Nurma Lindawati, S. Kep.

Ns
KOMITE PPI RSU HAJI SURBAYA
 TUJUAN PEMBELAJARAN

TUJUAN UMUM
Setelah proses pembelajaran peserta mampu melakukan kebersihan
tangan dengan benar sesuai dengan standart WHO

TUJUAN KHUSUS
Peserta mengerti latar belakang mengapa cuci tangan penting
Peserta dapat memperagakan 6 langkah cuci tangan
Peserta mampu menjelaskan dan memahami tentang five momen cuci
tangan
 BACKGROUND
Historikal : Semmelweis
Mikroorganisme di kulit

Resistensi mikroba terhadap antibiotik

HAIs banyak disebabkan oleh kontaminasi tangan

 Ignaz Semmelweis, 1815-1865
1840s: General Hospital of 16
Vienna

Maternal mortality, 1842

14
Divided into two clinics, 12
alternating admissions 10

every 24 hours: 8
6
First Clinic: Doctors
4
and medical students
2
Second Clinic: 0
Midwives First Clinic Second
Clinic
Hand Hygiene: Not a New Concepte
Maternal Mortality due to Postpartum Infection
General Hospital, Vienna, Austria, 1841-1850
18
Semmelweis Hand
Hygiene Intervention
16
Maternal Mortality (%)

14

12

10

0
1841 1842 1843 1844 1845 1946 1847 1848 1849 1850

MDs Midwives

Hand antisepsis reduces the frequency of patient infections

MIKROORGANISME DI KULIT
Mikroorganisme RESIDENT

Menetap di kulit
Menjaga keseimbangan flora

Mikoroorganisme TRANSIENT

Tidak menetap
Bisa pathogen maupun
apathogen
RANTAI PENULARAN INFEKSI
INFEKSI SILANG
SIAPA YANG WAJIB CUCI TANGAN
Setiap orang yang kontak langsung
dengan pasien

Setiap orang yang kontak tidak langsung

dengan pasien

Setiap orang yg berkontribusi dengan

prosedur yang dilakukan terhadap pasien

Setiap orang yang bekerja di RS

PERFORMA CUCI TANGAN DI RUMAH
SAKIT
LINGKUNGA UNIT RAWAT
N KERJA INTENSIVE
KESIBUKAN LEBIH BANYAK
MELAKUKAN CUCI
TANGAN SESUDAH
DARIPADA SEBELUM
DARI
5 MOMENT

KATEGORI
PROFESI DOKTER
 PENYEBAB KETIDAKPATUHAN CUCI
TANGAN
Menggunakan sarung tangan
Tidak ada anjuran/protokol
Kurang pengetahuan
Tidak ada reward dan punisment
Tidak ada role model atau supervisor
Lupa

Menyebabkan iritasi dan Mengapa Tidak setuju dengan rekomendasi

kekeringan pada kulit tidak yang dianjurkan
Sarana dan prasarana melakukan Kurang sosialisasi
hand
Terlalu sibuk Manajement tidak menganggap Hand
hygiene??? hygiene sebagai hal yang penting
JENIS KEBERSIHAN TANGAN

DENGAN AIR
MENGALIR
(HANDWASH)

DENGAN
ALKOHOL
(HANDRUB)
 TEKNIK
EFEKTIFITAS

WAKTU
TERGANTUNG
JUMLAH
 PRODUK

ALKOHOL, CHLORHEXIDINNE, CHLOROXYLENOL, HEXACHLOROPHENOL, YODIUM,

IODOPHOR, TRICLOSAN

EFEKTIF UNTUK KUMAN GRAM NEFEKTIF UNTUK

KUMAN GRAM NEGATIF +POSITIVEEGATIF
+POSITIVE

MICOBACTERIA DAN FUNGI PALING EFEKTIF

DIELIMINASI OLEH ALKOHOL
 ALKOHOL HANDRUB
Bila tangan tidak tampak kotor
100 ml alkohol 70% +1-2 ml gliserin 10%
ResepWHO
Formulasi 1, untuk menghasilkan Konsentrasi akhir ethanol 80 %,
gliserol 1,45%, H2O2 0,125%
Etanol 96% 833.3 ml
Hydrogen peroksida 3% 41.7 ml
Gliserol 98% 14.5 ml

Formulasi 2, untuk menghasilkan Konsentrasi akhir isopropil

alkohol 75%, gliserol 1,45%, H2O2 0,125%
Isopropil alkohol 99.8% 751.5 ml
Hidrogen peroksida 3% 41.7 ml
Gliserol 98% 14.5 ml
Tambahkan formula dg air distilasi/rebusan/dingin sp
mencapai 1000ml,campur sp homogen 2-15
TEKNIK CUCI TANGAN
Sebelum melakukan kebersihan tangan
pastikan perhiasan cincin, termasuk
cincin kawin, gelang, arloji, tidak dipakai.

Kulit dibawah perhiasan kolonisasi yang

berat, sulit dibersihkan/dekontaminasi

Memakai perhiasan akan sulit saat

memakai sarung tangan
KOLONISASI HAND PERSONAL (Shetty, 2009)
BILA CUCI TANGAN TIDAK SESUAI ATURAN
CUCI TANGAN YANG SALAH
 CUCI TANGAN YANG SALAH

Paling sering
tertinggal

Sering tertinggal

Tidak pernah
tertinggal
PENGGUNAAN GLOVE
TIDAK DAPAT
MENGGANTIKAN
CUCI TANGAN
DAPAT MENCEGAH
KONTAMINASI, APABILA
MENURUNKAN SESUAI
TRANSMISI, MENCEGAH ATURAN
KLB
CARA MENINGKATKAN KEPATUHAN
SISTEM (MIND SIDE, SARANA DAN
FIVE PRASARANA)
IMPROVEME
TRAINING/EDUKASI
NT
STRATEGIE EVALUATION AND FEED BACK
S WHO
OBSERVASI LANGSUNG
ELEKTRONIK MONITORING
EVALUASI PENGGUNAAN SABUN/HANDRUB

REMINDERS IN THE WORKPLACE

INSTITUTIONAL SAFETY CLIMATE

 DOKUMENTASI

Mengajarkan Hand Hygiene

mengajarkan perubahan perlaku Hand hygiene jajaran direksi
DOKUMENTASI

Hand hygiene pengunjung

 DOKUMENTASI

Kampanye memperingati Hand

Roadshow Hand Hygiene
hygiene sedunia
 DOKUMENTASI

Hand Hygiene Award KOMITMEN RSU HAJI

5 Mei 2015 SURABAYA
LOMBA LEAFLET DAN POSTER PPI
AYO HAND HYGIENE DOKTER.......
 DENGAN
ALKOHOL
(HANDRUB)
DENGAN AIR
MENGALIR
(HANDWASH)
FIVE MOMENT HAND HYGIENE
1. TELAPAK TANGAN 2. PUNGGUNG TANGAN
3. SELA-SELA JARI 4. PUNGGUNG JARI
5. IBU JARI 6. UJUNG-UJUNG JARI
 APPLICABLE GUIDELINES
Table 10.1 World Health Organization Consensus Recommendations Hand Hygiene in Health Care, 2009
HAND HYGIENE
2. Hand hygiene technique
A. Apply a palmful of alcohol-based handrub and cover all surfaces of the hands. Rub hands until dry (IB).
B. When washing hands with soap and water, wet hands with water and apply the amount of product necessary to cover all surfaces. Rinse hands with water and dry
thoroughly with a single-use towel. Use clean, running water whenever possible. Avoid using hot water, as repeated exposure to hot water may increase the risk of
dermatitis (IB). Use a towel to turn off tap/faucet (IB). Dry hands thoroughly using a method that does not recontaminate hands. Make sure towels are not used multiple
times or by multiple people (IB).
C. Liquid, bar, leaf or powdered forms of soap are acceptable. When bar soap is used, small bars of soap in racks that facilitate drainage should be used to allow the bars to
dry (II).
3. Recommendations for surgical hand preparation
A. Remove rings, wrist-watch, and bracelets before beginning surgical hand preparation (II). Artificial nails are prohibited (IB).
B. Sinks should be designed to reduce the risk of splashes (II).
C. If hands are visibly soiled, wash hands with plain soap before surgical hand preparation (II). Remove debris from underneath fingernails using a nail cleaner, preferably
under running water (II).
D. Brushes are not recommended for surgical hand preparation (IB).
E. Surgical hand antisepsis should be performed using either a suitable antimicrobial soap or suitable alcohol-based handrub, preferably with a product ensuring sustained
activity, before donning sterile gloves (IB).
F. If quality of water is not assured (as described in Table I.11.3) in the operating theatre, surgical hand antisepsis using an alcohol-based handrub is recommended before
donning sterile gloves when performing surgical procedures (II).
G. When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, typically 25
minutes. Long scrub times (e.g. 10 minutes) are not necessary (IB).
H. When using an alcohol-based surgical handrub product with sustained activity, follow the manufacturers instructions for application times. Apply the product to dry hands
only (IB). Do not combine surgical hand scrub and surgical handrub with alcohol-based products sequentially (II).
I. When using an alcohol-based handrub, use sufficient product to keep hands and forearms wet with the handrub throughout the surgical hand preparation procedure (IB).
J. After application of the alcohol-based handrub as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves (IB).
IFIC Basic Concepts of Infection Control
TERIMAKASIH