Bab 2- Pencegahan Infeksi

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  • PENCEGAHAN INFEKSI

  • INFEKSIInvasi mikroorganisme berbahaya (patogen) ke dalam tubuh

  • Pencegahan InfeksiMemotong jalur penyebaranorganisme infeksius diantara orang-orang dengan cara:Menghindari kontak langsung cairan tubuhMemusnahkan organisme infeksius

  • 8 Aturan DasarSetiap orang berpotensi menularkan infeksiMemakai sarung tanganMenggunakan pelindung kontak lainMelakukan upaya kerja yang amanMencuci tanganMenggunakan bahan antiseptikMembuang limbah dengan benarMemproses instrumen dan bahan dengan benar

  • Setiap Orang Berpotensi Darah Semen Sekresi vagina Semua cairan tubuh lain

  • INGAT!!!!!SETIAP ORANG BERPOTENSI MENULARI & TERTULARI

  • Memakai Sarung TanganUntuk kontak dengan cairan tubuhUntuk kontak dengan mukosa & kulit yang tak utuhUntuk kontak dengan bahan & instrumen terkontaminasiUntuk menangani limbah

  • Jenis Sarung TanganSarung tangan periksaSarung tangan rumah tanggaSarung tangan bedah (steril & DTT)

  • Pelindung Kontak LainMaskerKacamata pelindungCelemekGaun operasiKain linenSepatu boot

  • Upaya Kerja Yang AmanMencegah perlukaan saat bekerjaMemegang benda tajamMenutup jarum suntikMenyerahkan instrumen tajamMelakukan teknik operasi yang benarSarung tangan gandaMelepas gaun operasi sebelum sarung tanganLain-lain

  • Bahan AntiseptikMembunuh atau menghilangkan sebanyak mungkin mikroorganisme tetapi aman bagi kulit/mukosa dimana antiseptik digunakanSelalu ada kemungkinan alergi atau hipersensitif

  • Contoh Bahan AntiseptikAlkohol (60-90%), etil isopropil atau metil spiritusCetrimide dalam berbagai konsentrasi (misal: Savlon)Chlorhexidine gluconate (4%) (misal: Microshield, Hibiscrub, Hibitane)Hexachlorophene (3 %) (misal: Phisohex)Parachlorometoxylenol (PCMX atau Chloroxylenol), dalam berbagai konsentrasi (misal: Dettol)Iodine (1 sampai 3%), dalam air atau tinctur (misal: Lugol)Iodophor, dalam berbagai konsentrasi (misal: Betadine)

  • Buang Limbah dengan BENARMemakai sarung tangan rumah tanggaPisahkan dalam wadah menurut jenisnyaTerkontaminasi: wadah tertutup/tidak bocorTajam: wadah tahan tusukMusnahkan sesuai jenisnya: kubur, bakar, tampung, dllCuci tangan

  • Jenis LimbahLimbah terkontaminasi (biohazard)Perlu pengelolaan khususLimbah tidak terkontaminasiDiperlakukan seperti sampah umum

  • Prosesing Instrumen & BahanUntuk dipakai / dipakai ulang Potensi cedera pada petugas3 Langkah pokokDekontaminasiPencucian & pembilasanSterilisasi atau Disinfeksi Tingkat Tinggi

  • Alat-alat Kesehatan yang terkontaminasi darah, jaringan dan cairan tubuh lainnyaDEKONTAMINASI rendam 10 dalam larutan klorin 0,5%CUCI dan BILAS pakai sarung tangan. Hati-hati tertusuk instrumen tajam* Instrumen yang terbungkus dalam keadaan steril dapat disimpan 1 minggu. Instrumen steril tanpa dibungkus harus disimpan dalam wadah steril atau DTT dengan tertutup rapat atau segera dipakai

  • Disinfection with hot water

    TemperatureDuration1. Sanitary equipment80 C4560 seconds2. Cooking utensils80 C1 minute3. Linen70 C 95 C25 minutes10 minutes

  • Spectrum of activity achieved of the main disinfectants

  • Level of disinfection for patient equipment in relation with type of care

  • Principal sterilization methodsThermal sterilization Wet sterilization: exposure to steam saturated with water at 121 C for 30 minutes, or 134 C for 13 minutes in an autoclave; (134 C for 18 minutes for prions). Dry sterilization: exposure to 160 C for 120 minutes, or 170 C for 60 minutes; this sterilization process is often considered less reliable than the wet process, particularly for hollow medical devices.

  • Principal sterilization methodsChemical sterilization Ethylene oxide and formaldehyde for sterilization are being phased out in many countries because of safety and greenhouse gas emission concerns. Peracetic acid is widely used in the United States and some other countries in automatic processing systems.

  • Surgical wound infections (surgical siteinfections)Factors which influence the frequency of surgicalwound infection include surgical technique extent of endogenous contamination of thewound at surgery (e.g. clean, clean-contaminated) duration of operation underlying patient status operating room environment organisms shed by the operating room team.

  • Dekontaminasi & Pembersihan Alat alat KesehatanPembedahan / assisten bedah (dokter perawat dll)Pengolahan alat-alat kesehatan bedah Pembersihan dan pembuangan sampahTujuan Dekontaminasi & Pembersihan:Melindungi seseorang yang menangani/memegang alat-alat bedah dan perlengkapan lainnya yang kontak dengan darah/jaringan/cairan tubuh dari penyakit-penyakit yang serius dan penyebar-luasan penyakit melalui alat-alat kesehatanRISK AIDSHep. B

  • Jenis-jenis SterilisasiSterilisasi PanasSterilisasi penguapan dan tekanan tinggi (Autoclaving) 121C (250F) selama 20-30 menitSterilisasi pemanasan kering (oven) 170C (340F) selama 1 jamSterilisasi Kimia (Sterilisasi dingin)Seperti merendam dalam glutaraldehyde (8-10 jam) atau formaldehyde (24 jam)Sterilisasi GasSeperti gas formaldehyde atau uap basah formaldehydeSterilisasi dengan Ultra VioletSterilisasi kimia dengan Formaldehyde

  • KelompokEfektifitas melawan BakteriPotensi PemakaianKeteranganGram positifGram negatifTbVirusEndo-sporaJamur Kecepatan aksiPengaruh oleh zat organikSurgical scrubPersi-apanAlkohol (60-90% etil atau isopropil)Sangat baikSangat baikBaikBaikTidak adaBaikCepat Data bervariasiYaYaTidak dipakai pada selaput lendirChlorhexidine1 (4%) (Hibitane, Hibiscrub)Sangat baikSangat baikTidak baikCukupTidak adaCukupLambatSedikitYaYaMempunyai efek persisten yang baikHexachlorophene (3%)(pHisoHex)BaikTidak adaTidak baikCukupKurangBurukLambatSedikitYaTidakDapat terjadi pertumbuhan bakteri secara reboundPreparat Yodium (3%)Yodium dan alkohol (tinktura yodii)Sangat baikSangat baikBaikBaikTidak adaBaikRata-rataSedikitTidakYaTidak dipakai pada lapisan mukosaYodophor (1 : 2500)(Betadine)Sangat baikBaikBaikBaikBaikLambatYaYaYaDapat dipakai untuk lapisan mukosa

  • Ambulatory Surgery Operating Room

    Design Guide Plates and Data Sheets: Ambulatory Surgery Operating Room VA Design Guide Ambulatory Surgery, 1997

  • Design StandardsAmbulatory Surgery Operating Room

    ARCHITECTURAL Ceiling: Plaster Ceiling Ht: 2895 mm (9'-6 )* Wall Finish: Plaster (SC) Paint Wainscot: -- Base: Welded Seamless Flooring Floor Finish: Welded Seamless Flooring Slab Depr: Notes: Additional 8 accessible space above ceiling for microscope or 10- 2.

  • Design StandardsAmbulatory Surgery Operating Room

    LIGHTING General: 200 FC, (see Note 1) Special: Surgical Light (see Note 2) Emergency: 50% Gen Fluorescent (see Note 3) Notes: 1. Color improved lamps matching color temperature of surgical light. 2. (1) TYPE 840A, 1500 W 3. Battery backup in (4) fixtures.

  • Design StandardsAmbulatory Surgery Operating Room

    POWER General: (1) Module each wall Special: (2) 7-1/2 KVA 12-Circuit IPU Emergency: Each IPU & X-Ray unit (1) Film Processor per Suite POWER General: (1) Module each wall

  • Design StandardsAmbulatory Surgery Operating Room

    COMMUNICATIONS Patirnt Monitor: Yes Nurse Call: -- Code One: -- CCTV: Empty ConduitTelephone:Wall Mounted Hand FreeIntercom:Part of TelephonePub. Addr:Empty ConduitADP: -- Radio: Empty Conduit

  • Design StandardsAmbulatory Surgery Operating Room

    HEATING, VENTILATING AND AIR CONDITIONING Dry Bulb Temp Cooling: 190 C (68F) Dry Bulb Temp Heating: 230 C (75F) Minimum % Outside Air: 100100% Exhaust Air: Yes Noise Criteria: NC-40 Steam: --Relative Humidity/Cooling: 55%Relative Humidity/Heating: 50%

  • Design StandardsAmbulatory Surgery Operating Room

    HEATING, VENTILATING AND AIR CONDITIONING Minimum Air Changes/Hr.: 15 Occupied 8 Unoccupied Room Pressure: Positive AC Load Lights: 91W/m2 (8.5W/SF) AC Load Equipment:119W/m 2 (11.1W/SF) Number of People:12Special Exhaust: --

  • Design StandardsAmbulatory Surgery Operating Room

    PLUMBING AND MEDICAL GASES Cold Water: -- Hot Water: -- Laboratory Air: --Laboratory Vacuum: --Sanitary Drain --

  • Design StandardsAmbulatory Surgery Operating Room

    PLUMBING AND MEDICAL GASES Medical Air:Yes Medical Vacuum: Yes Oxygen: YesNitrogen Oxide: YesNitrogen: YesAnesthesia Evac: Yes

  • Immediate control measures for outbreak managementPrevention of hospital-acquired infections : A practical guide 2nd edition. World Health Organization Department of Communicable Disease, Surveillance and Response

    Type of transmission suspected Suggested action Cross-transmission (transmission between individuals) Patient isolation and barrier precautions determined by infectious agent(s) Hand transmission Improvements in handwashing Airborne agent Patient isolation with appropriate ventilation Agent present in water, waterborne agent Checking of water supply and all liquid containers Use of disposable devices Foodborne agent Elimination of the food at risk

  • Differential nosocomial infection risk by patient and interventions

    Risk of infection Type of patients Type of procedures 1 Minimal Not immunocompromised ; no significant underlying disease Non-invasive No exposure to biological fluids *

    2 Medium Infected patients, or patients with some risk factors (age, neoplasm) Exposure to biological fluids or Invasive non-surgical procedure (e.g. peripheral venous catheter, introduction of urinary catheter) 3 High Severely immunocompromised patients, (

  • Aseptic measures appropriate for different levels of risk of infection

    Risk of infection Asepsis Antiseptics Hands Clothes Devices* 1 Minimal Clean None Simple handwashing or hand disinfection by rubbing Street clothes Clean or disinfected at intermediate or low level 2 Medium Asepsis Standard antiseptic products Hygienic handwashing or hand disinfection by rubbing Protection against blood and biological fluids, as appropriate Disinfected at sterile or high level 3 High Surgical asepsis Specific major products Surgical handwashing or surgical hand disinfection by rubbing Surgical clothes: dress, mask, caps, sterile gloves Disinfected at sterile or high evel * All devices entering sterile body cavities must be sterile.

  • Akreditasi Kamar Operasi (Depkes)Kamar yang tenang, tempat pasien menunggu tindakan anestesi, dan dilengkapi dengan fasilitas untuk induksi anestesi.Kamar pulih (recovery).Ruang ganti pakaian pria dan wanita terpisah.Kamar operasi yang berhubungan langsung dengan kamar induksi (lihat diatas).Ruang yang cukup untuk menyimpan peralatan, linen,. Obat/farmasi termasuk bahan narkotik.Ruang untuk mendukung fungsi pendidikan/pelatihan.Ruang/tempat pengumpulan/pembuangan peralatan dan linen bekas pakai operasi. (Alur kotor & bersih tidak boleh bertemu)Tersedia ruang istirahat dan kelengkapan yang cukup bagi petugas yang harus berada di Kamar Operasi dalam jangka lama (misalnya WC, makanan, minuman, ruang duduk).

  • Modern operating roomsCurrent air standards are virtually free of particles larger than 0.5 m (including bacteria) when no people are in the room.Conventional operating rooms are ventilated with 20 to 25 changes per hour of high-efficiency filtered air delivered in a vertical flow. High-efficiency particulate air (HEPA) systems remove bacteria larger than 0.5 to 5 m in diameter and are used to obtain downstream bacteria-free air. The operating room is usually under positive pressurerelative to the surrounding corridors, to minimize inflow of air into the room.

  • Akreditasi Kamar Operasi

  • Operating room environment

    A recommended schedule for cleaning Purposes (Airborne bacteria must be minimized, and surfaces kept clean)every morning before any interventioncleaning of all horizontal surfacesbetween procedurescleaning and disinfection of horizontal surfaces and all surgical items (e.g. tables, buckets)at the end of the working daycomplete cleaning of the operating theatre using a recommended disinfectant cleaneronce a weekcomplete cleaning of the operating room area, including all annexes such as dressing rooms, technical rooms, cupboards.

  • Jarak antar Tempat Tidur

  • Cleaning of the hospital environment

    NamePatient Contact MethodZone Ano patient contact. (e.g. administration, library)Normal domestic cleaning Zone Bcare of patients who are not infected, and not highly susceptible, cleaned by a procedure that does not raise dust. Dry sweeping or vacuum cleaners are not recommended. The use of a detergent solution improves the quality of cleaning. Disinfect any areas with visible contamination with blood or body fluids prior to cleaning.Zone Cinfected patients (isolation wards)Clean with a detergent/disinfectant solution, with separate cleaning equipment for each roomZone D:highly-susceptible patients (protective isolation) or protected areas such as operating suites, delivery rooms, intensive care units, premature baby units, casualty departments and haemodialysis units. Clean using a detergent/ disinfectant solution and separate cleaning equipment.

  • PenutupKomitmenPemenuhan inputSistemikKonsistenIMPLEMENTASI PENCEGAHAN INFEKSI MEMERLUKAN

  • Cuci TanganHand washing may be the single most important infectionprevention procedure(Hatcher RA dkk)

  • Jenis Cuci TanganCuci tangan biasaCuci tangan untuk tindakan operasi (surgical scrubbing)

  • Kapan Cuci TanganSebelum & setelah kontak dengan pasienSebelum & setelah pakai sarung tanganSetelah terpapar cairan tubuh atau bahan/instrumen terkontaminasiLainnya

  • Categories of health care waste

    Waste categoryDescription and examplesInfectious wasteWaste suspected to contain pathogens, e.g. laboratory cultures; waste from isolation wards; tissues (swabs), materials, or equipment that have been in contact with infected patients; excretaPathological wasteHuman tissues or fluids, e.g. body parts; blood and other body fluids; fetusesSharpsSharp waste, e.g. needles; infusion sets; scalpels; knives; blades; broken glassPharmaceutical wasteWaste containing pharmaceuticals, e.g. pharmaceuticals that are expired or no longer needed; items contaminated by or containing pharmaceuticals (bottles, boxes)Cytotoxic wasteWaste containing substances with genotoxic properties, e.g. waste containing cytostatic drugs (often used in cancer therapy); genotoxic chemicals

  • Categories of health care waste

    Waste categoryDescription and examplesChemical wasteWaste containing chemical substances, e.g. laboratory reagents; film developer; disinfectants that are expired or no longer needed; solventsWastes with high content of heavy metalsBatteries; broken thermometers; blood pressure gauges; etc.Pressurized containersGas cylinders; gas cartridges; aerosol cans

    Radioactive wasteWaste containing radioactive substances, e.g. unused liquids from radiotherapy or laboratory research; contaminated glassware, packages, or absorbent paper; urine and excreta from patients treated or tested with unsealed radionucleotides; sealed sources

  • Differential nosocomial infection risk by patient and interventions

    1 MinimalNot immunocompromised; no significant underlying diseaseNon-invasiveNo exposure to biological fluids *2 MediumInfected patients, or patients with some risk factors (age, neoplasm)Exposure to biological fluids orInvasive non-surgical orprocedure (e.g. Peripheral venous catheter, introduction of urinary catheter)3 HighSeverely immunocompromised patients, (

  • Risk of infectionAsepsisAnti-septicsHandsClothes

    Devices*1 MinimalCleanNoneSimple handwashing or hand disinfectionby rubbingStreet clothesClean ordisinfected atintermediate or low level 2 MediumAsepsisStandard antisepticproductsHygienic handwashing or hand disinfection by rubbingProtection against blood and biological fluids, as appropriateDisinfected at sterile or high level3 HighSurgical asepsisSpecific major productsSurgical handwashing or surgical hand disinfection byrubbingSurgical clothes, dress, mask, caps, sterile glovesDisinfected at sterile or high level