn phi dng vt bng kim loi khui n
Nu phi s dng l thuc cn dng vt dng bng kim loi khui n, hy bo v tay ca bn vi 1 chn sch nh mt ming gc nh khi m lthuc.
39
CHUN B THUC
Chun b thuc & tim trong khu vc
sch dnh cho tim thuc ni m
khng c kh nng b nhim mu
hoc l dch tit.
40
-
11/24/2013
D Nguyn Th Kim Lin 21
CHUN B THUC
Ngn np tt c bmt c th lau chi ddng,
Khng mu/ dng c vy bn.
Lau bng cn 70O
( isopropyl alcohol / ethanol) cho kh trc khi chun bthuc & khi b bn.
41
CHUN B THUC
Dng c cn thit cho vic pha thuc: kim - ng tim dng 1 ln. Dung dch pha thuc nh nc ct/
dung mi c bit. Alcohol swab hoc l bng gn. hp ng vt sc nhn.
42
-
11/24/2013
D Nguyn Th Kim Lin 22
RT THUC
St khun nt cao su vi alcohol swab
/gn c cn trc khi m kim qua l
thuc.
Dng kim- ng tim v khun cho mi
ln m kim vo trong l a liu.
Khng bao gi lu kim trn l a liu.
43
44
-
11/24/2013
D Nguyn Th Kim Lin 23
B kim ng vo tay hoc l nhng b mt
hoc l nhng vt dng khng c v trng.
Nhng b mt & tay cha vi khun
Dng c v
khun tr
nn ht v
khun nu b
chm vo n.
45
46
-
11/24/2013
D Nguyn Th Kim Lin 24
Che u ca ng thuc hoc l l thuc bng cht khng khun l khng cn thit Khng bao gi dng
ming bng t y cho
vic kh khun.
Tt c cht kh khun c
th tr nn nhim v ly
lan bnh tt
Nu l thuc c y,
dng ng gi ring \
47
GHI TRN L THUC SAU KHI RT
Ngy thng pha thuc.
Loi & lng dch pha.
m c.
Hn dng sau khi s dng li.
Tn v ch k ca ngi s dng
thuc.
48
-
11/24/2013
D Nguyn Th Kim Lin 25
TIM THUC
Thc hin 5 ng.
Ra tay
St khun np l thuc.
49
Dng cy kim v khun & ng tim v khun cho mi ln tim
M bm tim trc
mt bn bo m
rng ng tim v kim
cha c s dng
trc .
50
-
11/24/2013
D Nguyn Th Kim Lin 26
THUC RT XONG Mt khi ng tim v kim rt thuc ra
t l a liu thc hin thuc cng
sm cng tt.
Nu cha c thc hin ngay lp tc
y np kim dng k thut xc 1 tay.
Lu gi trong bn ht u kh hoc
l vt tng t.51
NHNG IM QUAN TRNG
Khng kim ng vo bt k mt
phng b nhim no.
Khng s dng li bm tim, thm ch
thay kim.
52
-
11/24/2013
D Nguyn Th Kim Lin 27
NHNG IM QUAN TRNG
Khng ng vo np l/ nt cao su sau khi st khun.
Khng m vo l a liu vi cng mt cy kim & 1 ng tim.
Khng bm li thuc qua 1 cy kim / bm tim s dng cho 1 bn nu n c s dng rt thuc li mt ln na ( cho d cho cng 1 bn / bn khc)
53
54
-
11/24/2013
D Nguyn Th Kim Lin 28
NHNG IM QUAN TRNG
Khng dng
ti dch/ chai
dch truyn
nh l ngun
dng cho
nhiu bn.
55
Mng sng ca a b & nim tin ca b m t trong tay bn
56
-
11/24/2013
D Nguyn Th Kim Lin 29
THAM KHO Injection safety- WHO http://www.who.int/injection_safety/about/resources/BackInfoUnsaf
e/en/ Glove use information leaflet- WHO WHO best practices for injections and related procedures toolkit -
SIGN Unsafe injection practices: outbreak, Incidents, and Root Causes-
David Pegues- MD- Prof. Of Clinical Medicine-Los Angeles California-Medscape Education
Giving safe Injections-World Health Organization-International Council of NursesEEmail: [email protected]
www.injectionsafety.orgmail: [email protected]
57
THAM KHO Health and Safety (Sharp Instruments in Healthcare) Regulations 2013-
Guidance for employer and employees. : www.hse.gov.uk/healthservices/index.htm. Published by the Health and Safety Executive
2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings-http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
MMWR- Center for Disease Control and Prevention Weekly./ Vol. 62/ No.21
Preventing Needlestick Injuries among Healthcare Workers: A WHOICN Collaboration SUSAN Q. WILBURN, BSN, MPH, GERRY EIJKEMANS, MD-Preventing Needlestick Injuries
WHO guidelines on drawing blood best practices in phlebotomy ISBN 978 92 4 159922 1 World Health Organization 2010
Guiding principles to ensure injection device security- WHO Hng dn Tim an ton- B y t Hng dn phng nga chun-Phm c McG PR]]\\]]] 58
-
11/24/2013
D Nguyn Th Kim Lin 30
59