Hand Hygiene

Clinical Application Specialist

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page

 welcome to hospital

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 3

 - HAI’s - healthcare assosiated infections

Infeksi yang terjadi pada pasien selama proses

perawatan di rumah sakit (setelah 48 jam) atau
fasilitas layanan kesehatan lain yang tidak ada
atau tidak dalam masa inkubasi ketika masuk

Termasuk infeksi yang didapat di rumah sakit, tetapi muncul setelah pulang dan
Infeksi pada petugas rumah sakit sehubungan dengan pekerjaannya

Ducel G et al. 2002. Prevention of hospital-acquired infections : A practical guide. WHO

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page

 Most frequent sites of infection
and their risk factors
URINARY TRACT INFECTIONS 34% 13% LOWER RESPIRATORY TRACT INFECTIONS
Urinary catheter Mechanical ventilation
Urinary invasive procedures Aspiration
Advanced age Nasogastric tube
Severe underlying disease Central nervous system depressants
Urolitiasis Antibiotics and anti-acids
Pregnancy Prolonged health-care facilities stay
Diabetes Most common Malnutrition
Advanced age
sites of health
LACK care-
OF Surgery
associated infection Immunodeficiency
HAND
and the risk factors
SURGICAL SITE INFECTIONS underlying the
HYGIENE BLOOD INFECTIONS
Inadequate antibiotic prophylaxis occurrence of Vascular catheter
Incorrect surgical skin preparation infections Neonatal age
Inappropriate wound care Critical care
Surgical intervention duration Severe underlying disease
Type of wound Neutropenia
Poor surgical asepsis Immunodeficiency
Diabetes New invasive technologies
Nutritional state Lack of training and supervision
Immunodeficiency
Lack of training and supervision 17% 14%

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page

 Hand
Hygiene

Tindakan membersihkan tangan dengan

sabun dan air

mengunakan

mengalir atau Alkohol

based Handrub
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 9
 Routine
handrub
20-30s
Hand
rub
Surgical
+ 60s
handrub
Hand
Hygiene
Surgical 2-5mnt
handscrub
Hand
wash Medicated
soap 40-60s
handwash
Plain soap
handwash
40-60s
WHO. 2009. Guidelines on Hand Hygiene in Healthcare. Geneva
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 10
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 11
 ZONA PASIEN dan AREA PERAWATAN

2
3

1
5
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page
H Sax, University Hospitals, Geneva 2006
 Sebelum kontak pasien
Sebelum tindakan aseptik
Setelah kontak cairan tubuh
Setelah kontak pasien
Setelah Kontak lingkungan pasien

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page

 Paling
sering
terlewat

sering
terlewat

jarang
terlewat

Reference: “Taylor L” (1978)

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page
 Langkah Routine handrub

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 22
Apa
Terbaik…

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 23

Alcohol based?
Ethanol 60-80%,Propanol,Isopropanol
-
- Membunuh bakteri gram negatif dan gram positif, jamur, Tubercle bacilli,
virus (envelope & non envelope virus).
- Daya kerja cepat
- Tidak menimbulkan residu
- Paling direkomendasikan CDC dan WHO

WHO. 2009. Guidelines on Hand Hygiene in Healthcare. Geneva

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 24
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 25
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 29
 Kepatuhan Hand Hygiene

50%

www.hopisafe.ch

Pittet D et al, Lancet 2000; 356: 1307-1312

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page

 Menurunkan kejadian HAI’s
Alcohol-based handrubbing
Handwashing (soap + water)

12/94 12/95 12/96 12/97

www.hopisafe.ch
Pittet D et al, Lancet 2000; 356: 1307-1312
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page
 System change :
alcohol-based
handrub

Institutional safety System change: access

climate to safe continuous water
supply and towels

WHO MULTI MODAL

STRATEGY
Reminders in the Training and
workplace
education

Observation and
feedback

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 34

 1. System change ; Alcohol-based handrub
a. Bed/ brankart pasien
Penyediaan b. Trolley tindakan
Alkohol based c. Kamar pasien
d. Nurse Station
Handrub di : e. Poster dan SOP Hand Hygiene
f. Sesuai ukuran kantong baju
perawat

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 35

 LANJUTAN ……………..

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 36

 2.System change: access
to safe continuous water
supply and towels
• 1 washtafel / 10 pasien

• Ketersediaan sabun dan handuk

bersih (Misal ; handuk kertas)

• Kualitas air terjamin

• Tempat sampah/tisu/handuk
sekali pakai dg tipe pijakan

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 37

 Panduan WHO untuk handwash
 Gunakan air mengalir, hindari air panas
 hindari menggunakan sikat tangan/brushes, gunakan sponge
jika tangan terlihat kotor dan plain soap.
 Untuk keperluan antisepsis boleh menggunakan sabun
antimikroba (2-5 menit) atau handrub (teknik untuk bedah;
60 detik)
 Jika kualitas air di IBS tidak memenuhi standar, maka untuk
antisepsis diprioritaskan dengan handrub sebelum
mengenakan sterile gloves
 Jika handrub berkualitas tersedia di RS, maka sabun
antimikroba tidak direkomendasikan untuk digunakan.
 Hindari menambahkan sabun atau handrub pada kemasan
setengah kosong
PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 38
3. Training and
Education

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 39

 Audit
Ward
Kepatuhan
Infrastruktur
Hand
Survey
hygiene

Survey
Pengetahu- Survey
an & Kebutuhan
Persepsi Handrub &
Handwash

4. Observation & Feedback

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 40
 Audit Fasilitas

4
4
Menghitung Kebutuhan Alkohol Based Handrub

Contoh, di ICU RS A. Tenaga ruangan tsb 25 orang per shift, tapi

kira-kira hanya 15 orang yang melakukan kontak langsung ke
pasien dengan kesempatan untuk melakukan hand hygiene
22x perjam, x 5 jam kerja efektif perhari x 22 hari kerja
perbulan x 2 cc alkohol-based handrub = 72.6 L alkohol-based
handrub per bulan (+10% yang terbuang) = 79.9 L alkohol-
based handrub perbulan untuk ruang ICU.

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 48

 5.
REMINDER
Poster 5
Moments

Poster
Handrub

Poster
Handwash

PT. BBraun Medical Indonesia | Clinical Application Specialist49

| Page
6. Institutional safety climate

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 50

 Terima

PT. BBraun Medical Indonesia | Clinical Application Specialist | Page 78