Hướng dẫn làm sạch phòng mổ

o
TI LIU HNG DN
LM SCH
MI TRNG PHNG M
2012
TI LIU HNG DN
LM SCH
MI TRNG PHNG M
2012
TI LIU HNG DN LM SCH MI TRNG PHNG M
LI GII THIU
T nm 2009, Chng trnh tng cng h thng y t tuyn tnh do t chc Hp tc Quc t c GIZ ti tr v ang h tr B Y t thc hin mt s ni dung nhm ci thin kh nng tip cn dch
v y t cht lng cao cho ngi dn thuc cc tnh trong phm vi d n.
Xc nh cng tc kim sot nhim khun bnh vin l mt trong nhng thch thc ln i vi h
thng y t ti Vit Nam, trong kim sot nhim khun bnh vin v phng nhim khun vt m l
mt trong nhng ni dung quan trng v c bn ca chng trnh an ton ngi bnh. Tuy nhin,
hot ng kim sot nhim khun ca cc bnh vin hin nay cn nhiu bt cp nh: s tun th v
sinh tay, cng tc kh khun, tit khun dng c v v sinh mi trng bnh vin cha c quan
tm ng mc.
Hiu r vai tr quan trng ca kim sot nhim khun bnh vin, trong thi gian qua, GIZ phi hp
vi B Y t thc hin nhiu kha tp hun cp nht cho nhn vin y t nhng kin thc v phng v
kim sot nhim khun bnh vin nh qun l cht thi y t, tim an ton, kh khun-tit khun dng
c y t, cng nh chc nng v nhim v ca cc n v tit trng trung tm/ khoa kim sot nhim
khun bnh vin. Qu III v IV nm 2012, GIZ c Chuyn gia kim sot nhim khun phi hp vi
Cc Qun l Khm, cha bnh B Y t thc hin kho st thc trng cng tc v sinh mi trng
phng m ca 6 bnh vin thuc d n ti hai tnh Ngh An v Thi Bnh. Kt qu cho thy, cng tc
v sinh mi trng phng m bnh vin c cc bnh vin quan tm nhng cha c s u t
thch ng v c s vt cht, v t chc, v trang b kin thc kim sot nhim khun, c bit l k
nng thc hnh lm sch v v sinh mi trng phng m, cng nh thiu c hng dn chun trin
khai cng tc ny. y chnh l nguy c dn ti s khng an ton cho mi trng phu thut.
Qua kho st thc trng v sinh mi trng phng m cc bnh vin ni trn, cc Chuyn gia kho
st nhn c s ng h v xut ca lnh o v cn b, nhn vin lin quan n phng m
ca cc bnh vin. Cc bnh vin ngh D n GIZ sm cung cp ti liu hng dn v lm sch/
v sinh mi trng phng m v t chc nhiu kha hun luyn chuyn v sinh phng m lm c
s bnh vin thc hin tt hn, chuyn nghip hn vn ny.
V nhng l do trn, D n GIZ phi hp vi Cc Qun l Khm, Cha bnh gi ti cc bnh vin
trong phm vi D n GIZ b ti liu Hng dn lm sch mi trng v sinh phng m. Ti liu gm
3 phn:
Phn 1: Hng dn lm sch mi trng phng m/khu phu thut.
Phn 2: Cc Quy trnh thc hnh lm sch mi trng.
Phn 3: Cc bng kim nh gi cc quy trnh thc hnh.
Ban Qun l D n GIZ v Cc Qun l Khm, Cha bnh ngh Gim c cc S Y t v Gim c
cc bnh vin thuc d n giao cho khoa Kim sot nhim khun v khoa Phu thut/phng m nghin
cu v p dng ti liu vo thc hnh. Cc bnh vin c th s dng Phn 1 hng dn thc hin,
Phn 2 in thnh poster treo ni cn thit, Phn 3 lm ti liu t kim tra/kim tra, nh gi.
Ti liu c ny c bin son ln u nn khng trnh khi nhng thiu st v mt ni dung v
trnh by, D n rt mong nhn c nhng kin ng gp qu bu ca ngi s dng v cc n
v ti liu c hon thin hn cho ti bn ln sau. Mi kin ng gp xin c gi bng vn bn
v Ban qun l D n ca GIZ.
Trn trng cm n!
C VN TRNG D N
GIM C D N
Anna Frisch
Trn Qu Tng
MC LC
LI GII THIU................................................................................................................................... 2
PHN I - HNG DN LM SCH MI TRNG PHNG M ..................................................... 5
I.
MC TIU.................................................................................................................................... 6
II.
NGUYN TC LM SCH PHNG M/KHU PHU THUT V KHU VC YU CU V

KHUN. ....................................................................................................................................... 6
III.
QUY TRNH LM SCH ............................................................................................................. 7
1.
2.
2.1
2.2
2.3
2.4
2.5
Chun b phng tin, ha cht .................................................................................................. 7

Quy trnh thc hnh ..................................................................................................................... 7
Quy trnh lm sch phng m khi bt u mt ngy lm vic ..................................................... 7
Quy trnh lm sch phng m gia 2 ca phu thut .................................................................... 8
Quy trnh lm sch phng m khi kt thc tt c cc cuc phu thut trong ngy ..................... 9
Quy trnh lm sch bung tm, nh v sinh ................................................................................ 9
X l mi trng b vng bn, mu hoc cht tit c th..................................................... 10
IV.
LCH LM SCH/V SINH PHNG M/KHU PHU THUT ................................................. 12
V.
HNG DN PHA MT S HO CHT KH KHUN LM SCH, V SINH MI TRNG

PHNG M/KHU PHU THUT .............................................................................................. 11
1.
2.
3.
4.
5.
6.
7.
8.
Nguyn tc la chn ha cht lm sch v kh khun mi trng bnh vin ......................... 12

Nguyn tc pha v s dng ha cht lm sch, v kh khun mi trng, dng c ............... 12
Mt s ha cht c th s dng trong lm sch mi trng phng m .................................... 13
Hng dn cch pha ha cht cha clo lm sch, kh khun b mt mi trng bung bnh
v phng/khu phu thut ........................................................................................................... 13
Cch pha dung dch Javel 120 clo (dung dch ca Php) hoc clorox 160 (ca M) ................ 15
Cch pha ha cht Surphanios v Chlospray............................................................................ 15
Cch pha vin Presept 2,5 g s dng trong v sinh v kh khun mi trng ........................ 15
Mt s im cn lu khi s dng ha cht ............................................................................. 15
VI.
TRCH NHIM C NHN TRONG V SINH PHNG M/KHU PHU THUT..................... 16
1.
2.
3.
4.
5.
6.
7.
8.
9.
Lnh o BV .............................................................................................................................. 16
Trng khoa/Trng Phng/khu phu thut ............................................................................. 16
iu dng trng Phng/khu phu thut................................................................................ 16
iu dng/k thut vin Phng/Khu phu thut ...................................................................... 17
H l/y cng/nhn vin v sinh phng/khu phu thut .............................................................. 17
Phu thut vin .......................................................................................................................... 17
Sinh vin, hc vin ..................................................................................................................... 18
Trng khoa Kim sot nhim khun ....................................................................................... 18
Trng phng iu dng ........................................................................................................ 18
PHN II - CC QUY TRNH THC HNH ........................................................................................ 19
A.
QUY TRNH LM SCH MI TRNG PHNG M ............................................................. 20
I.
II.
III.
IV.
C S L LUN, TI LIU THAM KHO ................................................................................ 20

I TNG P DNG............................................................................................................. 20
PHNG TIN, HA CHT ..................................................................................................... 20
QUY TRNH LM SCH MI TRNG PHNG M TRC KHI BT U MT NGY LM
VIC........................................................................................................................................... 21
QUY TRNH LM SCH MI TRNG PHNG M GIA 2 CA PHU THUT ................... 22
QUY TRNH LM SCH MI TRNG PHNG M KHI KT THC TT C CC CUC M
TRONG NGY ........................................................................................................................... 24
V.
VI.
B.
QUY TRNH LM SCH MI TRNG NH TM, NH V SINH KHU PHU THUT ...... 26
C.
QUY TRNH PHA DUNG DCH KH KHUN MI TRNG PHNG M ............................ 28
I.
II.
III.
IV.
C S L LUN, TI LIU THAM KHO ................................................................................ 28

I TNG P DNG............................................................................................................. 28
PHNG TIN, HA CHT ..................................................................................................... 28
QUY TRNH PHA DUNG DCH KH KHUN MI TRNG PHNG M ............................. 29
PHN III - CC BNG KIM QUY TRNH THC HNH ................................................................. 31

BNG KIM 1 - Chun b dng c v ha cht cho thc hnh lm sch mi trng phng m ...... 32
BNG KIM 2 - Quy trnh thc hnh lm sch mi trng phng m trc khi bt u mt ngy lm
vic .......................................................................................................................... 32
BNG KIM 3 - Quy trnh thc hnh lm sch mi trng phng m gia 2 ca phu thut............ 33
BNG KIM 4 - Quy trnh thc hnh lm sch mi trng phng m khi kt thc tt c cc ca phu
thut trong ngy ....................................................................................................... 34
BNG KIM 5 - Quy trnh thc hnh lm sch mi trng nh tm, nh v sinh ............................ 35
BNG KIM 6 - Chun b phng tin v ha cht pha dung dch kh khun lm sch mi
trng ................................................................................................................... 36
BNG KIM 7 - Quy trnh thc hnh pha dung dch kh khun lm sch mi trng phng m .... 36
BNG KIM
- NH GI V SINH MI TRNG BNH VIN .................................................. 37
PHN I
HNG DN LM SCH
MI TRNG PHNG M
HNG DN LM SCH MI TRNG PHNG M

Mi trng bnh vin bao gm khng kh, nc, cht thi, nn nh, tng, trn, ca s, b mt vt
dng trong mi trng.
Mi trng bnh vin, c bit l nhng ni thc hin phu thut, th thut v nhng ni c nguy c cha
ng vi sinh vt cng cao, nht l vi sinh vt gy bnh qua mu, dch tit, cht thi y t t bnh nhn.
Vn bn hng dn ny tp trung vo cc phng php lm sch, kh khun mi trng khu phu
thut thng qua vic s dng phng php vt l, ha hc lm sch, kim tra v gim st mi
trng nhm to ra v duy tr mi trng sch, an ton v gim thiu nguy c ly nhim vi khun gy
bnh cho ngi bnh v nhn vin y t.
I. MC TIU
1.
Cung cp nhng hng dn v v sinh mi trng phng/khu phu thut, bao gm:
- Nguyn tc v sinh.
- Tn sut v sinh.
- Quy trnh v sinh.
- Bng kim thc hnh v gim st v sinh.
2.
Hng dn xy dng phn cng trch nhim c nhn trong v sinh mi trng phng/ khu phu
thut v khu vc yu cu v khun (Phng , phng th thut v khun).
3.
Hng dn la chn v s dng ha cht kh khun thng dng ang c s dng trong cc
bnh vin thuc phm vi d n GIZ.
II.NGUYN TC LM SCH PHNG M/KHU PHU THUT V KHU

VC YU CU V KHUN.
1.
V sinh mi trng phng/khu phu thut l nguyn tc c bn m bo an ton v phng

nga nhim khun lin quan n phu thut. Mi thnh vin lm vic ti tng phng m, nhn
vin khoa Phu thut-gy m hi sc phi thc hin v gim st nhng ngi tham gia hot
ng ti khu vc phu thut tun th nguyn tc lm sch, v khun bung phu thut.
2.
Bnh vin phi c vn bn hng dn, quy trnh, trch nhim lm sch, kim tra, gim st ti khu
phu thut/phng m, bao gm:
- Quy nh nhim v thc hin lm sch, nhim v gim st, kim tra, duy tr v sinh mi trng
ca kp phu thut khi tham gia vo cc cuc phu thut ti phng m;
- Quy nh v cc ch ti khi cc c nhn hon thnh hoc khng hon thnh nhim v v sinh
phng m;
- Hng dn quy trnh thc hnh v sinh phng m, khu phu thut;
- Hng dn nguyn tc pha v s dng ha cht, phng tin v sinh phng m;
- K hoch thc hin sinh phng m;
- Lch v cng c kim tra gim st v sinh phng m.
3.
Nhn vin lm sch, ngi gim st/kim tra cng tc v sinh phng m phi c trang b (o
to) cc kin thc c bn, chuyn su v nguyn tc, phng php, quy trnh lm sch mi
trng khu/bung phu thut, phn loi v thu gom cht thi y t ngay ti phng m.
4.
Khu phu thut phi c phng tin v sinh tay v phng tin phng h c nhn gm:
- Qun, o mc lt trong (cc tay) dnh ring cho khu phu thut;
- M, giy trm kn tc s dng mt ln;
- Khu trang y t che kn mi ming s dng mt ln;
- Dp dnh ring cho khu phu thut hoc bt giy/vi s dng mt ln (Dp phi c c ra
hng ngy)
5.
Ngi lm v sinh phi s dng phng tin phng h c nhn (PTPHCN) ng theo hng dn
phng nga chun phng phi nhim vi mu, dch c th v tn thng do vt sc nhn
trong qu trnh thc hin v sinh phng m.
6.
Khn lau b mt v ti lau nn phng m phi c git sch, kh khun, lm kh trc khi a
vo s dng trong phng/khu phu thut s dng mt ln ging nh cc vi khc.
7.
vi, gng tay, vt dng phu thut sau khi s dng trong cuc m v cht thi phi c phn
loi v thi b vo thng, ti cha m khng c ci, vt b xung nn hoc bn, my mc
khc trong phng m.
8.
Khu phu thut phi c ni x l, ct gi phng tin v sinh v ni cht thi lng sau khi v
sinh. Ch nhng dng c tht cn thit lin quan n phu thut trong bung phu thut v
sp xp gn gng.
9.
Loi b v lau kh khun vt/m mu, dch tit c th ngay mi khi pht sinh theo ng quy trnh.
10. Thc hin nguyn tc v sinh ni sch trc, bn sau, t trn xung di v t trong ra ngoi
(i li).
III. QUY TRNH LM SCH

1.
Chun b phng tin, ha cht
1)
Phng tin phng h c nhn: gng tay v sinh, ng, khu trang, qun o bo h, tp d chng thm.
2)
Khn lau sch, kh, s lng cho lm sch m khng phi git ti phng m.
3)
Ti lau v cc u lau (mops) kh, sch, s lng cho lm sch m khng phi git ti phng m.
4)
Xe hoc x cha nc sch: dng.
5)
Ha cht hoc dung dch st khun theo quy nh ca bnh vin, khi lng dng (Cloramine,
Javel, Presept v cn 70 ).
6)
Ti, hp mi thay thng rc.
7)
Bin bo t.
2.
Quy trnh thc hnh
2.1 Quy trnh lm sch phng m khi bt u mt ngy lm vic

1)
Ra tay, lm kh tay, mang phng tin phng h bao gm c i gng tay v sinh.
2)
Pha mi dung dch v sinh kh khun theo ng nng v hng dn ca bnh vin hoc nh
sn xut (5.4) ni thong kh (bn ngoi phng m).
3)
S dng khn lau kh, sch, thm dung dch kh khun hoc cn 70 mi trng lau b
mt mi trng phng m nu nhn thy vt bn hoc bi trn tng, n m hoc n th thut,
cc b mt my mc, ni tht trong phng m.
4)
S dng ti lau kh, sch, thm dung dch kh khun lau nn phng m. K thut lau sn:
chia i sn, lau theo ng dch dc, i li, ng lau sau khng trng vi ng lau trc.
Thay ti lau cho mi din tch sn khong 10m2.
5)
Tho gng tay v b vo thng cha cht thi y t.
6)
t bin bo trn, trt ca ngi khc khng bc vo cho n khi phng kh, cuc m
mi bt u.
Ch :
a) C th dng khn lau sch, kh lau b mt bn, my mc (chng kh) nu sau 10 pht m
vt dng v sn cha kh.
b) Quy trnh lm sch ny c p dng c nhng phng phu thut khng c phu thut thng
xuyn. Quy trnh ny c thc hin mi 24 gi i vi cc phng m thng thng, khng c
p lc dng lin tc v lc khng kh c kim sot.
2.2 Quy trnh lm sch phng m gia 2 ca phu thut

1)
Ra tay, mang phng tin phng h v

i gng khi tay kh.
2)
Pha mi dung dch v sinh kh khun

theo ng hng dn v nng ca
nh sn xut hoc bnh vin ni
thong kh (bn ngoi phng m).
3)
Gom v phn loi cht thi a vo ti/

thng rc.
4)
Gom v phn loi vi dnh mu, dch

c th v khng dnh mu, dch c th
cho vo ti ng vi theo phn loi
5)
dch, lm sch bn ngoi bnh ht

(hoc thay bnh ht mi).
6)
Tho gng, ra tay, lm kh tay v i gng mi.
7)
Dng khn kh, sch thm dung dch kh khun hoc cn 700 lau sch v lau kh khun b
mt mi trng xung quanh, ni c kh nng tip xc vi ngi bnh hoc b vy bn vi mu,
v dch c th trong ca phu thut trong khng gian xung quanh bn m vi bn knh 1,3m, bao
gm c tng, my o huyt p, cc truyn, b mt n m, my gy m, my truyn dch
8)
Dng khn kh, sch thm dung dch kh khun lau kh khun bn phu thut.
9)
Dng khn/ti lau sch, kh thm dung dch kh khun lau sn, xung quanh bn m vi bn
knh khong 1,3m v lau rng hn nu c mu v dch tit bn xa hn m bo cc b mt
mi trng xung quanh c lau sch.
Vng lm sch gia 2 ca phu thut lin tc
10) K thut lau: chia i sn, lau theo ng dch dc, ng lau sau khng trng vi ng lau
trc, lau git li. Thay ti lau sau mi ln din tch mt sn 10m2. Ch s dng khn hoc ti/
u lau ring bit cho mi ca phu thut.
11)
Lt ti nilon mi vo thng ng cht thi.
12) Tho b gng tay cho vo ti/thng cht thi, ra tay v lm kh tay.
13) t bin bo Sn t ca ra vo ngi khc khng bc vo cho n khi phng kh,
cuc m mi bt u.
Ch : Dng khn lau sch, kh lau kh b mt mi trng nu sau 10 pht lau bng dung
dch kh khun khng kh.
2.3 Quy trnh lm sch phng m khi kt thc tt c cc cuc phu thut trong ngy
1)
Ra tay, lau kh tay, mc phng tin phng h v i gng tay v sinh.
2)
Pha mi dung dch kh khun theo hng dn v nng quy nh ca bnh vin hoc nh sn
xut ni thong kh.
3)
Thu gom, phn loi cht thi vo cc ti, thng ng cht thi y t. Thu, gom tt c vi bn,
phn loi vi dnh mu, dch c th v khng dnh mu, dch c th cho vo ti ng vi
theo phn loi.
4)
dch thi, lm sch v kh khun bnh ht hoc thay bnh ht mi.
5)
Tho gng, ra tay, lau kh tay v i gng mi.
6)
Dng khn lau sch, kh, thm dung dch kh khun hoc cn 70 lau sch nm m ca-t,
thit b tt, bt in, iu khin my, in thoi, bn phm cc thit b chuyn dng, my tnh (nu
c), ng nghe, b mt ca my v dng c y t (huyt p k, my gy m, bm tim in) v
n m.
7)
Dng khn lau kh, sch, thm dung dch kh khun hoc cn 70 lau kh khun bn phu thut.
8)
Chuyn tt c cc ni tht, bn phu thut ra gia bung. Lun chuyn lau c ht

din tch sn, m bo mi ch ca nn u c lau sch.
9)
Dng khn lau hoc ti sch, kh thm dung dch kh khun lau sn. m bo mi ch ca
sn c lau sch. S dng k thut lau: chia i sn, chuyn thit b v mt pha, lm sch
mt na ch kh, chuyn thit b sang na lm sch, tip tc lm sch na cn li, lau theo
ng dch dc, ng lau sau khng trng vi ng lau trc. Lau ht din tch sn theo
nguyn tc di chuyn li, t ch sch nht n ch bn nht, t trn xung di, t trong ra
ngoi. Thay khn/ti lau cho mi din tch sn khong 10m2.
10) Chuyn tt c cc phng tin, my mc trong phng tr li ng v tr quy nh.

11)
Lm rng, c sch cc thng cha cht thi, lm kh, lt ti nilon vo trong thng cha cht thi
v t li ch c.
12) C ra sch v ct dng c v sinh vo ni quy nh

13) Tho b gng, ra tay v lm kh tay.
14) t bin bo trn, trt ca ngi khc khng bc vo cho n khi phng kh, ng ca
phng chun b cho ngy hm sau.
15) Vit bo co v gi xut thay th, sa cha tt c nhng g h hng ti iu dng trng
phng m hoc ngi c trch nhim.
Ch : Dng khn lau sch, kh lau kh b mt mi trng nu sau 10 pht lau bng dung
dch kh khun khng kh.
2.4 Quy trnh lm sch bung tm, nh v sinh
1)
Ra tay, lau kh tay, mc phng tin phng h v i gng tay v sinh.
2)
Pha mi dung dch kh khun theo hng dn v nng quy nh ca bnh vin hoc nh sn
xut ti ni thong kh, bn ngoi nh tm hoc nh v sinh.
3)
Gom cht thi vo cc ti/thng rc y t
4)
Lau sch tay nm, cnh, khung ca, tng v cng tc n.
5)
Loi b tt c nhng vt bn, hoen , , trn tng, sn.
6)
Lau sch gng, lm sch bn trong v bn ngoi ca bn ra, vi nc.
7)
Lm sch tt c cc khung, my, hp ng dung dch hoc x phng v sinh tay, hp ng khn
lau tay, cc khung, dy, mc o, k
8)
S dng ha cht kh khun v bn chi ch, c cho sch t, cht bn trn cc b mt bn trong
ca bn tm, vi hoa sen, lan can, tng xung quanh, sau xt nc ra sch v lau kh.
9) C ra sch b, bn cu ca nh v sinh bao gm c bn trong, bn ngoi, pha di ca vnh
bn cu bng dung dch ty ra hoc kh khun trong thi gian ti thiu 10 pht.
10) Thu gom cht thi trong thng cht thi, thay tt c cc ti ng cht thi bng ti cht thi sch
nu bn.
11)
Tho gng tay, b vo thng cht thi y t. Ra tay v lm kh tay.
12) Tip thm khn giy, giy v sinh, ti ng cht thi, x phng nu cn.
2.5 X l mi trng b vng bn, mu hoc cht tit c th
Trng hp phu thut ngi bnh c nhim khun cha r cn nguyn, vng bn hoc trn dch c
th khng xc nh c v tr dch t ngi bnh th phi tin hnh v sinh, kh khun trit nh
mt trng hp nhim trn dch c th hoc mu trc khi s dng li.
Vt mu, dch tit vng vi trn bn, sn, tng, dng c: i gng v sinh, dng khn, giy thm
mu, dch tit v thi b vo 1 ti nilon, buc li ri t vo ti ng cht thi y t ly nhim. dung
dch kh khun vo vt lau (hoc thm vo vi, gy lau ph ln v tr dnh mu) v lu li 10 pht. Sau
dng khn lau li theo quy trnh lm sch b mt, sn theo hng dn phng nga chun ca B
Y t.
10
IV. LCH LM SCH/V SINH PHNG M/KHU PHU THUT

Danh mc v tr v sinh
Bung phu thut:

- Bt u ngy lm vic
- Gia 2 ca phu thut
- Cui ngy phu thut
- Tng v sinh
Hng ngy
Hng tun
X
X
X
X
Bung tm, nh v sinh nhn vin: nn, b x, bn ra, chn

tng
2 ln/ngy
v khi cn
Phng hi tnh: bao gm nn, tng, bn ra tay, bn u

ging
2 ln/ngy
v khi cn
Bung v sinh, nh tm bnh nhn: nn, b x, bn ra,

chn tng, ni x l bn,.
4 ln/ngy
v khi cn
Vn phng, gh ngi, phng knh quan st phu thut (looker

room)
Tt c b mt ngang (gi, k, my tnh, bn phm tnh)

trong vn phng, phng theo di
Bo dng, v sinh thit b, my mc (lau chi bn trong v

tra du m)
My hp, sy, ca, t

ni tht bao gm c xe y, cng y, cc bnh xe,
my mc, phng tin, ng nghe in thoi, bn phm my
chuyn dng, tay vn, xe y...
X
X
T lnh, my lm
Kho v khu vc lu gi sch
Tng, bao gm c ca ra vo v ca s ca khoa
Trn nh, bao gm c n trn, phin lc iu ha khng kh
Hng thng
V. HNG DN PHA MT S HO CHT KH KHUN LM

SCH, V SINH MI TRNG PHNG M/KHU PHU THUT
Mi trng BV c vai tr quan trng gp phn ly nhim cho ngi bnh, nhn vin y t, khch thm
v cng ng, bi v ti y c th cha mt s tc nhn gy bnh c kh nng ly lan l t hoc thnh
dch. Ngy nay, nhiu tc nhn gy bnh ti cc bnh vin c nguy c ly lan thnh dch, trong v ngoi
bnh vin nh: Vi khun a khng thuc: T cu vng khng Methicilline (MRSA), cu khun ng
rut khng vancomycine (VRE), Acinetobacter a khng, Clotridium difficile, Vi rt gy nhim khun c
nguy c gy dch nh vi rt hp bo ng h hp (RSV), Rotavirus, Enterovirus 71 (gy bnh cnh
Tay-Chn-Ming), Cm A, SARS Vic p dng ng nhng khuyn co v v sinh mi trng c
ngha quyt nh trong vic kim sot ly nhim trong cc c s y t, cng nh trong cng ng.
Kho st thc trng cng tc v sinh phng/khu phu thut ca 6 bnh vin thuc d n GIZ nm
2012 cho thy hu ht cc bnh vin s dng ha cht thng dng cha clo lm sch v kh khun
mi trng phng/khu phu thut. Trong c 3/6 bnh vin s dng cloramin B (Thi Thy, Din
Chu, Qunh Lu), 2/6 bnh vin s dng Javel (Ph sn Thi Bnh v ng Hng). Ch c 1 bnh
vin a khoa Ngh An s dng Precept. Ba trong 6 bnh vin (Ph sn Thi Bnh, ng Hng, a
khoa Ngh An) c s dng ha cht v sinh cng nghip c hng thm v sinh mi trng bn
ngoi phng phu thut do cc cng ty v sinh cng nghip thc hin (thc cht cc loi ha cht ny
u cha clo). V th, vic hng dn s dng ha cht cho v sinh mi trng khu phu thut ny
tp trung vo vic s dng cc ha cht cha clo l ch yu.
11
1.
Nguyn tc la chn ha cht lm sch v kh khun mi trng bnh vin
1)
Ha cht phi c ph khng khun rng.
2)
C kh nng lm sch v ty ra tt.
3)
Tc dng nhanh khi tip xc vi b mt mi trng.
4)
C kh nng pha long v nng sau pha n nh ko di.
5)
Khng b phn hy bi tc ng ca cc yu t mi trng.
6)
An ton cho nhn vin, ngi bnh, mi trng.
7)
Hiu qu kh khun ko di trn b mt mi trng, vt dng.
8)
D dng s dng.
9)
Khng mi (c mi d chu nu c).
10) Kinh t v d tm kim trn th trng.
2.
Nguyn tc pha v s dng ha cht lm sch, v kh khun mi

trng, dng c
2.1. Ha cht c chia thnh nhng liu

nh cho tng ln pha, ph hp vi khi
lng dung dch s dng mi ln, mi
ngy. Bn ngoi gi,l ha cht m
c phi c nhn ghi: tn, hm lng,
cch pha m bo ngi dng
thun tin, pha chnh xc.
2.2. Ha cht lm v sinh v kh khun
c pha mi ngy, pha ng nng
ch dn theo mc ch, i tng lm
sch, kh khun (v d nh: sn, b
mt vt dng, dng cc dnh mu,
dch tit?) v sau pha vn phi bo
qun trnh bay hi v lm mt tc dng
trong sut qu trnh cha s dng, thi
gian bo qun sau pha ty theo loi
sn phm s dng ( v d nh i vi
sau pha ch c trong vng 24 gi).
Ha cht Cloramin B chia thnh nhng liu nh
2.3. Ha cht lun c bo qun trong thng, hp y np, mu ti, trnh nh sng v cch
xa tm tay ca tr em, xa ni thc phm ch bin. Cm ng ho cht kh khun trong cc
dng c, chai thng ( v ang) dng cha thc n, nc ung thng dng trn th trng.
2.4. Pha ha cht ni c thng kh tt. Ngi thc hin pha ho cht khi pha, khng ng u ngn
gi. Nn pha theo ng hng dn ca nh sn xut v theo khuyn co ca c quan v sinh
mi trng v kim sot nhim khun. V d: Ch nn pha dung dch c cha clo vi nc lnh
(nc nng s ph hy sodium hypochlorit lm dung dch khng hiu qu). Cm ht ho cht
bng ng ht trc tip vo ming, cn o lng s dng bm ht (qu bp) bng tay, my.
2.5. Khng ng chung cc loi ha cht trong cng vt cha hoc hoc pha trn vi cht ty ra
khc (trnh cc phn ng ho hc trung ho, lam gim hiu qu, phn tc dng ca ha cht).
12
2.6. Khi pha ha cht, ngi pha phi s dng y phng tin phng h c nhn nh: khu
trang, gng tay cao su v tp d chng thm nc, knh bo v mt trnh dung dch b bn vo
mt, ming v c th. Ra tay ngay sau khi tho gng.
2.7. iu dng trng khoa/khu/phng phu thut v iu dng trng khoa KSNK chu trch
nhim hng dn, kim tra nhn vin thc hnh v sinh pha v bo qun ha cht kh khun
cho ng nng .
2.8. Tt c nhn vin y t ph trch vic v sinh mi trng v nhng ngi lm trc tip u phi
c hc v vn chn la ha cht, cch s dng v x l khi c s c sy ra, tai nn ng
c, d ng, bng ho cht.
3.
Mt s ha cht c th s dng trong lm sch mi trng phng m
C rt nhiu khuyn co cho vic s dng ha cht trong v sinh phng m, tuy nhin vi nhng c
s y t ngun lc cn hn ch, th ha cht thng c khuyn co, sn c v khng t l Clo,
ngoi ra cn c th lau nhng b mt my mi trng nh, khi khn cp, cng c th s dng ho
cht st khun pha trong cn 70 , tuy nhin rt hn ch i vi nhng vng c s dng dao in
trong phu thut.
- kh khun b mt ngi ta c th s dng dung dch hydrogen peroxide phun sng kh,
hoc h tr bng tia cc tm c bc sng khong 280 nm, tuy nhin hai phng php trn kh
tn km cho nhng ni c ngun lc gii hn.
- Vic s dng dung dch c cha clo v sinh khu vc phng m, cho n hin nay vn c
khuyn co ca WHO v nhiu t chc khc.
4.
Hng dn cch pha ha cht cha clo lm sch, kh khun b mt

mi trng bung bnh v phng/khu phu thut
Cc hp cht cha Clo (Cl) l mt nguyn t thuc nhm halogen c s dng rng ri kh
khun do c hot tnh dit khun cao nh phn ng xy ha kh. Khi ha tan trong nc, cc ha
cht ny s gii phng ra mt lng clo hot tnh c tc dng dit trng.
Hot cht c tc dng ch yu ca cc hp cht cha Clo l Axit Hypoclor (HClO) dng khng phn
ly. Hot cht ny s bn vng hn cc ch phm cha Clo c pH axit, do vy cc ch phm Clo c
pH cng thp (cng axit) th tc dng dit khun cng mnh. Chng hn, Natri Dichloro Isocyanurate
(NaDCC) s c tc dng mnh hn hn so vi dung dch Javel c cng hm lng Clo tng cng do
hai nguyn nhn: Do Javel c bn cht kim cn NaDCC c bn cht axit; hn na vi NaDCC, ch
c 50% lng Clo sn c nm dng t do (HClO v OCl-), phn cn li l nm dng hp cht
(monochloroisocyanurate v dichloroisocyanurate).
Cc ha cht c cha clo thng s dng Vit Nam bao gm:
- Cloramin B cha hm lng 25 30% clo hot tnh
- Cloramin T cha hm lng 25% clo hot tnh
- Canxi hypocloride (Clorua vi) cha hm lng 70% clo hot tnh
- Bt Natri dichloroisocianurate cha hm lng 60% clo hot tnh
- Nc Javen (Natri hypocloride hoc Kali hyphocloride).
13
Nn phn khu vc phu thut lm 3 vng khc nhau da vo nguy c phi nhim vi mu, dch c
th v i hi nng ha cht khc nhau nh bng 1 di y:
Bng 1: Phn loi mc nhim b mt mi trng bnh vin v nng dung dch clo
cn thit cho lm sch, kh khun b mt
Mc nhim
B mt mi trng
Nng clo
nhim nh
Mt mi trng c coi l nhim nh hoc khng b nhim

nu b mt mi trng hoc vt dng khng b phi nhim vi
mu hoc cht dch c th, hoc c th mi trng c dng c
tip xc vi mu hoc cht dch c th (v d nh phng khch,
vn phng, th vin, lu tr, kho gi dng c sch, phng quan
st phu thut, phng chun b dng c th thut, phu thut)
0,1%
nhim trung
bnh
Mt mi trng c coi l nhim mc trung bnh nu hot

ng thng quy gy cho b mt mi trng v/ hoc c dng c
ang b phi phim mu hoc dch c th hoc cht thi cha mu
hoc dch tit. V d:
- Bung bnh nhn,
- Bung tm, nh v sinh
- Hnh lang khu iu tr, khu phu thut, ni c bnh nhn i li.
- Khoa khm bnh
0,5%
nhim nng
Mt mi trng c coi l b nhim nng nu b mt v / hoc

dng c thng xuyn tip xc vi mu hoc dch c th. V d:
- B dng c , dng c phu thut, dng c th thut xm
ln, bn m, bn , dng c ni soi, dng c thng tin, dng c
tim truyn tnh mch, dng c thay bng, bnh ht
-Phng m, phng , phng ni soi, phng th thut xm ln,
phng tiu phu, bung gii phu bnh l, phng m t thi, phng
thng tim, bung iu tr bnh nhn bng, bung cp cu.
- Nh v sinh ca ngi bnh tiu chy mt kim sot
1%
Cc dung dch pha t cc ha cht cha clo trn th trng hin nay vi nng 0,5% v 1,25%
clo hot tnh thng c s dng ty theo mc ch v cch thc ca vic kh khun. Vic tnh
nng dung dch phi da vo clo hot tnh. V cc ha cht khc nhau c hm lng clo hot
tnh khc nhau, cho nn phi tnh ton khi lng ha cht cn thit t c dung dch c
nng clo hot tnh mun s dng.
Lng ha cht cha clo cn pha s lt dung dch vi nng clo hot tnh theo yu cu c
tnh theo cng thc sau:
Lng ha cht (gam)
Nng clo hot tnh ca dung dch cn

pha (%) X s lt
Hm lng clo hot tnh ca ha cht s
dng (%)*
X 1000
* Hm lng clo hot tnh ca ha cht s dng lun c nh sn xut ghi trn nhn, bao b hoc
bng hng dn s dng sn phm.
V d:
pha 10 lt dung dch c nng clo hot tnh 0,5% t bt cloramin B 25% clo hot tnh, cn:
(0,5 x 10/25) x 1000 = 200 gam.
pha 10 lt dung dch c nng clo hot tnh 0,5% t bt canxi hypocloride 70% clo hot tnh, cn:
(0,5 x 10 / 70 ) x 1000 = 72 gam.
pha 10 lt dung dch c nng clo hot tnh 0,5% t bt natri dichloroisocianurate 60% clo hot
tnh, cn: (0,5 x 10 / 60) x 1000 = 84 gam.
14
Bng 2: Lng ha cht cha clo pha 10 lt dung dch vi cc nng clo hot tnh
thng s dng trong v sinh b mt mi trng
Tn ha cht
(hm lng clo hot tnh)
Lng ha cht cn pha 10 lt

dung dch c nng clo hot tnh
0,1%
0,25%
0,5%
1,25%
Cloramin B 25%
25 g
100g
200g
500g
Canxi HypoCloride (70%)
7.2g
36g
72g
180g
Bt Natri dichloroisocianurate (60%)
8.4g
42g
84g
210g
Cch pha
2,5%
1000g Ha tan hon ton

360g lng ha cht cn
thit cho va vi
420g 10 lt nc sch,
nhit thng.
Cc dung dch kh khun c clo s gim tc dng nhanh theo thi gian, cho nn ch pha lng
cn s dng v phi s dng cng sm cng tt sau khi pha. Tt nht ch pha v s dng trong ngy,
khng nn pha sn d tr. Dung dch kh trng cha clo pha cn bo qun ni kh, mt, y
kn, trnh nh sng.
5.
Cch pha dung dch Javel 120 clo (dung dch ca Php) hoc clorox
160 (ca M)
Pha long 1 phn Javel 12 clo hoc clorox 16 clo vi 20 hoc 8 phn nc lnh lau chi b
mt mi trng, dng c s dit c cc loi vi khun, virut bao gm c virut cm.
6.
Cch pha ha cht Surphanios v Chlospray
S dng dung dch Surphanios nng 0,25% pha t l 20 ml ha cht vi 8 lt nc sch nhit
thng thng ngm kh khun dng c hoc thm khn lau, lau b mt mi trng bung bnh,
phng phu thut, b mt bn, phng tin, my mc.
Trng hp s dng Chlorspray 0, 25% lau b mt my mc, ch cn phun, xt b mt my mc
m khng cn pha.
7.
Cch pha vin Presept 2,5 g s dng trong v sinh v kh khun mi trng
Vin nn Presept ca Johnson and Johnson c mt trn th trng Vit Nam gn 20 nm nay, n thun
tin cho vic bo qun, vn chuyn v pha s dng. Presept c ng vin 2.5g hoc 1g. Ty thuc
mc ch s dng khc nhau m pha nng khc nhau v lu gi thi gian ngm kh khun khc
nhau. Trong trng hp v sinh b mt v kh khun mi trng, cn dng 1 vin Precept 2,5 g pha
trong 10 lt nc sch, nhit thng thng c nng 0,14% clo (1400 ppm) trong thi gian 10
pht. Trng hp b mt mi trng dnh mu hoc cht tit, tiu dit virut cm s dng dung dung
dch presept c nng m c 1% (10.000 ppm, tc 7 vin 2,5 g/1 lt nc) v gi trong thi gian
10 pht.
8.
Mt s im cn lu khi s dng ha cht

- Trnh s tay ln mt. Nu clo vo mt, ngay lp tc phi ra vi nc sch t nht 15 pht v
sau i khm.
- Clo khng c s dng chung hoc trn vi cht ty ra khc, v n s lm gim hiu qu v
l nguyn nhn ca s phn tc dng ca ha cht.
- Kh c c to ra khi clo t do c trn vi acid ca cht ty ra nh l khi s dng lm sch
v kh khun nh v sinh v kh c ny c th l nguyn nhn gy cht hoc tn thng. Nu
cn thit th bc u tin l s dng cht ty ra v sau lm sch vi nc v cui cng
mi s dng dung dch c clo t do kh khun.
15
- Clo nguyn cht khng b pha long s gii phng ra kh c khi n tip xc vi nh sng v phi
cha ni c nhit lnh v t trong nh kho trnh tm vi ca tr em.
- Sodium hypochlorit s b mt tc dng vi thi gian, m bo hiu qu ca sn phm, s
dng clo mi mua v trnh qu lu.
- Dung dch clo phi c pha mi ngy, c dn tn, ngy s dng v khng s dng khi pha
qu 24 gi v phi i.
- Cht hu c lm mt tc dng ca clo, do vy b mt phi c lm sch cc cht hu c trc
khi kh khun vi clo.
- y kn dung dch clo sau khi pha, trnh nh sng, trong thng ti (nu c th) v xa
tm tay ca tr em.
VI. TRCH NHIM C NHN TRONG V SINH PHNG M/KHU

PHU THUT
1.
Lnh o BV
- Thit k phng/khu phu thut t cc tiu chun v an ton mi trng, m bo c th thc
hnh v sinh thun tin, hiu qu.
- u t iu kin cho phng/khu phu thut thc hin v sinh phng m.
- Ban hnh cc vn bn hng dn, cc ch ti lin quan v v sinh bnh vin.
- Ch o cc khoa, phng trong bnh vin phi hp vi phng/khu phu thut thc hin v sinh
phng m.
- Kim tra, gim st.
2.
Trng khoa/Trng Phng/khu phu thut

- Chu trch nhim trc Gim c v cht lng cng tc khoa/phng m, trong c cht lng
v sinh mi trng phng m thng qua phn cng, ch o, kim tra vic sp xp, v sinh, v
khun phng/khu phu thut.
- xut kp thi nhng yu cu cn thit m bo v v sinh an ton ti khu phu thut lnh
o bnh vin gii quyt.
- nh gi v ghi chp li mc hon thnh cng vic ca cc thnh vin trong cng tc v sinh
v duy tr v sinh phng/khu phu thut.
- Thc hin cng tc o to, hun luyn cho nhn vin, hc sinh, sinh vin v v sinh phng m.
3.
iu dng trng Phng/khu phu thut

- Chu trch nhim trc trng khoa v vic t chc thc hin cng tc v sinh phng/khu phu thut.
- Phn cng iu dng, k thut vin, h l ca khoa/phng chu trch nhim v sinh/sp xp
phng/khu phu thut.
- Gim st/kim tra tun th ra/vo phng m m bo v sinh, v khun phng/khu phu thut.
16
- Gim st cht lng cng tc v sinh phng/khu phu thut.

- Lp k hoch, t chc thc hin lch v sinh phng m, dng c v phng tin trong phng/khu
phu thut.
- D tr, lnh v phn phi phng tin, ha cht m bo cho cng tc v sinh phng m.
- Lp k hoch bo dng phng tin, gim st bo qun, vn hnh h thng phng/khu phu
thut ng qui trnh
- xut Trng khoa hnh thc thng, pht cc c nhn thc hin v sinh phng m.
- Tham gia o to, hun luyn cho nhn vin, hc sinh, sinh vin v v sinh phng m.
4.
iu dng/k thut vin Phng/Khu phu thut

- Chu trch nhim trc trng khoa v iu dng trng Phng/khu phu thut v cht lng
v sinh mi trng, phng tin, dng c phng/khu phu thut.
- Thc hin ng nguyn tc, quy trnh v sinh mi trng, b mt bn trong phng/khu phu
thut, qun l vi v phn loi, thu gom cht thi y t ng quy nh.
- Chu trch nhim bo qun, lm sch, cc trang thit b chuyn khoa phc v phu thut.
- Phn loi, thu gom v vn chuyn cht thi ca mi cuc m vo ng ni quy nh.
- Phn loi v thu gom vi vo phng tin thu gom theo quy nh h l mang i x l.
- Gim st, n c, h tr cc thnh vin trong kp phu thut thc hin ng quy nh v sinh
phng m.
- Hng dn hc sinh, sinh vin thc hin ng nguyn tc, quy nh v sinh phng m.
5.
H l/y cng/nhn vin v sinh phng/khu phu thut

- H l/Nhn vin v sinh phng khu phu xthut phi c o to kin thc v sinh lm sch
phng/ khu phu thut, c kim tra k nng thc hnh trc khi tham gia lm sch ti phong/
khu phu thut.
- Chu trch nhim v sinh sn, tng, ca v thu gom cht thi y t.
- Chu trch nhim trc iu dng trng Phng/Khu phu thut v cng tc v sinh khu vc
ph cn phng m nh vn phng, hnh lang, khu tip n ngi bnh, khu hi tnh, phng thay
, khu vc v bn v sinh tay, nh tm, nh v sinh, khu vc x l dng c, khu vc ct gi
v sinh, cc t , kho ng dng c v phng tin vn chuyn ngi bnh.
- Chu s gim st, kim tra ca iu dng trng Phng/Khu phu thut.
6.
Phu thut vin

- Chu s gim st ca Kp/nhn vin phng m v VSVK.
- Thc hin ng nguyn tc, quy nh v sinh phng m, bao gm: v sinh tay, mang v tho
phng tin phng h, ra vo phng m
- Gim st mi thnh vin tham gia phu thut tun th qui trnh an ton phu thut, ra vo phng m.
17
7.
Sinh vin, hc vin
Thc hin ng nguyn tc, quy nh v sinh phng m, bao gm: v sinh tay, mang v tho phng
tin phng h, ra vo phng m
8.
Trng khoa Kim sot nhim khun

- Hng dn, kim tra, gim st mi trng v sinh Phng/Khu phu thut.
- Chu trch nhim cht lng v khun dng c, phng tin, vi cho phng m.
- Kim sot thng xuyn v ghi chp li kt qu kim sot mi trng Phng/Khu phu thut.
- Phi hp vi Phng iu dng, Phng/khu phu thut lp k hoch, t chc o to, hun
luyn v sinh phng m.
9.
Trng phng iu dng

- Phi hp vi khoa kim sot nhim khun thc hin cng tc kim tra, gim st quy trnh v kt
qu v sinh phng/khu phu thut.
- Phi hp vi khoa kim sot nhim khun v phng k hoch tng hp trong o to, xy dng
quy trnh, quy nh v sinh phng m trnh lnh o bnh vin xem xt, ph duyt.
TI LIU THAM KHO
18
1.
B Y t, Quyt nh s 3671/Q-BYT ngy 27/9/2012 ph duyt Hng dn Kim sot nhim

khun, Ti liu Hng dn Kh khun tit khun.
2.
Vin V sinh dch t Trung ng, Hng dn pha ha cht kh trng cha Clo, 2012
3.
Trn Hu Luyn, Bnh vin Trung ng Hu, Hng dn s dng ha cht kh khun trong y t, 2011.
4.
BS.Nguyn Th Thanh H, Bnh vin Nhi ng I, Hng dn v sinh mi trng bnh vin, 2011.
5.
B Y t, Hng Chng nhim khun, 2004
6.
APSIC Guideline for environmental cleaning and disinfection, Version 9, 2012.
7.
Provincial Infectious Diseases Advisory Committee (PIDAC) of Ontario Health Department,

Canada, Best Practices for Environmental cleaning for Prevention Control of Infection in all
Health Care Settings, 2009.
PHN II
CC QUY TRNH THC HNH
19
A. QUY TRNH LM SCH MI TRNG PHNG M

I.
C S L LUN, TI LIU THAM KHO

- Hng dn KSNK, B Y t 2012 theo Quyt nh s 3671/Q-BYT ngy 27/9/2012 ph duyt
Hng dn Kim sot nhim khun.
- Hng dn Chng nhim khun tp I, B Y t, 2004.
- Hng dn V sinh v kh khun mi trng ca Hip Hi Kim sot nhim khun Khu vc
Chu Thi Bnh Dng, bn tho ln 9, 2012.
- Thc hnh tt nht v v sinh mi trng v kim sot nhim khun trong cc c s y t, Hi
ng t vn v kim sot nhim khun thuc S Y t Bang Ontario, Canada, 2009.
II.
I TNG P DNG
1)
Nhn vin v sinh phng/khu phu thut/Phng /Phng th thut can thip c xm ln.
2)
Bc s, iu dng, K thut vin phng/khu phu thut/ Phng /Phng th thut can thip c
xm ln.
3)
Bc s, iu dng khoa Kim sot nhim khun
(i tng 2, 3 bit, kim tra, gim st hoc thc hin)
III.
PHNG TIN, HA CHT
1)
Phng tin phng h c nhn: gng tay v sinh, ng, khu trang, qun o bo h, tp d
nilon.
2)
Khn/ti lau sch, kh, s lng lm sch.
3)
Chi, xng ht rc cn di
4)
Xe hoc x ng nc sch
5)
Ha cht hoc dung dch st khun theo quy nh ca BV, khi lng dng (Cloramine, Javel,
Presept, cn 70 ).
6)
Ti nilon mi lt thng rc
7)
Bin bo t
Phng tin v sinh v phng h c nhn
20
IV. QUY TRNH LM SCH MI TRNG PHNG M TRC KHI BT

U MT NGY LM VIC
Bc 1
Bc 2
Bc 3
Bc 4
Bc 5
Bc 6
Ra tay, lm kh tay, mang phng tin phng h

lao ng v i gng tay v sinh.
Pha dung dch kh khun mi theo hng dn

ca bnh vin hoc nh sn xut ni thong kh
(bn ngoi phng m).
S dng khn lau kh, sch, thm cn 70 hoc

dung dch kh khun mi trng lau b mt
mi trng phng m nu nhn thy vt bn hoc
bi trn tng, n m hoc n th thut, cc b
mt my mc, ni tht trong phng.
S dng ti lau kh, sch, thm dung dch kh

khun lau nn phng m. K thut lau sn: chia
i sn, lau theo ng dch dc, ng lau sau
khng trng vi ng lau trc. Thay ti lau cho
mi din tch sn khong 10m2.
Tho gng tay, b vo thng cha cht thi y t

v ra tay.
t bin bo trn, trt ca ngi khc

khng bc vo cho n khi phng kh,
cuc m mi bt u.
Ch : Sau 10 pht, nu vt dng v sn c lau bng dung dch kh khun cha kh th dng khn
lau sch, kh lm kh b mt.
21
V. QUY TRNH LM SCH MI TRNG PHNG M GIA 2 CA

PHU THUT
22
Bc 1
Ra tay, mang phng tin phng h v i gng

v sinh khi tay kh
Bc 2
Pha mi dung dch v sinh kh khun theo ng

nng v cch pha theo hng dn ca bnh
vin hoc nh sn xut ni thong kh.
Bc 3
Gom v ht rc a vo ti/thng rc y t.
Bc 4
Gom ton b vi bn cho vo ti ng vi.
Bc 5
dch, lm sch bn trong v bn ngoi bnh ht

hoc thay bnh ht mi.
Bc 6
Tho gng, ra tay, lm kh tay v i gng mi
Bc 7
Dng khn kh, sch thm cn 70 hoc dung

dch kh khun lau kh khun b mt mi
trng xung quanh, ni c kh nng tip xc vi
ngi bnh hoc b vy bn vi mu, dch c th
trong ca phu thut trong khng gian xung quanh
bn m vi bn knh 1,3m, bao gm c tng,
my o huyt p, cc truyn, b mt n m, my
gy m, my truyn dch
Bc 8
Dng khn kh, sch thm dung dch kh khun

lau kh khun bn phu thut.
Bc 9
Dng khn/ti lau sch, kh thm dung dch kh

khun lau sn quanh bn m vi bn knh
khong 1,3m (rng hn mu v dch tit bn xa
hn) m bo cc b mt mi trng xung quanh
c lau sch. S dng k thut lau: chia i sn,
lau theo ng dch dc, lau git li, ng lau
sau khng trng vi ng lau trc. Thay ti
lau sau mi ln din tch mt sn 10m2. S dng
khn hoc ti/u lau ring bit cho mi ca phu
thut.
Bc 10
Dng ti nilon mi lt thng ng cht thi
Bc 11
Tho b gng tay b vo ti/thng cht thi, ra

tay v lm kh tay.
Bc 12
t bin bo Sn t ca ra vo
Ch : Dng khn lau sch, kh lau kh b mt mi trng nu sau 10 pht lau bng dung dch
kh khun khng kh.
23
VI. QUY TRNH LM SCH MI TRNG PHNG M KHI KT

THC TT C CC CUC M TRONG NGY
Bc 1
Ra tay, mang phng tin phng h v i gng v

sinh khi tay kh.
Bc 2

nng hng dn ca bnh vin hoc nh sn
xut ni thong kh (bn ngoi phng m).
Bc 3
24
Gom cht thi vo cc ti/thng rc y t.

Thu, gom, phn loi tt c vi cho vo ti cha
theo quy nh phn loi. Khng vi dnh mu,
dch c th ln vi vi khc.
Bc 4
dch thi, lm sch v kh khun bnh ht hoc

thay bnh ht mi.
Bc 5
Bc 6
Dng khn lau sch, kh, thm dung dch kh khun

hoc cn 70 lau sch nm m ca-t, thit b
tt, bt in, iu khin my, in thoi, bn phm
cc thit b chuyn dng, my tnh (nu c), ng
nghe, b mt ca my v dng c y t (huyt p k,
my gy m, bm tim in) v n m.
Bc 7
Dng khn lau kh, sch, thm dung dch kh

khun lau kh khun bn phu thut.
Bc 8
Chuyn tt c cc ni tht, bn phu thut ra gia

bung. Lun chuyn lau c ht din tch
sn, m bo mi ch ca nn u c lau sch.
Bc 9
Dng khn lau hoc ti sch, kh thm dung dch

kh khun lau sn. m bo mi ch ca sn
c lau sch. S dng k thut lau: chuyn thit
b v mt pha, chia i sn, lm sch mt na
ch kh, chuyn thit b sang na lm sch,
tip tc lm sch na cn li, lau theo ng
dch dc, ng lau sau khng trng vi ng
lau trc. Lau ht din tch sn theo nguyn tc
di chuyn li, t ch sch nht n ch bn nht,
t trn xung di, t trong ra ngoi. Thay khn/
ti lau cho mi din tch sn khong 10m2.
Bc 10
Chuyn tt c cc phng tin, my mc trong

phng tr li ng v tr quy nh.
Bc 11
Lm rng, c sch cc thng cha cht thi, lm

kh, lt ti nilon cha cht thi mi vo trong
thng v t li ch c.
Bc 12
C sch v ct dng c v sinh vo ni quy

nh.
Bc 13
Tho gng tay, ra tay v lm kh tay.
Bc 14
t bin bo trn, trt ca ngi khc

khng bc vo cho n khi phng kh, ng
ca phng chun b cho ngy hm sau.
Bc 15
Vit bo co v gi xut thay th, sa cha

nhng h hng ti iu dng trng phng m
hoc ngi c trch nhim.
Ch : Dng khn lau sch, kh lau kh b mt mi trng nu sau 10 pht lau bng dung dch
kh khun khng kh.
25
B. QUY TRNH LM SCH MI TRNG NH TM, NH V

SINH KHU PHU THUT
(C th p dng cho cc nh tm, nh v sinh ca cc khoa, phng trong bnh vin)
Bc 1
Ra tay, mang phng tin phng h v i gng

v sinh khi tay kh.
Bc 2
Pha mi dung dch kh khun theo hng dn

v nng quy nh ca bnh vin hoc nh sn
xut ti ni thong kh, bn ngoi nh tm hoc
nh v sinh.
Bc 3
Gom cht thi vo cc ti/thng rc y t.
Bc 4
Lau sch tay nm, cnh, khung ca, tng v

cng tc n.
Bc 5
Loi b tt c nhng vt bn, hoen , , trn

tng, sn.
Bc 6
26
Lau sch gng, lm sch bn trong v bn ngoi

ca bn ra, vi nc.
Ra sch h thng thot nc di bn ra, s
dng ha cht kh khun ngm trong thi gian
ha cht tip xc lm sch bn ra sau xi
nc cho sch v kh.
Bc 7
Lm sch tt c cc khung, my, hp ng dung

dch hoc x phng v sinh tay, hp ng khn
lau tay, cc khung, dy, mc o, k.
Bc 8
S dng ha cht kh khun v bn chi ch, c

cho sch t, cht bn trn cc b mt bn trong
ca bn tm, vi hoa sen, lan can, tng xung
quanh, sau xt nc ra sch v lau kh.
Bc 9
C ra sch b, bn cu ca nh v sinh bao

gm c bn trong, bn ngoi, pha di ca vnh
bn cu bng dung dch ty ra hoc kh khun
trong thi gian ti thiu 10 pht.
Bc 10
Thu gom cht thi trong thng cht thi, thay tt

c cc ti ng cht thi bng ti cht thi sch
nu bn.
Bc 11
Tho gng tay, b vo thng cht thi y t. Ra

tay v lm kh tay.
Bc 12
Tip thm khn giy, giy v sinh, ti ng cht

thi, x phng nu cn.
27
C. QUY TRNH PHA DUNG DCH KH KHUN MI TRNG

PHNG M
I.
C S L LUN, TI LIU THAM KHO

1. Hng dn KSNK, B Y t 2012 theo Quyt nh s 3671/Q-BYT ngy 27/9/2012 ph duyt
Hng dn Kim sot nhim khun;
2. Hng dn Chng nhim khun tp I, B Y t, 2004;
3. Hng dn V sinh v kh khun mi trng ca Hip Hi Kim sot nhim khun Khu vc
Chu Thi Bnh Dng, bn tho ln 9, 2012;
4. Thc hnh tt nht v v sinh mi trng v kim sot nhim khun trong cc c s y t, Hi
ng t vn v kim sot nhim khun thuc S Y t Bang Ontario, Canada, 2009;
5. Hng dn pha dung dch clo ca Vin V sinh Dch t Trung ng;
6. Hng dn s dng ha cht kh khun ca Bnh vin Nhi ng I, 2011.
II. I TNG P DNG

1. Nhn vin v sinh phng/khu phu thut/phng /phng th thut;
2. Bc s, iu dng, k thut vin phng/khu phu thut/ phng , phng th thut;
3. Bc s, iu dng khoa Kim sot nhim khun.
(i tng 2, 3 bit gim st, kim tra hoc thc hin khi cn)
III. PHNG TIN, HA CHT

1) Phng tin phng h c nhn: gng tay v
sinh, ng, khu trang, qun o bo h, tp
d nilon.
2) Xe hoc x ng nc sch, nhit
thng, s lng va pha
3) Ha cht hoc dung dch st khun cn
thit, hm lng dng (Cloramine, Javel,
Presept).
Phng tin, ha cht pha dung dch kh khun
28
IV. QUY TRNH PHA DUNG DCH KH KHUN MI TRNG

PHNG M
Bc 1
Ra tay, lm kh tay
Bc 2
Mang phng tin phng h:

M, gng tay, knh, khu trang, tp d
Bc 3
Chn a im pha thong kh. ng u gi (nu

c gi).
Bc 4
Ly nc sch vo thng, x, chu theo t l nh

pha ch v hng dn bng 1, bng 2 (km quy
trnh ny).
Bc 5
Ch ha cht vo nc sch theo mc ch s dng

v nng hng dn ca nh sn xut hoc ca
bnh vin (bng 1, 2 km theo quy trnh ny).
Bc 6
Dng que g hoc nha khuy nc v ha cht

cho n khi ha cht c ha tan trong nc.
Bc 7
y np thng, hoc x dung dch ha cht nu cha

dng ngay. Dng dung dch pha trong vng 24 gi.
29
Bng 1: Phn loi mc nhim b mt mi trng bnh vin v nng dung dch clo
cn thit cho lm sch, kh khun b mt
Mc nhim
B mt mi trng
Nng clo
nhim nh
Mt mi trng c coi l nhim nh hoc khng b nhim

nu b mt mi trng hoc vt dng khng b phi nhim vi
mu hoc cht dch c th, hoc c th mi trng c dng c
tip xc vi mu hoc cht dch c th (v d nh phng khch,
vn phng, th vin, lu tr, kho gi dng c sch, phng quan
st phu thut, phng chun b dng c th thut, phu thut)
0,1%
nhim trung
bnh
Mt mi trng c coi l nhim mc trung bnh nu hot

ng thng quy gy cho b mt mi trng v/ hoc c dng c
ang b phi phim mu hoc dch c th hoc cht thi cha mu
hoc dch tit. V d:
0,5%
- Bung bnh nhn,

- Bung tm, nh v sinh
- Hnh lang khu iu tr, khu phu thut, ni c bnh nhn i li.
- Khoa khm bnh
nhim nng
Mt mi trng c coi l b nhim nng nu b mt v / hoc

dng c thng xuyn tip xc vi mu hoc dch c th. V d:
1%
- B dng c , dng c phu thut, dng c th thut xm

ln, bn m, bn , dng c ni soi, dng c thng tin, dng c
tim truyn tnh mch, dng c thay bng, bnh ht
- Phng m, phng , phng ni soi, phng th thut xm ln,
phng tiu phu, bung gii phu bnh l, phng m t thi, phng
thng tim, bung iu tr bnh nhn bng, bung cp cu.
- Nh v sinh ca ngi bnh tiu chy mt kim sot
Bng 2: Lng ha cht cha clo pha 10 lt dung dch vi cc nng clo hot tnh
thng s dng trong v sinh b mt mi trng
Tn ha cht
(hm lng clo hot tnh)
30
Lng ha cht cn pha 10 lt

dung dch c nng clo hot tnh
0,1%
0,25%
0,5%
1,25%
Cloramin B 25%
25 g
100g
200g
500g
Canxi HypoCloride (70%)
7.2g
36g
72g
180g
Bt Natri dichloroisocianurate
(60%)
8.4g
42g
84g
210g
Cch pha
2,5%
1000g Ha tan hon ton

360g lng ha cht cn
thit cho va vi
420g 10 lt nc sch,
nhit thng.
PHN III
CC BNG KIM QUY TRNH

THC HNH
(S dng cho ngi thc hnh v ngi gim st: dng du (X) in vo
tng ng vi cc danh mc hoc bc tin hnh)
31
BNG KIM 1 - Chun b dng c v ha cht cho thc hnh lm sch mi trng phng m
Thc hin
Danh mc
TT
Bc 1
Qun o bo h: qun, o, m, gng tay
Bc 2
Tp d khng thm nc
Bc 3
Khu trang y t
Bc 4
Knh bo h
Bc 5
X, thng ng nc
Bc 6
Ti lau, khn lau kh, sch vi s lng

lm sch
Bc 7
Ha cht kh khun thng dng
Bc 8
Ti nilon mi lt thng rc
Bc 9
Bin bo Sn t
C nhng khng
t yu cu
Khng
c
BNG KIM 2 - Quy trnh thc hnh lm sch mi trng phng m trc khi bt u mt
ngy lm vic
Thc hin
32
TT
Cc bc
Bc 1
Ra tay, lm kh tay, mang phng tin phng h

lao ng v i gng tay v sinh.
Bc 2
Pha dung dch kh khun mi theo hng dn ca

bnh vin hoc nh sn xut ni thong kh (bn
ngoi phng m).
Bc 3
S dng khn lau kh, sch, thm dung dch kh

khun mi trng lau b mt mi trng phng
m nh tng, n m hoc n th thut, cc b
mt ni tht trong phng.
Bc 4
S dng ti lau kh, sch, thm dung dch kh

khun lau nn phng m. K thut lau sn: chia
i sn, lau theo ng dch dc, ng lau sau
khng trng vi ng lau trc. Thay ti lau cho
mi din tch sn khong 10m2
Bc 5
Tho gng tay b vo thng cha cht thi y t v

ra tay.
Bc 6
t bin bo Sn t ca.
Tt
Bnh
thng
Khng t
yu cu hoc
khng lm
BNG KIM 3 - Quy trnh thc hnh lm sch mi trng phng m gia 2 ca phu thut
Thc hin
TT
Cc bc
Bc 1
Ra tay, lau tay kh, mc phng tin phng h

v i gng v sinh.
Bc 2

hng dn v nng ca nh sn xut hoc
bnh vin ni thong gi.
Bc 3
Gom v ht rc a vo ti/thng rc.
Bc 4
Gom ton b vi bn cho vo ti.
Bc 5
dch, lm sch bn trong v bn ngoi bnh ht

hoc thay bnh ht sch.
Bc 6
Bc 7
S dng khn lau kh, sch, thm dung dch kh

khun/hoc cn 700 lau tng, my o huyt
p, cc truyn, b mt n m
Bc 8
Dng khn kh, sch thm dung dch kh khun

lau kh khun bn phu thut.
Bc 9
Dng khn/ti lau sch, kh thm dung dch kh

khun lau sn, xung quanh bn m vi bn knh
khong 1,3 m v lau rng hn nu c mu v dch
tit bn xa hn m bo cc b mt mi trng
xung quanh c lau sch.
Tt
Bnh
thng
Khng t
yu cu hoc
khng lm
Chia i sn, lau theo ng dch dc, ng

lau sau khng trng vi ng lau trc. Thay ti
lau sau mi ln din tch mt sn 10m2. Ch s
dng khn hoc ti/u lau ring bit cho mi ca
phu thut.
Bc 10
Dng ti nilon mi lt thng ng cht thi.
Bc 11
Tho b gng tay s dng b vo thng cha

rc y t, ra tay, lm kh tay.
Bc 12
t bin bo Sn t ca.
33
BNG KIM 4 - Quy trnh thc hnh lm sch mi trng phng m khi kt thc tt c cc ca
phu thut trong ngy
Thc hin
34
TT
Cc bc
Bc 1
Ra tay, lm kh tay, mc phng tin phng h

v i gng tay v sinh.
Bc 2

hng dn ca bnh vin hoc nh sn xut ti
ni thong kh (bn ngoi phng m).
Bc 3
Gom v ht rc a vo ti/thng rc ng quy

nh phn loi cht thi y t. Thu gom ton b
vi bn, phn loi cho vo ti ng vi theo
mc phi nhim vi mu v dch tit.
Bc 4
dch thi (hoc thay bnh ht), c ra-kh khun

bn trong v bn ngoi bnh ht.
Bc 5
Bc 6
Dng khn lau sch, kh, thm cn 70 hoc

dung dch kh khun lau sch nm m ca, thit
b tt, bt in v iu khin my mc, n, in
thoi, bn phm cc thit b chuyn dng, my tnh
(nu c), ng nghe, tay nm t, b mt ca my
mc v dng c (huyt p k, my gy m, bm
tim in) v n m.
Bc 7
Dng khn lau kh, sch, thm dung dch kh

khun v lau kh khun bn phu thut.
Bc 8
Chuyn tt c cc ni tht, bn phu thut ra

gia bung.
Bc 9
Dng khn lau hoc ti kh, sch, thm dung dch

kh khun lau kh khun sn. m bo mi
ch ca sn c lau sch:
- Chuyn thit b v mt pha, chia i sn, lm
sch mt na, ch kh,chuyn thit b sang na
lm sch, tip tc lm sch na cn li, lau theo
ng dch dc, ng lau sau khng trng vi
ng lau trc.
- Thay khn/ti lau cho mi din tch sn khong
10m2. Lau ht din tch sn theo nguyn tc di
chuyn li, t ch sch nht n ch bn nht, t
trn xung di, t trong ra ngoi.
Bc 10
Chuyn tt c cc phng tin, my mc trong

phng tr li ng v tr quy nh.
Bc 11
Lm rng v c sch cc thng cha cht thi, lm

kh v t li ch c v lt ti nilon mi vo thng
ng cht thi.
Bc 12
C sch v ct dng c v sinh vo ni quy nh.
Bc 13
Tho b gng tay v sinh cho vo thng cha rc

y t.
Bc 14
t bin bo Sn t ca v ng ca.
Bc 15
Vit bo co v gi xut nhng g cn thay th

sa cha cho iu dng trng phng m hoc
ngi c trch nhim.
Tt
Bnh
thng
Khng t
yu cu hoc
khng lm
BNG KIM 5 - Quy trnh thc hnh lm sch mi trng nh tm, nh v sinh
Thc hin
TT
Cc bc
Bc 1
Ra tay, lm kh tay, mc phng tin phng h

v i gng tay v sinh.
Bc 2

hng dn ca bnh vin hoc nh sn xut ti
ni thong kh (bn ngoi phng m).
Bc 3
Gom v ht rc cho vo ti/thng rc.
Bc 4
Lau sch tay nm, cnh, khung ca, tng v

cng tc n.
Bc 5
Loi b tt c nhng vt bn, hoen , , trn

tng, sn.
Bc 6
Tt
Bnh
thng
Khng t
yu cu hoc
khng lm
Lau sch gng, lm sch bn trong v bn ngoi

ca bn ra, vi nc.
Ra sch h thng thot nc di bn ra, s
dng ha cht kh khun ngm trong thi gian
ha cht tip xc lm sch bn ra sau xi
nc cho sch v kh.
Bc 7
Lm sch tt c cc khung, my, hp ng dung

dch hoc x phng v sinh tay, hp ng khn
lau tay.
Bc 8
Lm sch cc khung, dy, mc o, k .
Bc 9
S dng ha cht kh khun v bn chi ch, c

cho sch t, cht bn trn cc b mt bn trong
ca bn tm, vi hoa sen, lan can, tng xung
quanh, sau xt nc ra sch v lau kh.
Bc 10
C ra sch b, bn cu ca nh v sinh bao gm

c bn trong, bn ngoi, pha di ca vnh bn
cu bng dung dch ty ra hoc kh khun trong
thi gian ti thiu 10 pht.
Bc 11
Thu gom cht thi trong thng cht thi, thay tt

c cc ti ng cht thi bng ti cht thi sch
nu bn.
Bc 12
Tho gng tay, b vo thng cht thi y t. Ra tay

v lm kh tay.
Bc 13
Tip thm khn giy, giy v sinh, ti ng cht

thi, x phng nu cn.
35
BNG KIM 6 - Chun b phng tin v ha cht pha dung dch kh khun
lm sch mi trng
TT
Thc hin
Danh mc
C
C nhng khng
t yu cu
Khng c
Bc 1 Qun o bo h, m, khu trang, ng cao su

Bc 2 Tp d khng thm nc
Bc 3 Knh bo h
Bc 4 X, thng, xe ng nc sch c th tnh c
th tch
Bc 5 Ha cht c chia liu nh, c nhn ghi r
hm lng, hng dn pha . Khi lng ph
hp vi khi lng nc v nng
Bc 6 Ni pha: thong kh, ngi pha ng u gi
(nu c)
Bc 7 Ha cht kh khun thng dng
Bc 8 Ti nilon mi lt thng rc
Bc 9 Bin bo Sn t
BNG KIM 7 - Quy trnh thc hnh pha dung dch kh khun lm sch mi trng phng m
Thc hin
TT
Cc bc
Bc 1 Ra tay, lm kh tay.
Bc 2 Mang phng tin phng h v ng quy cch.
Bc 3 Chn a im pha thong kh. ng u gi (nu c
gi).
Bc 4 Ly nc sch vo thng, x, chu
theo t l nh pha ch.
Bc 5 Ch ha cht vo nc sch theo ng hng dn t
l v mc ch s dng.
Bc 6 Dng que g hoc nha khuy nc v ha cht cho
n khi ha cht c ha tan trong nc.
Bc 7 y kn np thng, x dung dch nu cha dng ngay.
36
Tt
Bnh
thng
Khng t
yu cu hoc
khng lm
Gi Ca
K. tra
Knh
Sn
Trn
Qut
Tng
iu
ha
T,
gi,
k
DC
trong
phng
Bn
ra
X
Khn lau Thng
phng
tay
rc
BNG KIM
NH GI V SINH MI TRNG BNH VIN
Bn
tiu,
cu
Ti
lau
Mi
Khc
Ch k
ca Ngi
nh gi
A IM KT:..
S dng: thng k v t xut tt c cc khoa phng trong BV. Phiu ny c th treo c nh mt v tr no thun tin hoc c iu dng trng gi
ng dng: nh gi trch nhim ngi thc hin v sinh, ngi gim st cng tc v sinh v tnh trng v sinh ca n v
Ngy
Kim
tra
NH GI: t
Khng t
(Dnh Cho ngi nh gi)
BNH VIN:
KHOA (PHNG):
37
Chng trnh Tng cng H thng y t tuyn tnh

Phng 105 Nh 2G
Khu Ngoi giao on Vn Phc
298 ph Kim M, H Ni, Vit Nam
Tel: +84 4 37 26 43 90
Fax: +84 4 37 26 43 93
Email: office.kvhealth@giz.de
Website: www.giz.de/vietnam

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TI LIU HNG DN LM SCH MI TRNG PHNG M

TI LIU HNG DN LM SCH MI TRNG PHNG M

PHN I - HNG DN LM SCH MI TRNG PHNG M ..................................................... 5

NGUYN TC LM SCH PHNG M/KHU PHU THUT V KHU VC YU CU V

QUY TRNH LM SCH ............................................................................................................. 7

Chun b phng tin, ha cht .................................................................................................. 7

LCH LM SCH/V SINH PHNG M/KHU PHU THUT ................................................. 12

HNG DN PHA MT S HO CHT KH KHUN LM SCH, V SINH MI TRNG

Nguyn tc la chn ha cht lm sch v kh khun mi trng bnh vin ......................... 12

TRCH NHIM C NHN TRONG V SINH PHNG M/KHU PHU THUT..................... 16

TI LIU HNG DN LM SCH MI TRNG PHNG M

PHN II - CC QUY TRNH THC HNH ........................................................................................ 19

QUY TRNH LM SCH MI TRNG PHNG M ............................................................. 20

C S L LUN, TI LIU THAM KHO ................................................................................ 20

QUY TRNH PHA DUNG DCH KH KHUN MI TRNG PHNG M ............................ 28

C S L LUN, TI LIU THAM KHO ................................................................................ 28

PHN III - CC BNG KIM QUY TRNH THC HNH ................................................................. 31

- NH GI V SINH MI TRNG BNH VIN .................................................. 37

TI LIU HNG DN LM SCH MI TRNG PHNG M

TI LIU HNG DN LM SCH MI TRNG PHNG M

HNG DN LM SCH MI TRNG PHNG M

II.NGUYN TC LM SCH PHNG M/KHU PHU THUT V KHU

V sinh mi trng phng/khu phu thut l nguyn tc c bn m bo an ton v phng

TI LIU HNG DN LM SCH MI TRNG PHNG M

III. QUY TRNH LM SCH

Chun b phng tin, ha cht

Xe hoc x cha nc sch: dng.

Ti, hp mi thay thng rc.

Quy trnh thc hnh

2.1 Quy trnh lm sch phng m khi bt u mt ngy lm vic

Tho gng tay v b vo thng cha cht thi y t.

TI LIU HNG DN LM SCH MI TRNG PHNG M

2.2 Quy trnh lm sch phng m gia 2 ca phu thut

Ra tay, mang phng tin phng h v

Pha mi dung dch v sinh kh khun

Gom v phn loi cht thi a vo ti/

Gom v phn loi vi dnh mu, dch

dch, lm sch bn ngoi bnh ht

Tho gng, ra tay, lm kh tay v i gng mi.

Vng lm sch gia 2 ca phu thut lin tc

Lt ti nilon mi vo thng ng cht thi.

TI LIU HNG DN LM SCH MI TRNG PHNG M

Ra tay, lau kh tay, mc phng tin phng h v i gng tay v sinh.

dch thi, lm sch v kh khun bnh ht hoc thay bnh ht mi.

Tho gng, ra tay, lau kh tay v i gng mi.

Chuyn tt c cc ni tht, bn phu thut ra gia bung. Lun chuyn lau c ht

10) Chuyn tt c cc phng tin, my mc trong phng tr li ng v tr quy nh.

12) C ra sch v ct dng c v sinh vo ni quy nh

Ra tay, lau kh tay, mc phng tin phng h v i gng tay v sinh.

Gom cht thi vo cc ti/thng rc y t

Lau sch tay nm, cnh, khung ca, tng v cng tc n.

TI LIU HNG DN LM SCH MI TRNG PHNG M

Loi b tt c nhng vt bn, hoen , , trn tng, sn.

Lau sch gng, lm sch bn trong v bn ngoi ca bn ra, vi nc.

Tho gng tay, b vo thng cht thi y t. Ra tay v lm kh tay.

TI LIU HNG DN LM SCH MI TRNG PHNG M

IV. LCH LM SCH/V SINH PHNG M/KHU PHU THUT

Bung phu thut:

Bung tm, nh v sinh nhn vin: nn, b x, bn ra, chn

Phng hi tnh: bao gm nn, tng, bn ra tay, bn u

Bung v sinh, nh tm bnh nhn: nn, b x, bn ra,

Vn phng, gh ngi, phng knh quan st phu thut (looker