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INFECTION CONTROL RISKASSESSMENT (ICRA) UNTUK

PENCEGAHAN INFEKSI DI RS

Luwiharsih

BIDANG DIKLAT KARS

LUWI-ICRA HAI-12062013 1

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FOKUS DARI PROGRAMStandar PPI 6.• RS menggna!an "ende!atan #erda$ar r%$%!& da'am

menent!an &!$ dar% "r&gram PPI d% RS ada'a "en*egaan+

"engenda'%an dan "engrangan %ne!$% ter!a%t "e'a,anan

!e$eatan.

E'emen Pen%'a%an PPI 6.

. RS te'a meneta"!an &!$ "r&gram me'a'% "engm"'an

data ,ang ada d% Ma!$d dan T/an a) $am"a% )

0. Data ,ang d%!m"'!an a) $am"a% ) d%e1a'a$%2d%ana'%$%$.

3. 4erda$ar!an e1a'a$%2ana'%$%$ data+ ma!a d%am#%' t%nda!an

mem&!$ ata mem&!$ 'ang "r&gram PPI.

4. Rumah sakit melakukan asesmen terhadap risiko paling

sedikit setiap tahun dan hasil asesmen didokumentasikan.

ICRA

LUWI-PPI 2062013

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FOKUS DARI PROGRAM

Standar PPI 5.

• RS mengidentifkasi prosedur dan proses terkait denganrisiko ineksi dan mengimplementasi strategi untukmenurunkan risiko ineksi.

E'emen Pen%'%an PPI 5.1. RS telah meng%dent%!a$% "r&$e$ ter!a%t dengan

r%$%!& %ne!$% (lihat juga MPO.5, EP 1

!. RS telah meng%m"'ementa$% $trateg% penurunan risikoineksi pada seluruh proses (lihat juga MPO.5, EP 1

". RS meng%dent%!a$% r%$%!& mana (lihat juga PP#. $.1 s%dPP#.$.5 &ang mem'utuhkan ke'ijakan dan atau prosedur,edukasi sta, peru'ahan praktik dan kegiatan lainn&auntuk mendukung penurunan risiko

Ine*t%&n *&ntr&' r%$! a$$e$$ment (ICRA) "ada EP + 0+

3

LUWI-PPI 2062013

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INFECTION CONTROL RISK ASSESSMENT

• Mer"a!an #ag%an dar% "r&$e$"eren*anaan PPI

• Se#aga% 'ang!a a7a' nt!

mengem#ang!an ren*ana dengan #a%! • Peren*anaan ,g d%'a!!an $e*ara#er$ama+ mer"a!an #ent! da$ar dar%"r&gram.

• Mem#ant me'a!!an &!$ $r1e%'an*edan !eg%atan "r&gram 'a%nn,a

• Mer"a!an !etentan "er$,aratan ,angar$ d%"en%.


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• Me'a!!an %dent%!a$% r%$%!& t! %ne!$% ,ang

d%"er&'e dan d% tran$m%$%!an #erda$ar!an 8

o '&!a$% ge&gra+ *&mmn%t, dan "&"'a$% ,ang

d%'a,an%

o A$an+ "eng&#atan dan "e'a,anan ,ang

d%$ed%a!an

o Ana'%$%$ dar% !eg%atan $r1e%'an*e dan data %ne!$%

'a%nn,a.

• Ident%!a$% r%$%!& $et%a" ata dan #%'a ter/ad%

"er#aan ,ang $%gn%*ant


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• R%$! A$$e$$ment d%da"at!an dengan

ma$!an %nterd%$*%"'%nar, 8

• Ine*t%&n "re1ent%&n "er$&ne'

(K&m%te2Pan%t%a2T%m PPIRS+ IPCN)

• Med%*a' Sta

• Nr$%ng

• La%nn,a

• Pr%&r%ta$ dan d&!men r%$%!&


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RISK ASSESSMENT PROCESS

• Per$%a"an dan "eren*anaan

o F&rm'%r90

F&rm'%r e1a'a$% "eng&rgan%$a$%an PPI F&rm'%r "er$%a"an r%$! a$$e$$men

o Standard

o La"&ran

o Pengetaan tentang I$$e ,ang ter/ad%

$aat %n%


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RISK ASSESSMENT PROCESS

• Re!r%tment T%m

o Undangan

o

M%nta %n&rma$% dan $'an90"en%ng!atan

o Ma$a'a PPI a"a ,ang "a'%ng "ent%ng

o Pen,e#a# a"a ,ang $er%ng d%tem!an

"ada 7a!t 1%$%t+ adm%$$%&n+

"e'a!$anaan "r&$edr+ d''


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RISK ASSESSMENT TEAM

• K&m%te2Pan%t%a2T%

m PPIRS : IPCN

• Sta med%$

• La#&rat&r%m

• Farma$%• Nr$%ng

• Srger,

• Ra7at ;a'an

• San%ta$% RS

• Eng%neer%ng

• CSSD

• K&m%te Mt RS


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RISK ASSESSMENT MEETING

• K&m%tmen "e$erta ra"at

• <a!t d%$!$% #an,a! ma$!an dar%

"e$erta

• Pr%&r%ta$ r%$%!&

•

Tent!an Ren*ana PPI


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E=ALUASI ORGANISASI

• D%$!r%"$%!an a!t&r90

• Karater%$t%! ,ang men%ng!at!an r%$%!&

%ne!$%

• Karater%$t%! ,ang menrn!an r%$%!& %ne!$%

• Ma$!an dar% ra"at+ &rm %$%an ,ang $da

d%'eng!a"%

• Teman dar% r%$! a$e$men


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E=ALUASI ORGANISASI

• Fa!t&r9a!t&r ,ang terma$! 8

o Ge&gra dan en1%r&nmenta'

o

Karater%$t%! "&"'a$%o Area endem%! %ne!$%

o Area 'a%nn,a ,ang ter!a%t %ne!$%

o Karater%$t%! a$an med%$

o Pe'a,anan ,ang d%$ed%a!an

LUWI-ICRA HAI-12062013 1!

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G"OGRAFI DAN POPULASI RISK ASS"SSM"NT

LUWI-ICRA HAI-12062013 1#

FAKTOR KARATERISTIK YGMENINGKATKAN RISIKO

KARATERISTIK YGMENINGKATKAN RISIKO

Geografi & lingkungan RS

Karateristik populasi

Area lainnya – terkaitrisiko

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G"OGRAP$I% AND POPULATION RISK

ASS"SSM"NT


FAKTOR KARATERISTIK YGMENINGKATKAN RISIKO

KARATERISTIK YGMENINGKATKAN RISIKO

Area ene!i" infe"tions

Mei"al "area"#arateristik

Ser$i"e pro$ie

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RISK ASSESSMENT

• Ke'&m"&! !er/a2T%m m'a%

#e!er/a me'a!!an r%$!

a$$e$$men

Me'a!!an e1a'a$%

"&ten$%a' r%$%!& t!

%ne!$%2!&ntam%na$%2

ter"a"ar d% $et%a" 3 !ateg&r%

dar% "r&#a#%%t,+ %m"a*t dan

*rrent $,$tem$.


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%OTENSIA RISK'%RO(EM

%RO(A(IITY RISK IM%A)T *+EAT+,FINAN)IA, EGA,

REG-ATORY.

)-RRENT SYSTEM'%RE%ARE/NESS

S)ORE

4 3 2 1 0 5 4 3 2 1 5 4 3 2 1

INF"%TION %ONTROL RISK ASS"SSM"NT

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RISK GROUP

• Ant%#%&t%* > re$%$tant &rgan%$m$

• Kegaga'an dar% !eg%atan2t%nda!an "en*egaan

• Keg%atan %$&'a$%

• Ke#%/a!an : Pr&$edr

• Ke$%a"an

• HAI$

• En1%r&nment

• Ke$eatan Kar,a7an

• La%nn,a


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Ant%#%&t%* > re$%$tant &rgan%$m$

• MRSA

• C. Diff

• VRE

• ESBL/Othe !"# $e%"ti&e B"'tei"


LUWI ICRA HAI 12062013 19

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Kegaga'an dar% !eg%atan2t%nda!an"en*egaan

• a)k o *and *&giene

• a)k o Respirator& *&giene%+ough

Etiuette

• a)k o Patient in-uena immuniation

• a)k o Patient Pneumo/a0

#mmuniation


LUWI ICRA HAI 12062013 !

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(E!IA)A$ ISOLASI

•L"'* +f St"," Pe'"ti+,

•L"'* +f Ai+,e Pe'"ti+,

•L"'* +f D+et Pe'"ti+,

•L"'* +f C+,t"'t Pe'"ti+,

LUWI-ICRA HAI-12062013 !

LUWI ICRA HAI 12062013 !1

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(EBIA(A$ PROSEDUR

• L"'* +f 'e,t +i'ie4 +f +'ee4 54e'if7

• 8"ie t+ f++9 e4t"i4he +i' "t"

+'ee 54e'if7

LUWI-ICRA HAI-12062013 !1

LUWI ICRA HAI 12062013 !!

7/21/2019 RCM ICRA


PREPARED$ESS

• E:+4e t+ i+te+i4#e A%e,t

• E:+4e t+ SARS/P",e#i' I,fe,;"/Othe

Re4i"t+ I,fe'ti+,4

LUWI-ICRA HAI-12062013 !!

LUWI ICRA HAI 12062013 !#

7/21/2019 RCM ICRA


He"th'"e A'<ie I,fe'ti+,4 5HAI47

• S%i'" Site I,fe'ti+,4 5SSI7 C"i"'

• SSI +th+ei' +i,t Re"'e#e,t

• SSI "i,,"

• VAP i, ICU4

• HAP

• IAD ICU

• IAD ",% e"9"t",

• D"i4i4 Re"te I,fe'ti+,

• IS(

• Ote"*

• Se,ti,e e&e,t

• HAI "i,,"

LUWI-ICRA HAI-12062013 !#


7/21/2019 RCM ICRA


E$VIRO$ME$)

• C+,t"#i,"te i"4i4 9"te 44te#

• I,fe'ti+, f+# I,"e<"te Steii;"ti+,

• Le%i+,e" Di4e"4e

• I,fe'ti+, f+# i,"e<"te Ai h",i,%

• P+e#4 9ith 'e",i,%/e4i,fe't",

• C+,t"#i,"ti+,/I,fe'ti+, f+# h"#"' e,&i+,#e,t

• I,fe'ti+, Re"te t+ C+,t'ti+,/Re,+&"ti+,



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EMPLO=EE HEAL)H

• a)k o sta in-uena immuniation

• a)k o )omplian)e 2ith health re/ie2s

• E0posure to 'lood'orne pathogens

• Risk o unkno2n e/el o )ommuni)a'le

3isease 4mong emplo&ee

• E0posure to pertussis



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O)HER

• Ri4* +f '+##,it Ote"*

• $e9 +%"#

• $e9 P+'ee

•



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Meneta"!an t%ga n%'a%nt! $et%a" r%$%!&

• Pr&#a#%'%t,

• Ris&'i()a*+

• Crrent $,$tem2Pre"aredne$$



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PRO4A4ILIT?CONSIDERATIONS

• R%$%!& ,ang d%!ena'2d%!eta%

• R%7a,at data

• La"&ran da'am '%teratr



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PROBABILIT,

• > ? e:e'tit

• 3 ? Li*e

• 2 ? M"e

• 1 ? R"e

• 0 ? $e&e


LUWI-PPI 2062013

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P"NILAIAN PROBABILITAS'FR"KU"NSI

LUWI PPI 2062013

TINGKATRISIKO

DESKRIPSI

1 Sangat /arang2 rare (@ tan2!a'%)

! ;arang2n'%!e, (@ 0 > tan2!a'%)

" Mng!%n2 P&$%#'e ( 90 tan2!a'%)

Ser%ng2L%!e', (#e#era"a !a'%2tan)

5 Sangat $er%ng2 a'm&$t *erta%n (t%a"m%ngg2 #'an)

LUWI-ICRA HAI-12062013 #1

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IMPACT CONSIDERATIONS

• Mengan*am /%7a dan ata !e$eatan

• D%$r"t%&n & $er1%*e$

• Ke%'angan ng$%

• Ke%'angan !e"er*a,aan !&mn%!a$%

• Dam"a! !eangan

• Lega' %$$e$

• Dam"a! reg'at&r,

• Standard2"er$,aratan

LUWI ICRA HAI 12062013 #1

LUWI-ICRA HAI-12062013 #!

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RISK'IMPA%T

• @ ? C"t"4t+hi' L+44

5Life/Li#/f,'ti+,/fi,",'i"7

• > ? Sei+4 L+44 58,'ti+,/8i,",'i"/Le%"7

• 3 ? P++,%e Le,%th +f St"

• 2 ? M+e"te Ci,i'"/8i,",'i"• 1 ? Mi,i#" Ci,i'" 8i,",'i"

#!

P"NILAIAN DAMPAK KLINIS'KONS"KU"NSI'S"-"RIT, .1/LUWI-PPI 2062013

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P"NILAIAN DAMPAK KLINIS'KONS"KU"NSI'S"-"RIT, .1/

TK RIKS De$!r%"$% Dam"a!

Td!$%gn%*ant

T%da! ada *edera

0 M%n&r • Cedera r%ngan + m%$ '!a 'e*et• Da"at d%ata$% dng P3K

3 M&derat • Cedera $edang+ m%$ 8 '!a r&#e! • 4er!rangn,a ng$%

m&t&r%!2$en$&r%!2"$%!&'&g%$ ata

%nte'e!ta' (re1er$%#e'. Td!#er#ngan dng "en,a!%t

• Set%a" !a$$ ,g me"er"an/ang"era7atan

B Ma,&r • Cedera 'a$2#erat+ m%$ 8 *a*at+ 'm"• Ke%'angan ng$% m&t&r%!2$en$&r%!2

"$%!&'&g%$ ata %nte'e!ta'(%re1er$%#e')+ td! #er#ngan dng"en,a!%t

Katatr&"%! Kemat%an ,g td! #er#ngan dng"er/a'anan "en,a!%t


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CURRENT S?STEMS CONSIDERATIONS

• Ke#%/a!an dan "r&$edr $aat %n%

• Im"'ementa$% dar% ren*ana

• Stat$ tra%n%ng

• Ind%!at&r &t*&me ata "r&$e$

• Ter$ed%an,a #a*!" $%$tem

• C&mmn%t,2"#'%* ea't re$&r*e$


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CURRENT S?STEMS

• @ ? $+,e

• > ? P++

• 3 ? 8"i

• 2 ? !++

• 1 ? S+i


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%OTENSIA RISK'%RO(EM

%RO(A(IITY RISK IM%A)T *+EAT+,FINAN)IA, EGA,

REG-ATORY.

)-RRENT SYSTEM'%RE%ARE/NESS

S)ORE

4 3 2 1 0 5 4 3 2 1 5 4 3 2 1

$OSPITAL A%0UIR"D INF"%TION

S%i'" Site I,fe'ti+, 3 4 2 9

Ve,t A44+'i"te P,e#+,i" 3 4 3 10

Ce,t" Li,e Re"te B++ Ste"#I,fe'ti+, 5CLBSI7/IAD

4 4 4 12

INF"%TION %ONTROL RISK ASS"SSM"NT

LUWI-PPI 2062013

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T"RIMA KASI$

RCM ICRA

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