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PENCEGAHAN INFEKSI

INFEKSI

Invasi mikroorganisme berbahaya (patogen) ke dalam tubuh

Pencegahan Infeksi
Memotong jalur penyebaran organisme infeksius diantara orangorang dengan cara: 1. Menghindari kontak langsung cairan tubuh 2. Memusnahkan organisme infeksius

4.8 Aturan Dasar 1. 7. 8. 6. Setiap orang berpotensi menularkan infeksi Memakai sarung tangan Menggunakan pelindung kontak lain Melakukan upaya kerja yang aman Mencuci tangan Menggunakan bahan antiseptik Membuang limbah dengan benar Memproses instrumen dan bahan dengan benar . 2. 5. 3.

Setiap Orang Berpotensi • Darah • Semen • Sekresi vagina • Semua cairan tubuh lain .

INGAT!!!!! SETIAP ORANG BERPOTENSI MENULARI & TERTULARI .

Memakai Sarung Tangan     Untuk kontak dengan cairan tubuh Untuk kontak dengan mukosa & kulit yang tak utuh Untuk kontak dengan bahan & instrumen terkontaminasi Untuk menangani limbah .

Jenis Sarung Tangan    Sarung tangan periksa Sarung tangan rumah tangga Sarung tangan bedah (steril & DTT) .

Pelindung Kontak Lain       Masker Kacamata pelindung Celemek Gaun operasi Kain linen Sepatu boot .

Upaya Kerja Yang Aman  Mencegah perlukaan saat bekerja    Memegang benda tajam Menutup jarum suntik Menyerahkan instrumen tajam     Melakukan teknik operasi yang benar Sarung tangan ganda Melepas gaun operasi sebelum sarung tangan Lain-lain .

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Bahan Antiseptik   Membunuh atau menghilangkan sebanyak mungkin mikroorganisme tetapi aman bagi kulit/mukosa dimana antiseptik digunakan Selalu ada kemungkinan alergi atau hipersensitif .

etil isopropil atau metil spiritus Cetrimide dalam berbagai konsentrasi (misal: Savlon) Chlorhexidine gluconate (4%) (misal: Microshield. Hibitane) Hexachlorophene (3 %) (misal: Phisohex) Parachlorometoxylenol (PCMX atau Chloroxylenol). Hibiscrub.Contoh Bahan Antiseptik        Alkohol (60-90%). dalam air atau tinctur (misal: Lugol) Iodophor. dalam berbagai konsentrasi (misal: Betadine) . dalam berbagai konsentrasi (misal: Dettol) Iodine (1 sampai 3%).

bakar.Buang Limbah dengan BENAR   Memakai sarung tangan rumah tangga Pisahkan dalam wadah menurut jenisnya   Terkontaminasi: wadah tertutup/tidak bocor Tajam: wadah tahan tusuk   Musnahkan sesuai jenisnya: kubur. tampung. dll Cuci tangan .

Jenis Limbah  Limbah terkontaminasi (biohazard)  Perlu pengelolaan khusus  Limbah tidak terkontaminasi  Diperlakukan seperti sampah umum .

Prosesing Instrumen & Bahan    Untuk dipakai / dipakai ulang Potensi cedera pada petugas 3 Langkah pokok    Dekontaminasi Pencucian & pembilasan Sterilisasi atau Disinfeksi Tingkat Tinggi .

Instrumen steril tanpa dibungkus harus disimpan dalam wadah steril atau DTT dengan tertutup rapat atau segera dipakai . jaringan dan cairan tubuh lainnya DEKONTAMINASI rendam 10’ dalam larutan klorin 0.5% CUCI dan BILAS pakai sarung tangan.Alat-alat Kesehatan yang terkontaminasi darah. 30 mnt (dibungkus) Oven 170°C 60’ 160°C 120’ Rebus 20’ Kimiawi Rendam 20’ * Instrumen yang terbungkus dalam keadaan steril dapat disimpan 1 minggu. Hati-hati tertusuk instrumen tajam Metode Terbaik Metode Alternatif STERILISASI Disinfektan Tingkat Tinggi Otoklaf: 20 mnt (tanpa bungkus).

Cooking utensils 3. Linen 80 °C 80 °C 70 °C 95 °C Duration 45–60 seconds 1 minute 25 minutes 10 minutes .Disinfection with hot water Temperature 1. Sanitary equipment 2.

Spectrum of activity achieved of the main disinfectants .

Level of disinfection for patient equipment in relation with type of care .

• Dry sterilization: exposure to 160 °C for 120 minutes. or 170 °C for 60 minutes. .Principal sterilization methods    Thermal sterilization • Wet sterilization: exposure to steam saturated with water at 121 °C for 30 minutes. (134 °C for 18 minutes for prions). or 134 °C for 13 minutes in an autoclave. particularly for hollow medical devices. this sterilization process is often considered less reliable than the wet process.

.Principal sterilization methods    Chemical sterilization • Ethylene oxide and formaldehyde for sterilization are being phased out in many countries because of safety and greenhouse gas emission concerns. • Peracetic acid is widely used in the United States and some other countries in automatic processing systems.

clean-contaminated) duration of operation underlying patient status operating room environment organisms shed by the operating room team. clean.g. .Surgical wound infections (surgical site infections)  Factors which influence the frequency of surgical         wound infection include surgical technique extent of endogenous contamination of the wound at surgery (e.

Dekontaminasi & Pembersihan Alat –alat Kesehatan    Pembedahan / assisten bedah (dokter perawat dll) Pengolahan alat-alat kesehatan bedah Pembersihan dan pembuangan sampah RISK  AIDS Hep. B Tujuan Dekontaminasi & Pembersihan: Melindungi seseorang yang menangani/memegang alat-alat bedah dan perlengkapan lainnya yang kontak dengan darah/jaringan/cairan tubuh dari penyakit-penyakit yang serius dan penyebar-luasan penyakit melalui alat-alat kesehatan .

Jenis-jenis Sterilisasi  Sterilisasi Panas   Sterilisasi penguapan dan tekanan tinggi (Autoclaving) ±121°C (250°F) selama 20-30 menit Sterilisasi pemanasan kering (oven) ±170°C (340°F) selama 1 jam Seperti merendam dalam glutaraldehyde (8-10 jam) atau formaldehyde (24 jam) Seperti gas formaldehyde atau uap basah formaldehyde  Sterilisasi Kimia (Sterilisasi dingin)   Sterilisasi Gas    Sterilisasi dengan Ultra Violet Sterilisasi kimia dengan Formaldehyde .

Hibiscrub) Hexachlorop hene (3%) (pHisoHex) Preparat Yodium (3%) Yodium dan alkohol (tinktura yodii) Yodophor (1 : 2500) (Betadine) Sangat baik Sangat baik Baik Baik Tidak ada Baik Cepat Ya Ya Tidak pada lendir dipakai selaput Sangat baik Sangat baik Tidak baik Cukup Tidak ada Cukup Lambat Sedikit Ya Ya Mempunyai efek persisten yang baik Dapat terjadi pertumbuhan bakteri secara “rebound” Baik Tidak ada Tidak baik Cukup Kuran g Buruk Lambat Sedikit Ya Tidak Sangat baik Sangat baik Baik Baik Tidak ada Baik Rata-rata Sedikit Tidak Ya Tidak pada mukosa dipakai lapisan Sangat baik Baik Baik Baik Baik Lambat Ya Ya Ya Dapat untuk mukosa dipakai lapisan .Efektifitas melawan Bakteri Potensi Pemakaian Pengar uh oleh zat organi k Data bervari asi Kelompok Gram positif Gram negatif Tb Virus Endospora Jamur Kecepata n aksi “Surgi cal scrub” Persiapan Keterangan Alkohol (6090% etil atau isopropil) Chlorhexidin e1 (4%) (Hibitane.

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Ambulatory Surgery Operating Room  Design Guide Plates and Data Sheets: Ambulatory Surgery Operating Room –  VA Design Guide Ambulatory Surgery. 1997 .

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2”. .Design Standards Ambulatory Surgery Operating Room Ceiling: Ceiling Ht: Wall Finish: Wainscot: Base: Floor Finish: Slab Depr: Notes: ARCHITECTURAL Plaster 2895 mm (9'-6 )* Plaster (SC) Paint -Welded Seamless Flooring Welded Seamless Flooring Additional 8” accessible space above ceiling for microscope or 10”.

.Design Standards Ambulatory Surgery Operating Room LIGHTING General: 200 FC. (1) TYPE 840A. 2. (see Note 1) Special: Surgical Light (see Note 2) Emergency: 50% Gen Fluorescent (see Note 3) 1. Color improved lamps Notes: matching color temperature of surgical light. 1500 W 3. Battery backup in (4) fixtures.

Design Standards Ambulatory Surgery Operating Room POWER General: Special: (1) Module each wall (2) 7-1/2 KVA 12-Circuit IPU Emergency: Each IPU & X-Ray unit (1) Film Processor per Suite POWER General: (1) Module each wall .

Addr: Empty Conduit ADP: -Radio: Empty Conduit .Design Standards Ambulatory Surgery Operating Room COMMUNICATIONS Patirnt Monitor: Yes Nurse Call: -Code One: -CCTV: Empty Conduit Telephone: Wall Mounted Hand Free Intercom: Part of Telephone Pub.

Design Standards Ambulatory Surgery Operating Room HEATING. VENTILATING AND AIR CONDITIONING Dry Bulb Temp Cooling: 190° C (68°F) Dry Bulb Temp Heating: Minimum % Outside Air: 100% Exhaust Air: Noise Criteria: Steam: 230° C (75°F) 100 Yes NC-40 -- Relative Humidity/Cooling: Relative Humidity/Heating: 55% 50% .

Design Standards Ambulatory Surgery Operating Room HEATING. VENTILATING AND AIR CONDITIONING Minimum Air Changes/Hr.5W/SF) 119W/m 2 (11.1W/SF) Number of People: Special Exhaust: 12 -- .: Room Pressure: AC Load Lights: AC Load Equipment: 15 Occupied 8 Unoccupied Positive 91W/m2 (8.

Design Standards Ambulatory Surgery Operating Room PLUMBING AND MEDICAL GASES Cold Water: -- Hot Water: Laboratory Air: Laboratory Vacuum: Sanitary Drain ----- .

Design Standards Ambulatory Surgery Operating Room PLUMBING AND MEDICAL GASES Medical Air: Medical Vacuum: Yes Yes Oxygen: Nitrogen Oxide: Nitrogen: Anesthesia Evac: Yes Yes Yes Yes .

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Immediate control measures for outbreak management Type of transmission suspected Suggested action Cross-transmission (transmission Patient isolation and barrier between individuals) precautions determined by infectious agent(s) Hand transmission Improvements in handwashing Airborne agent Patient isolation with appropriate ventilation Checking of water supply and all liquid containers Use of disposable devices Elimination of the food at risk Agent present in water. Surveillance and Response . World Health Organization Department of Communicable Disease. waterborne agent Foodborne agent Prevention of hospital-acquired infections : A practical guide 2nd edition.

or patients with some risk factors (age. neoplasm) Exposure to biological fluids or Invasive non-surgical procedure (e. Non-invasive no significant underlying No exposure to biological fluids * disease Infected patients. endotracheal intubation) transplant .g. introduction of urinary catheter) 2 Medium 3 High Severely immunocompromised Surgery or High-risk invasive patients. organ catheter.Differential nosocomial infection risk by patient and interventions Risk of infection Type of patients Type of procedures 1 Minimal Not immunocompromised . (<500 WBC per ml) procedures (e. . central venous severe burns. peripheral venous catheter.g. multiple trauma.

evel sterile gloves 3 High Specific Surgical asepsis major products * All devices entering sterile body cavities must be sterile. . mask. sterile or high caps. level as appropriate Surgical clothes: Disinfected at dress.Aseptic measures appropriate for different levels of risk of infection Risk of infection Asepsis Antiseptics Hands Clothes Devices* Clean or disinfected at intermediate or low level Simple handwashing or Street clothes hand disinfection by rubbing Hygienic handwashing or hand disinfection by rubbing Surgical handwashing or surgical hand disinfection by rubbing 1 Minimal Clean None 2 Medium Asepsis Standard antiseptic products Protection Disinfected at against blood and sterile or high biological fluids.

makanan. Obat/farmasi termasuk bahan narkotik. (Alur kotor & bersih tidak boleh bertemu) Tersedia ruang istirahat dan kelengkapan yang cukup bagi petugas yang harus berada di Kamar Operasi dalam jangka lama (misalnya WC. Ruang/tempat pengumpulan/pembuangan peralatan dan linen bekas pakai operasi. Ruang yang cukup untuk menyimpan peralatan.. Ruang untuk mendukung fungsi pendidikan/pelatihan. linen. Kamar operasi yang berhubungan langsung dengan kamar induksi (lihat diatas). minuman. Kamar pulih (recovery).Akreditasi Kamar Operasi (Depkes)         Kamar yang tenang. dan dilengkapi dengan fasilitas untuk induksi anestesi. tempat pasien menunggu tindakan anestesi. Ruang ganti pakaian pria dan wanita terpisah. ruang duduk). .

Modern operating rooms
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Current air standards are virtually free of particles larger than 0.5 μm (including bacteria) when no people are in the room. Conventional operating rooms are ventilated with 20 to 25 changes per hour of high-efficiency filtered air delivered in a vertical flow. High-efficiency particulate air (HEPA) systems remove bacteria larger than 0.5 to 5 μm in diameter and are used to obtain downstream bacteria-free air. The operating room is usually under positive pressure relative to the surrounding corridors, to minimize inflow of air into the room.

Akreditasi Kamar Operasi

tables. including all annexes such as dressing rooms. buckets) complete cleaning of the operating theatre using a recommended disinfectant cleaner complete cleaning of the operating room area. cupboards. and surfaces kept clean) cleaning of all horizontal surfaces between procedures at the end of the working day once a week cleaning and disinfection of horizontal surfaces and all surgical items (e. . technical rooms.Operating room environment A recommended schedule for cleaning every morning before any intervention Purposes (Airborne bacteria must be minimized.g.

Jarak antar Tempat Tidur .

. with separate cleaning equipment for each room Zone C infected patients (isolation wards) Zone D: highly-susceptible patients (protective isolation) or protected areas such as operating suites. Disinfect any areas with visible contamination with blood or body fluids prior to cleaning. and not highly susceptible.g.Cleaning of the hospital environment Name Zone A Patient Contact no patient contact. Clean with a detergent/disinfectant solution. premature baby units. The use of a detergent solution improves the quality of cleaning. library) Method Normal domestic cleaning Zone B care of patients who are not infected. cleaned by a procedure that does not raise dust. casualty departments and haemodialysis units. Dry sweeping or vacuum cleaners are not recommended. delivery rooms. administration. intensive care units. (e. Clean using a detergent/ disinfectant solution and separate cleaning equipment.

Penutup IMPLEMENTASI PENCEGAHAN INFEKSI MEMERLUKAN     Komitmen Pemenuhan input Sistemik Konsisten .

Cuci Tangan Hand washing may be the single most important infection–prevention procedure (Hatcher RA dkk) .

Jenis Cuci Tangan   Cuci tangan biasa Cuci tangan untuk tindakan operasi (surgical scrubbing) .

Kapan Cuci Tangan     Sebelum & setelah kontak dengan pasien Sebelum & setelah pakai sarung tangan Setelah terpapar cairan tubuh atau bahan/instrumen terkontaminasi Lainnya .

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materials. e. genotoxic chemicals . e. e.g.g. boxes) Waste containing substances with genotoxic properties. waste containing cytostatic drugs (often used in cancer therapy). infusion sets.g. items contaminated by or containing pharmaceuticals (bottles.g. e. scalpels. body parts. excreta Pathological waste Sharps Pharmaceutical waste Cytotoxic waste Human tissues or fluids. broken glass Waste containing pharmaceuticals. tissues (swabs). or equipment that have been in contact with infected patients. blood and other body fluids. fetuses Sharp waste. e. pharmaceuticals that are expired or no longer needed.g. waste from isolation wards. needles. laboratory cultures. knives. blades.Categories of health care waste Waste category Description and examples Infectious waste Waste suspected to contain pathogens.

contaminated glassware. packages. sealed sources . urine and excreta from patients treated or tested with unsealed radionucleotides. e. laboratory reagents. disinfectants that are expired or no longer needed. e. broken thermometers. film developer. etc. unused liquids from radiotherapy or laboratory research. or absorbent paper.g. content of heavy metals Pressurized containers Radioactive waste Gas cylinders. solvents Wastes with high Batteries.Categories of health care waste Waste category Description and examples Chemical waste Waste containing chemical substances.g. blood pressure gauges. aerosol cans Waste containing radioactive substances. gas cartridges.

(<500 WBC per ml). or severe burns.g. neoplasm) Non-invasive No exposure to biological fluids * Exposure to biological fluids or Invasive non-surgical or procedure (e.g.Differential nosocomial infection risk by patient and interventions 1 Minimal Not immunocompromised. endotracheal intubation) 2 Medium 3 High Severely immunocompromised patients. no significant underlying disease Infected patients. multiple trauma. introduction of urinary catheter) Surgery High-risk invasive procedures (e. or patients with some risk factors (age. central venous catheter. Peripheral venous catheter. organ transplant .

Risk of infection 1 Minimal Asepsis Antiseptics Clean None Hands Clothes Devices* Simple handwashing Street clothes Clean or or hand disinfection disinfected at by rubbing intermediate or low level Hygienic Protection Disinfected at handwashing or against blood sterile or high hand disinfection by and biological level rubbing fluids. mask. as appropriate Surgical handwashing or surgical hand disinfection by rubbing Surgical clothes. caps. dress. sterile gloves Disinfected at sterile or high level 2 Medium Asepsis Standard antiseptic products 3 High Surgical asepsis Specific major products .