MIKROBIOLOGI DASAR TERKAIT

PELAYANAN CSSD

dr. ELITA DEVINA, Sp.MK

LAB.MIKROBIOLOGI KLINIK RSUD SIDOARJO
INHOUSE TRAINING CSSD
2018
SARS CoV-2003
Avian Influenza 2005
H1N1 Swine Flu-2009
MERS-CoV 2012-2014
Talaro and Chess, 2015
Evolutionary Timeline

Talaro and Chess, 2015

Fransisco Redi’s Experiment
Abiogenesis
Theory
 Pasteur and Theory of Germ

“Generatio Spontanea Theory”

Talaro and Chess, 2015

 Size comparison of viruses
with a yeast cell and Bacteria

Talaro and Chess, 2015

VIRUS
VIRUS STRUCTURE:
Consist of nucleic acid/ genome, surrounded by a protein coat

 Virion: the intact virus particle

 Capsid: the protein coat
 Capsomeres: the protein structural units of capsid
 Nucleic acid genome: either DNA or RNA
 Envelope: some virus particles are surrounded by a lipoprotein envelope;
containing viral antigens
Talaro and Chess, 2015
 Virus
Replication

Talaro and Chess, 2015

 Viruses enter the body through 4
main ways:

Inhalation: via respiratory tract.

 Ingestion: via gastrointestinal tract.
 Inoculation: through skin abrasions, mucous
membranes (e.g. sexual); transfusion;
injections; transplants; via the bite of an
arthropod.
 Congenital: i.e. from mother to fetus.
EFFECTS OF VIRUSES ON CELLS
1. Death: the infection is lethal; causes a cytopathic effect (CPE)
which kills the cell; e.g. multinucleated giant cells/ syncitia,
inclusion bodies.
2. Transformation: the cell is not killed, but is changed from a
normal cell to a malignant or cancerous cell.
3. Latent infection: virus remains within the cell in a potentially
active state, but produces no obvious effects on the cell’s
functions.
4. Haemadsorption: some viruses have haemaglutinin in their
outer coats adheres to erythrocytes
agglutination
Cytopathic changes in cells and
cell cultures infected by viruses

Talaro and Chess, 2015

Effect of Physical and Chemical Agents on Viruses

 Heat: most are inactivated at 56oC for 30 min or 100oC for a

few seconds.
 Cold: stable at low temperatures, can be stored at -70oC
for years.
 Drying: variable
 Ultraviolet: inactivates viruses
 Chloroform, ether and other organic solvents: enveloped
viruses are inactivated; those without envelopes are resistant
 Oxidizing & reducing agents: viruses are inactivated by
formaldehyde, chlorine, iodine & hydrogen peroxide
 (Effect of Physical and Chemical Agents on Viruses)

 Phenols: most viruses are relatively resistant.

 Virus desinfectants: the best are hypochlorite solution &
glutaraldehyde.
corrosive

Sensitization & irritation to users

 Virus HAI’s
– Adenoviral pharyngitis
– Influenza virus
– Parainfluenza virus
– Hepatitis A virus
– Hepatitis B virus
– Hepatitis C virus
– HIV
BACTERIA
Morphology of Bacteria

Talaro and Chess, 2015

Bacterial Structures
Bacteria Cell Wall

Madigan, et al, 2015

Endospore Formation
 Plasmid
(mobile genetic material)

Mechanism of
Bacterial Transfer Gene
Reproduction of Bacteria
DEFINISI

FLORA NORMAL
KOLONISASI
PATHOGEN
PATHOGEN POTENSIAL
OPPORTUNISTIC PATHOGEN
INFEKSI
PENYAKIT INFEKSI
PATHOGENITAS
DEFINISI

FLORA NORMAL PADA TUBUH MANUSIA

FLORA NORMAL : mikroba yang hidup pada kulit dan selaput lendir
manusia dalam keadaan normal / sehat

Ada 2 kelompok mikroba :

1. RESIDENT FLORA (FLORA TETAP) :
mikroba yang secara normal menetap pada bagian tubuh tertentu

2. TRANSIENT FLORA (FLORA SEMENTARA) :

mikroba non pathogen atau potensial pathogen yg tinggal di kulit atau
selaput lendir selama kurun waktu tertentu yg berasal dari lingkungan

Bila resident flora berubah, maka transient flora dapat membentuk

kolonisasi, berkembang biak dan menimbulkan penyakit
The origins of
microbiota
in newborns

Talaro and Chess, 2015

DEFINISI

KOLONISASI:
- MIKROBA (+) → MINGGU → BULAN → TAHUN
- Tidak ada luka, tidak invasi jaringan

Bacterial interactions with mucous membranes

BIOFILM FORMATION

Talaro and Chess, 2015

Biofilms Formation

Talaro and Chess, 2015

DEFINISI

PATHOGEN:
ORGANISME YG MENYEBABKAN SAKIT PADA
SUSCEPTIBLE HOST

PATHOGEN POTENSIAL:
FLORA NORMAL, tapi pada keadaan tertentu dapat
mengalahkan pertahanan tubuh host dan
menyebabkan sakit

OPPORTUNISTIC PATHOGEN:
- NORMAL HOST TAK SAKIT
- HOST DENGAN SISTEM IMUN ↓ → SAKIT
DEFINISI

INFEKSI:
Proses masuknya organisme ke dalam host, invasi dan
multiplikasi
- LUKA / INVASI → JARINGAN RUSAK OLEH
MIKROBA

PENYAKIT INFEKSI :
Manifestasi klinis dari kerusakan atau gangguan
struktur dan fungsi sel dan jaringan akibat proses
infeksi.
(+ symptoms, + signs, + syndromes)
 Ten most common pathogens
that account for 84% of all HAIs (n=33.848)
• Coagulase-negative staphylococci (15%)
• Staphylococcus aureus (15%)
• Enterococcus species (12%)
• Escherichia coli (10%)
• Pseudomonas aeruginosa (8%)
• Klebsiella pneumoniae (6%)
• Enterobacter species (5%)
• Acinetobacter baumannii (3%)
• Klebsiella oxytoca (2%)

Infect Control Hosp Epidemiol 2008; 29:996-1011

Talaro and Chess, 2015
KAITAN CSSD dengan KUALITAS PELAYANAN terhadap
KESELAMATAN PASIEN dan PENGENDALIAN INFEKSI

KESELAMATAN PASIEN

PENGENDALIAN
INFEKSI

CSSD

KUALITAS PELAYANAN RS
 FIVE FOR LIVE – LIVE IS FIVE

• Keselamatan pasien dari injury / cedera, infeksi akibat

1 paparan darah/cairan tubuh, keparahan penyakit.

• Keselamatan petugas dari cedera

2

• Keselamatan institusi, mencegah tuntutan hukum

3

• Keselamatan lingkungan , lingkungan bebas polutan

4

• Keselamatan bisnis RS memenuhi harapan semua fihak

5
 SASARAN KESELAMATAN PASIEN

• Sasaran 1 : Ketepatan identifikasi pasien

• Sasaran 2 : Komunikasi yang efektif
• Sasaran 3 : Keamanan obat yang perlu
diwaspadai (high-alert)
• Sasaran 4 : Kepastian tepat-lokasi, tepat-
prosedur, tepat-pasien operasi
• Sasaran 5 : Pengurangan risiko infeksi terkait
pelayanan kesehatan
• Sasaran 6 : Pengurangan risiko pasien jatuh
Prinsip Pencegahan & Pengendalian Infeksi
 Benda Asing Tertinggal

• Kasus di AS
 28,4 juta pasien ranap operasi
 1.550 kasus tertinggal benda asing
 Hanya 0,005458%
• Tidak luar biasa, tapi sangat berbahaya dan
merugikan RS
 Karakteristik Kasus Tertinggal Benda Asing
(Massachusetts, 2001)
Karakteristik Kasus (%)
Jenis Benda Asing yang Tertinggal:
 Kasa 69
 Clamp 7
 Lainnya (Mis: Retraktor, Elektrod) 24
Rongga Tempat Benda Asing Tertinggal:
 Abdomen atau pelvis 54
 Vagina 22
 Toraks 7
 Lainnya 17
Outcome:
Meninggal 2
Rawat ulang, LOS yang panjang, 59
Sepsis atau infeksi 43
 Operasi ulang 69
 Fistula atau obstruksi usus halus 5
 Perforasi viscera 7
 INFEKSI PEMBEDAHAN

 Sebagian besar infeksi

tempat pembedahan
disebabkan oleh Lingkungan
5%
masuknya mikro- Alkes/Linen Petugas
organisme ke dalam luka 10% 35%

operasi pada saat di kamar Pasien

bedah 50%

(Nichols RL dlm Bennet JV

& Brachman PS, 1992:463)