HP 08129146524

Palembang 22 Juni 1953

kapuyux@gmail.com
ANTI MICROBIAL RESISTANCE PROGRAM
IN 1sst EDITION SNARS
OF HOSPITAL ACREDITATION

Dr Djoni
j Darmadjaja,
j j SpB,MARS
p
KOMISI AKREDITASI RUMAH SAKIT

Report
Working Group
Antimicrobial Use
Human & Animal
Health

National workshop on NAP development to

combat AMR
30 May – 1 June 2016
Jakarta, Indonesia

AWAL KETERLIBATAN KARS DALAM

PPRA

1
NATIONAL ACTION PLAN-AMR
5 STRATEGIC OBJECTIVES OF
GLOBAL ACTION PLAN-AMR

Objective 1: Improve awareness and understanding of antimicrobial

resistance through effective communication, education and training.
Objective 2: Strengthen the knowledge and evidence base through
surveillance and research.
Objective 3: Reduce the incidence of infection through effective sanitation,
hygiene and infection prevention measures.
Objective 4: Optimize the use of antimicrobial medicines in human and
animal health.
Objective 5: Develop the economic case for sustainable investment that
takes account of the needs of all countries, and increase investment in new
medicines, diagnostic tools, vaccines and other interventions.

KARS INVOLVING IN NAP-AMR

2
 ANTIMICROBIAL RESISTENCE PROBLEM
CAUSING BY

NON PRUDENT ANTIBIOTIC USE

The increasing problem of antimicrobial resistance cause by the

unwise and unresponsible use of antimicrobials, so dispersion of
resistant microbes from patients to their environment due to poor
implementation of infection control and prevention practices.
In order to control resistant microbes in hospitals
hospitals, it is necessary to
develop antimicrobial resistance control programs in hospitals.
Control of antimicrobial resistance is an activity which aimed at
preventing and / or decreasing the incidence of resistant microbes.

ANTIBIOTIC HISTORY
Speed of
invention
antibiotics
NATIONAL LEVEL CONTROL
The emergence
resistance
germs

In the context of controlling antimicrobial resistance widely in both health

- Post antibiotic era
- Back to the times of
pre antibiotics
-Increased mortality
due to infectious diseases
Chart
Speculative
Time
Source of data KPPIRS RSCM
care facilities and in the community, at the national level an Antimicrobial
Control Committee has been established, here inafter abbreviated KPRA
by the Ministry of Health. In addition, there is a national action plan on
antimicrobial resistance (NAP AMR) supported by WHO.
An antimicrobial resistance control program (PPRA) is an integrated and
complete antimicrobial resistance control effort in health care facilities.

3
 ROLE OF KARS IN ANTIMICROBIAL
RESISTANCE CONTROL PROGRAM
BY
IMPLEMENTATION USING ACCREDITATION STANDARDS

Implementation of this program in hospitals will succeed well if get fully

supporting by hospital leaders / directors by forming regulation of
antimicrobial resistance control, establishment of management
organization, facility provision, and financial support to support PPRA
implementation in hospital
hospital. ESTABLISH A PPRA STANDARD
Use of antimicrobials wisely is the use of antimicrobials appropriate to IN SNARS ED 1
infectious diseases and their causes with optimal dosing regimens,
optimal duration of administration, side effects and the minimal adverse
effects of microbes on patients.

PENYELENGGARAAN PENGENDALIAN
I. GROUPS OF SERVICE (ARK,HPK,AP, RESISTENSI ANTIMIKROBA (PPRA)
STANDARDS FOCUS ON PAP,PAB,PKPO
PATIENTS MKE)
No STANDAR FOKUS AREA
((7 BAB))

1 st Edition (PMKP,PPI,TKRS, 1 PPRA.4 PENYELENGGARAAN PROGRAM TINGKAT RS

II. GROUPS OF STANDARDS MFK, KKS, MIRM) KETERLIBATAN DIREKTUR DALAM PENYUSUNAN
NATIONAL OF MANAGEMENT PROG
STANDARD (6 BAB)
DUKUNGAN ANGGARAN OPERASIONAL
OF HOSPITAL KEPATUHAN STAF AKAN PANDUAN PENGGUNAAN AB
LAPORAN DIREKTUR RS KE KPRA PUSAT SETIAP
ACCREDITATION III. PATIENT SAFETY GOALS SKP TAHUN

PONEK 2 PPRA.4.1 ORGANISASI PELAKSANA KEGIATAN DALAM BENTUK

HIV/AIDS KOMITE/TIM
IV. NATIONAL PROGRAMME TB BUKTI KEGIATAN ORGANISASI PRA
PPRA PENETAPAN INDIKATOR MUTU PRA
GERIATRI MONITORING DAN EVALUASI PROGRAM PRA
LAPORAN BERKALA KOMITE/TIM PRA KEPADA
V. INTEGRATION OF HEALTH DIREKTUR
EDUCATION IN HOSP SERVICES IPKP 2 STANDAR 10 EP

4
 IMPLEMENTATION OF ANTIMICROBIAL
RESISTANCE PROGRAM
IN HOSPITAL
STANDARD 4 - PPRA
The organization conducts antimicrobial resistance
control in accordance with the laws and regulations.
INTENT & PURPOSE OF
STANDARD OF PPRA 4
The organization prepares reports on the implementation of PRA
programs / activities including:
a). socialization and training of health personnel staff on antimicrobial
resistance control
b). surveillance patterns of antibiotic use in hospitals (including
reports on the implementation of antibiotic controls)
c). surveillance pattern of antimicrobial resistance
d). an integrated infectious disease study forum
INTENT & PURPOSE OF
STANDARD OF PPRA 4
Available regulation of antimicrobial resistance control in RS that
includes:
Control of antimicrobial resistance an antibiotic guidance for
therapy and surgical prophylaxis executing organization, Team /
Committee of PPRA consists of competent health personnel from:
Medical Staff, Nursing Staff, Pharmacy staff, Laboratory staff who
perform microbiological services, Committee of Pharmacy and
Therapy, Committee of Infection control.
STANDARD RATING ELEMENTS – PPRA 4
There are regulations and programs on antimicrobial resistance control in
hospitals according to the laws and regulations. (R)
There is evidence that hospital leaders are involved in programming. (D, W)
There is evidence of operational budget support, secretarial services,
facilities to support functional activities
activities, and PPRA organizational tasks
tasks. (D,
(D
O, W)
There is evidence of the use of antibiotic therapy and surgical prophylaxis in
all patient care processes according to the guidelines. (D, O, W)
The Director reports on PPRA activities regularly to KPRA at National level.
(D, W)
5
 Elemen penilaian PPRA 4 Telusur Skor
1) Regulasi tentang pengendalian
1. Ada regulasi dan program tentang R 10 TL
resistensi antimikroba di RS - -
pengendalian resistensi antimikroba (Panduan penggunaan Antibiotik 0 TT
profilaksis dan terapi)
p p)
di rumah sakit sesuai peraturan
2) Program pengendalian resistensi
perundang-undangan. (R) antimikroba RS

TRACER TOOLS 1) Bukti pelaksanaan rapat tentang

2. Ada bukti pimpinan rumah sakit
terlibat dalam menyusun program.
((D,W))
D 10 TL
penyusunan program melibatkan
pimpinan RS
5 TS
2) Bukti program PRA-RS yang sudah 0 TT
disetujui/ditanda tangani Direktur

W  Direktur
 Kepala unit pelayanan
 Kepala bidang/divisi
 Komite/Tim PPRA
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STANDAR NASIONAL AKREDITASI RUMAH SAKIT edisi 1

Elemen penilaian PPRA 4 Telusur Skor Elemen penilaian PPRA 4 Telusur Skor

3. Ada bukti dukungan anggaran D Bukti tersedianya anggaran 10 TL 5. Direktur melaporkan kegiatan PPRA D Bukti laporan tentang PPRA RS secara 10 TL
operasional PPRA 5 TS berkala minimal 1 (satu) tahun sekali -
operasional, kesekretariatan, sarana- O Lihat kantor sekretariat Komite/Tim 0 TT secara berkala kepada KPRA. (D,W) kepada KPRA Kemenkes 0 TT
prasarana untuk menunjang kegiatan PPRA ya
yangg ddilengkapi
e g ap sasarana
a a kantor
a o
dan ATK W Direktur RS
fungsi, dan tugas organisasi PPRA. Komite/tim PPRA
(D,O,W) W Komite/Tim PPRA

4. Ada bukti pelaksanaan D Bukti dalam rekam medis tentang 10 TL

pelaksanaan penggunaan antibiotik 5 TS
penggunaan antibiotik terapi dan sebagai terapi & profilaksis pembedahan 0 TT
pada seluruh proses asuhan pasien
profilaksis pembedahan pada
O Lihat pemberian antibiotik profilaksis saat
seluruh proses asuhan pasien sesuai di kamar operasi sesuai PPK
Lihat pemberian antibiotik terapi empiris
panduan. (D,O,W atau terapi definitif di ruangan sesuai PPK
W Dokter,
Perawat
Apoteker
Komite/tim PPRA
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6
 CONTROL OF ANTIBIOTIC RESISTENCE ANTIBIOTIC STEWARDSHIP
PROGRAM IN HOSPITAL
IN HOSPITAL
KOMITE PPRA

STANDARD 4.1
41– STANDARD 4.1
41–
PPRA Hospitals (Team / PPRA Committee) carry PPRA Hospitals (Team / PPRA Committee) carry out
out antimicrobial resistance control activities. antimicrobial resistance control activities.

INTENT & PURPOSE OF STANDARD RATING ELEMENTS – PPRA 4.1

STANDARD OF PPRA 4.1

1. There are organizations that manage antimicrobial resistance

PRA organization is led by medical staff who have got PPRA training
certificate
Hospitals develop antimicrobial resistance control program in hospital
consist of:
a) increased understanding and awareness of all staff
a). staff, patients and families
about antimicrobial resistance issues
b). control of antibiotic use in hospital
c). surveillance patterns of antibiotic use in hospitals
d). surveillance of antimicrobial resistance patterns
e). an integrated infectious disease study forum
control activities and carry out antimicrobial resistance control
programs of hospitals covering a) up to e) in intent and purpose. (R)
2. There is evidence of organizational activity that includes a) to e) in
the intent and purpose. (D, W)
3 There is a determination of quality indicators covering a) up to e) in
3.
intent and purpose. (D, W)
4. There is monitoring and evaluation of the antimicrobial resistance
control program which refers to the antimicrobial resistance control
indicator (D, W)
5. There is evidence of PPRA activity reporting on a regular basis and
includes items a) to d) in the intent and purpose. (D, W)

7
 Elemen penilaian PPRA 4.1 Telusur Skor

1. Ada organisasi yang mengelola R Bukti penetapan komite/tim PPRA yang 10 TL

dilengkapi uraian tugas, tanggung -
kegiatan pengendalian resistensi jawab dan wewenangnya (pedoman 0 TT
antimikroba dan melaksanakan e ja)
kerja)

program pengendalian resistensi

antimikroba rumah sakit meliputi a)

TRACER TOOLS sampai dengan e) di maksud dan

tujuan. (R)

2. Ada bukti kegiatan organisasi yang D Bukti pelaksanaan kegiatan 10 TL

komite/tim PPRA sosialisasi 5 TS
meliputi a) sampai dengan e) di program,pengendalian penggunaan
antibiotik,audit antibiotik kuantitatif &
0 TT
maksud dan tujuan. (D,W)
kualitatif,surveilans mikroba
resisten,forum kajian penyakit infeksi
W terintegrasi)
Komite/tim PPRA
PPA 30

STANDAR NASIONAL AKREDITASI RUMAH SAKIT edisi 1

Elemen penilaian PPRA 4.1 Telusur Skor

3. Ada penetapan indikator mutu D Bukti penetapan indikator mutu 10 TL

(perbaikan kuantitas, kualitas 5 TS
yang meliputi a) sampai dengan e) di penggunaan antibiotik,peningkatan 0 TT Elemen penilaian PPRA 4.1 Telusur Skor
maksud dan tujuan.
tujuan (D,W)
(D W) u u pe
mutu penanganan
a ga a pepenyakit
ya
infeksi,penurunan infeksi oleh mikroba 5. Ada bukti pelaporan kegiatan PPRA D Bukti laporan tentang kegiatan 10 TL
komite/tim PRA secara berkala 5 TS
resisten) secara berkala dan meliputi butir a) kepada Direktur RS 0 TT
W Komite/Tim PPRA sampai dengan d) di maksud dan
W Komite/tim PPRA,
Komite/Tim PMKP tujuan. (D,W) Direktur RS
4. Ada monitoring dan evaluasi D Bukti hasil pencapaian indikator mutu 10 TL
terhadap program pengendalian
5 TS
Direktur RS
W Komite/Tim PPRA
0 TT
resistensi antimikroba yang mengacu
Komite/Tim PMKP
pada indikator pengendalian
resistensi antimikroba (D,W)

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8
Indikator mutu PPRA
(PMK no.8/2015, pasal 11)

thank you ..
DJONI DARMADJAJA