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    Pencegahan Dan Kontrol Infeksi

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    Tettanya Iyu Sama Ariqah
    This document discusses strategies for controlling and preventing infections in hospitals. It addresses various topics including: - Sources of healthcare-associated infections including patients, contact between patients and staff, invasive procedures, and contaminated equipment. - Modes of transmission such as contact, droplets, device-related, airborne, foodborne, and from healthcare workers to patients. - Common sites of infection like the urinary tract, surgical sites, and lungs. As well as risk factors for these infections. - Pathogens that commonly cause infections and how they are spread. Including those with increasing drug resistance. - The impacts of healthcare-associated infections like increased morbidity, mortality, and costs. As well as the emergence of

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    Pencegahan Dan Kontrol Infeksi

    Uploaded by

    Tettanya Iyu Sama Ariqah
    165 views49 pages
    This document discusses strategies for controlling and preventing infections in hospitals. It addresses various topics including: - Sources of healthcare-associated infections including patients, contact between patients and staff, invasive procedures, and contaminated equipment. - Modes of transmission such as contact, droplets, device-related, airborne, foodborne, and from healthcare workers to patients. - Common sites of infection like the urinary tract, surgical sites, and lungs. As well as risk factors for these infections. - Pathogens that commonly cause infections and how they are spread. Including those with increasing drug resistance. - The impacts of healthcare-associated infections like increased morbidity, mortality, and costs. As well as the emergence of

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    Kontrol Infeksi

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    This document discusses strategies for controlling and preventing infections in hospitals. It addresses various topics including: - Sources of healthcare-associated infections including patients, contact between patients and staff, invasive procedures, and contaminated equipment. - Modes of transmission such as contact, droplets, device-related, airborne, foodborne, and from healthcare workers to patients. - Common sites of infection like the urinary tract, surgical sites, and lungs. As well as risk factors for these infections. - Pathogens that commonly cause infections and how they are spread. Including those with increasing drug resistance. - The impacts of healthcare-associated infections like increased morbidity, mortality, and costs. As well as the emergence of

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    165 views49 pages

    Pencegahan Dan Kontrol Infeksi

    Uploaded by

    Tettanya Iyu Sama Ariqah
    This document discusses strategies for controlling and preventing infections in hospitals. It addresses various topics including: - Sources of healthcare-associated infections including patients, contact between patients and staff, invasive procedures, and contaminated equipment. - Modes of transmission such as contact, droplets, device-related, airborne, foodborne, and from healthcare workers to patients. - Common sites of infection like the urinary tract, surgical sites, and lungs. As well as risk factors for these infections. - Pathogens that commonly cause infections and how they are spread. Including those with increasing drug resistance. - The impacts of healthcare-associated infections like increased morbidity, mortality, and costs. As well as the emergence of

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 49

    STRATEGI PENGENDALIAN

    DAN PENCEGAHAN INFEKSI


    DI RUMAH SAKIT

    Sudirman Katu
    Divisi Penyakit Tropik dan Infeksi Ilmu
    Penyakit Dalam FKUH/RSWS Makassar

    Risk of Fatal Outcome per Exposure

    10 -2

    10 -3

    Dangerous

    10 -4

    10 -5

    Acceptable Risk

    10 -6

    10 -7

    Safe

    10 -8

    Ultra-safe

    Environment

    Patient

    Antimicrobials

    Hands

    Rantai kejadian infeksi

    PENDAHULUAN
    Health Care Associated Infection ;
    dalam 48 jam perawatan di rumah sakit
    setelah 3 hari keluar dari rumah sakit
    30 hari setelah tindakan operasi.

    SUMBER INFEKSI HAI/HCAI


    Pasien sebagai sumber infeksi
    Kontak Langsung Pasien - Pasien Pengunjung
    Kontak Langsung Pasien Petugas
    Daya Tahan Pasien Rendah
    Umur, Terapi Steroid / Imuno Supresi, Imuno
    Defisiensi, DM / Sirosis Hati / Operasi, dsb
    Tindakan invasif
    Kontaminasi Peralatan Medik

    MODES OF TRANSMISSION
    Parenteral Transmission the spread of
    an agent through intact skin by a sharp
    e.g., needle stick injury.
    Common Vehicle Transmission the
    spread of an agent through a common
    contaminated source e.g., multi-dose vials.
    Vector Transmission occurs when a
    host is bitten by an animal or insect
    carrying the infectious agent e.g., mosquito
    transmitting and West Nile virus.

    MODES OF TRANSMISSION OF HAI


    PATHOGENS(1)
    Mode of transmission Reservoir/sourceExamples of pathogens
    Contact Patients/health care Staphylococcus aureus
    workers, fomites,Enterococcus spp.
    medical devices Enterobacteriaceae
    Clostridium difficile
    Respiratory syncytial virus
    Rotavirus
    Adenovirus
    Candida spp.
    Droplet spread Health care workers, Staphylococcus aureus
    patients
    Respiratory syncytial virus
    Influenza virus
    Device-related Water/respiratory
    Pseudomonas aeruginosa
    equipment,
    Acinetobacter spp.
    endoscopes
    Stenotrophomonas maltophilia
    Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010

    MODES OF TRANSMISSION OF HAI


    PATHOGENS(2)
    Mode of transmission
    Medication-related

    Reservoir/source
    Water/iv fluids
    disinfectants

    Examples of pathogens
    Burkholderia cepacia
    Acinetobacter spp.
    Serratia marcescens

    Transfusion,
    needlestick

    Patients/blood

    Hepatitis B virus, hepatitis C


    virus, HIV, etc.

    Transplantation

    Patients/donor tissue

    Cytomegalovirus
    Toxoplasma gondii
    Creutzfeld-Jacob agent

    Airborne

    Patients
    Hot water/showers
    Soil/dust

    Mycobacterium tuberculosis
    Legionella spp.
    Aspergillus spp.

    Foodborne

    Animals/food products
    Water/enteral feeding

    Salmonella spp.
    Enterobacter spp.
    Pseudomonas aeruginosa

    Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010

    BEBERAPA LOKASI/TEMPAT YANG MERUPAKAN SUMBER INFEKSI DI RUMAH SAKIT

    RISK FACTOR FOR HAI / HCAI IN


    ICU

    THE MOST COMMON SITES OF HEALTH CARE-ASSOCIATED INFECTION AND SOME


    SPECIFIC RISK FACTORS UNDERLYING THE OCCURANCE OF THESE INFECTIONS
    URINARY CATHETER
    URINARY INVASIVE PROCEDURES
    ADVANCED AGE
    SEVERE UNDERLYING DISEASE
    UROLITIASIS
    PREGNANCY
    DIABETES

    URINARY TACT
    INFECTION
    SURGICAL-SITE
    INFECTIONS
    INADEQUATE ANTIBIOTICS
    PROPHYLAXIS
    INCORRECT SURGICAL SKIN
    PREPARATION
    SURGICAL INTERVENTION DURATION
    TYPE OF WOUND
    INAPPROPRIATE WOUND CARE
    POOR SURGICAL ASEPSIS
    DIABETES
    NUTRITIONAL STATE
    IMMUNODEFICIENCY
    LACK OF TRAINING & SUPERVISION

    COMMON
    SITES AND
    RISK
    FACTORS

    MECHANICAL VENTILATIONS
    ASPIRATION
    USE OF ANTI-DEPRESANTS
    ANTIBIOTICS & ANTACIDS
    PROLONGED HOSPITAL STAY
    MALNUTRITION
    ADVANCED AGE
    NASOGASTRIC TUBE
    SURGERY
    IMMUNODEFICIENCY

    LUNG
    INFECTIONS
    BLOOD
    INFECTIONS

    WHO Global Patient


    Safety Challenge,
    2007

    VASCULAR CATHETER
    NEONATAL OR ADVANCED AGE
    SEVERE UNDERLYING DISEASE
    NEUTROPENIA
    IMMUNODEFICIENCY
    NEW INVASIVE TECHNOLOGY
    CRITICAL CARE
    LACK OF TRAINING & SUPERVISION

    HOST FACTORS PREDISPOSING TO HOSPITAL INFECTION


    Factor
    Example
    Age
    Neonates, elderly patients
    Underlying disease
    System of organ failure (e.g. liver cirrhosis, diabetes,
    mellitus, chronic obstructive pulmonary disease, renal
    failure), cancer,
    neutropenia
    Immunodeficiency
    Congenital, or acquired, (e.g. AIDS, immunosuppressive
    therapy, malnutrition)
    Specific immunity
    Susceptibility to viral infections
    Breach of Mucocutaneous
    Trauma, burns, surgery, endoscopy, indwelling devices
    barriers
    Mucosal and skin diseases
    Anesthesia, sedation
    Suppression of cough and peristalsis, hypoventilation
    Antibiotics, antacids
    Alterations of resident microflora and decrease of resistance
    to colonization by hospital flora
    Selection of antibiotic-resistant mutants and naturally
    resistant bacteria and yeasts
    Colonizing flora
    Carriage of opportunistic bacteria and fungi
    Latent infection
    Latent infection with intracellular pathogens reactivated by
    immunosuppression

    Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010

    Infections Associated with Invasive


    Devices and Procedures
    Device/procedure
    Type of infection
    Intravascular catheter
    Bacteremia; catheter site infection
    Bladder catheter
    Urinary tract infection
    Mechanical ventilation Pneumonia; sinusitis
    Stents
    Pyelonephritis; chongalitis;
    meningitis
    Surgery
    Surgical site infection; pneumonia
    Endoscopy
    Bacteremia; pneumonia;
    gastroenteritis and cholangitis
    Blood transfusion
    Bacteremia fungemia; viral infections

    Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010

    KUMAN PENYEBAB HAI/HCAI

    HAI Pathogens
    Organism Carriage site Methode of spread
    Staphylococcus aureus Nose, Groin Hairline Hands, skin scales
    skin lesions, wounds, droplet spread
    urinary catheters
    Group A streptoccoci
    Anterior nares throat, Hands, skin
    Skin lesions, wounds
    Gram-negative bacilli : Stool, urine, moist
    Hands, urinary,
    Multiply antibiotic skin lesions
    catheter, nonresistent
    clinical equipment,
    Pseudomonas
    ventilators,
    aeruginosa
    disinfectants,
    moist area in the
    environment

    TIPE INFEKSI HAI/HCAI


    One in 10 of hospitalised
    patients
    Urinary Tract Infection 30-40%
    Surgical Wound Infection 1719%
    Lower Resp. Tract Infection1618%
    Skin and Soft Tissue Infection

    INFECTIONS SPREAD BY HEALTH CARE WORKERS TO


    PATIENTS OR OTHER HEALTH CARE WORKERS
    Infection

    Comment

    Hepatitis B virus e-Antigen positivity and high level of viremia


    associated
    with transmission
    Hepatitis C virus Surgeon resumed work following medical
    control of his
    hepatitis c infection
    Methicillin-resistant Cloud adult and chronic sinusits may facilitate
    Staphylococcus aureus
    spread
    Group A streptococci Carriers may harbor the organism in throat, vagina,
    rectum, or skin
    Salmonella Routine surveillance for dietary workers of unproven benefit
    Tuberculosis Health care workers may spread disease through
    hospitals
    Measles, rubella Unvaccinated medical students are source of many outbreaks

    Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010

    MICROORGANISM WITH DRUG RESISTANCE THAT ARE MAJOR


    PROBLEMS IN HOSPITALS

    Gram-positive organism
    MRSA

    Klebsiella species

    MRSA (HRV) VRSA


    VRE

    Gram-negative organism

    Enterobacter species

    Pseudomonas aeruginosa
    Acinetobacter baumannii

    NOTE : HRV, heterogeneous resitance to vancomycin; MRSA,


    methicillin-resistant Staphylococcus aerus; VRE, vancomycinresistant enterococci; VRSA vancomycin-resistant S.aureus
    Levy, S. B. ; CID 2001:33 (Suppl 3)

    DAMPAK HAI / HCAI


    Peningkatan Morbiditas / Mortalitas
    Lama Perawatan
    Biaya
    Timbulnya MIkroorganisme yang Resisten
    Citra Profesi / Rumah Sakit
    Mediko Legal

    Hospital Associated
    Infection Control
    Programme to Ensure the
    Improvement of Health
    Service Quality

    INFRASTRUCTURE OF AN INFECTION CONTROL


    PROGRAMME
    Input
    Analysis &
    interpretation
    Action &
    enforcement

    Surveillance data
    Laboratory base
    Ward base
    ICO + ICN
    Infection Control Committee
    ICN
    ICO

    Control measures

    Containment
    Isolation &
    Focused
    treatment of epidemiological 1) Influencing
    PCPs
    infection
    studies
    2) Care of
    environment
    & equipment

    Administration &
    hospital staff
    Control usage
    of antibiotic &
    disinfection

    Staff
    health &
    education

    3) Prophylaxis
    for the healthcare workers
    4) Writing of
    policies

    Seto Wing Hong 2004


    DW

    AIMS OF HOSPITAL INFECTION


    SURVEILLANCE
    To identify high-risk patients and procedures and assign
    infection control priorities
    To monitor trends over time of incidence and patterns of
    infection
    To detect outbreaks of hospital infection
    To evaluate the efficacy of prevention and control
    interventions
    To evaluate quality assurance programs
    To educate and motivate health care providers and decision
    makers
    A number of aims can be assigned to hospital epidemiologic
    surveillance systems
    Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 1999

    The Awareness of HAI/HCAI


    Infection Control
    Over the past 30 years,
    nosocomial infection
    surveillance, prevention and
    control programs have been
    integrated into hospitals
    The goal is to ensure the well
    being of patients, staff,
    visitor and others in the
    healthcare environment
    DW

    The Critical Importance of


    HAI/HCAI Infections 1
    In 1976 the Joint Commission
    on Accreditation of Health
    Care Organizations (JCAHO)
    highlighted the nosocomial
    infection as preventable &
    controllable adverse hospital
    outcomes
    Scheckler WE et al Am J Infect Contr 1998;26:47

    DW

    The Critical Importance of


    HAI/HCAI Infections 2
    JCAHO published standards for :

    Organization
    Surveillance
    Reporting
    Evaluation
    Record maintenance
    & other requirements
    For infection prevention & control
    activities as a condition for hospital
    accreditation

    Scheckler WE et al

    Am J Infect Contr 1998;26:47


    DW

    The Benefit of HAI/HCAI


    Infection Control Programme
    SENIC (Wenzel 1995)
    Subsequent analyses have
    demonstrated that nosocomial
    infection prevention and control
    programs are:
    Clinically effective
    Cost effective
    DW

    Goals for Infection Control


    3 principal goals for hospital
    infection control programs :
    Protect the patient;
    Protect the healthcare worker;
    visitors, and others in the
    healthcare environment;
    Accomplish the previous two
    goals in a cost-effective manner

    Scheckler WE et al

    Am J Infect Contr 1998;26:47

    DW

    Monitoring the Achievement


    of Infection Control Goals 1

    JCAHO
    Every healthcare
    institution must
    developed specific
    objectives & outcome
    measures to determine
    whether they have
    achieved their infection

    DW

    Monitoring the Achievement


    of Infection Control Goals 2

    The outcome measures should


    relate directly to the specific goals
    of the infection control program,
    namely:
    To measure the effectiveness of
    procedures, policies, or
    programs to protect patients &
    healthcare providers
    To determine the cost
    effectiveness of these activities

    DW

    The Essential of Hospital


    Infection Control Program
    Hospital infection control
    is a quality improvement
    activity that focuses on
    improving the care of
    patients and protecting
    the health of staff
    DW

    Paradigm in Infection Control


    = Quality improvement
    programs

    Ongoing data collection &


    analyses
    Problem identification and
    definition
    Intervention to improve
    outcomes
    Reassessment to ensure that
    the intervention has led to the

    DW

    HAI/HCAI INFECTION CONTROL


    PROGRAM
    Target for HCW
    The save delivery of health care
    Promote HCW awareness
    - Of NI as a problem
    - That NI can (in part) be prevented
    Hospitals
    Should do the sick no harm

    ORGANIZATION OF HOSPITAL
    INFECTION CONTROL
    Structure & Function
    INFECTION CONTROL COMMITEE
    - Powerfull chairman
    - Representatives of all
    clinical & service

    - Policies &
    major decisions
    - Monitors I. C. T.

    departments

    INFECTION CONTROL TEAM


    - Infected control officer
    - Infected control nurse

    All day to day


    duties

    A RATIONAL CLASSIFICATION OF HOSPITAL


    INFECTION PREVENTION STRATEGIES(1)
    Target Objective Example of strategy
    Endogenous To prevent or Antibiotic prophylaxis in surgery
    Infection
    neutralize the
    Skin antisepsis before surgery
    translocation of
    Antiseptic-bound iv catheter
    commensal flora Intestinal decontamination of neutropenic
    patients
    Pneumococcal immunization before
    splepectomy
    Exogenous To prevent cross- Hand hygiene for patient care procedures
    Infection
    infection
    Isolation and decolonization of carriers of
    transmissible pathogens
    Sterilization or disinfection of invasive devices
    Cleaning and disinfection of fomites
    Outbreak detection and molecular
    epidemiologic
    studies to determine the mode
    and vehicles of spread

    Bennett & Brachman's Hospital Infections, 5th Ed, 2007 Lippincott Williams & Wilkins

    A RATIONAL CLASSIFICATION OF HOSPITAL


    INFECTION PREVENTION STRATEGIES(2)
    Target

    Objective

    Example of strategy

    Antimicrobial
    To prevent the
    Restricted usage of broad-spectrum
    resistance emergence, and
    antimicrobial agents
    spread of
    Optimized anti-infectious therapy (agents,
    resistance genes
    dosage and duration)
    To prevent the
    Detection, monitoring and timely reporting
    spread of
    of antimicrobial resistance
    resistant strains
    Isolation precautions and treatment of
    of microcarriers of transmissible resistant strains
    organisms
    Molecular epidemiologic studies to
    distinguish between mutant selection,
    gene or clone
    dissemination
    A classification of strategies to prevent hospital infection and control antimicrobial
    resistance
    Bennett & Brachman's Hospital Infections, 5th Ed, 2007 Lippincott Williams & Wilkins

    10 Kewaspadaan standar terdiri dari


    1. Kebersihan tangan
    2. Alat Pelindung Diri
    (APD)
    3. Peralatan perawatan
    pasien(non kritikal, semi
    kritikal dan kritikal )
    4. Pengendalian Lingkungan
    5. Pemrosesan peralatan
    pasien dan
    penatalaksanaan linen

    6.Kesehatan
    karyawan/perlindungan
    petugas kesehatan
    7.Penempatan pasien sesuai
    sumber transmisi
    8. Hygiene respirasi/Etika
    batuk
    9. Praktek penyuntikan yang
    aman
    10. Praktek lumbal fungsi

    45

    Kewaspadaan berdasarkan Transmisi


    Transmisi
    1. Kontak spt : MRSA kewaspadaan standar :
    Kebersihan tangan dan penggunaan APD
    2. Dropplet Pneumonia kewaspadaan standar :
    Kebersihan tangan, masker dan goggle
    3. Air bone Kewaspadaan standar
    . Tekanan negatif atau natural ventilation
    . Masker N 95
    . Pintu kamar harus selalu tertutup

    46

    Resume

    HAI/HCAI is a preventable &


    controllable adverse hospital
    outcomes
    Hospital infection control is a
    quality improvement activity
    that focuses on improving the
    care of patients and
    protecting the health of staff
    DW

    Resume

    HAI/HCAI control program is


    clinically effective & costeffective
    Specific objectives & outcome
    measures must be developed
    to determine whether they
    have achieved their infection
    control goals
    DW

    TERIMA KASIH

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