DAFTAR RIWAYAT HIDUP

• Nama: Dr. dr. Hindra Irawan Satari, SpA(K), MTropPaed

• Jabatan:
Ketua, PP Perkumpulan Pengendalian Infeksi Indonesia (Perdalin),
2017-sekarang
Ketua POKJA PPI, Kemkes RI, 2017-sekarang
Div. Infeksi dan Pediatri Tropis, Dep IKA FKUI-RSCM, 1992-sekarang
Ketua Komite PPI, RSCM; 2007-2017
• Pendidikan
– Dokter Umum, FK UNPAD, 1981
– Dokter Spesialis Anak, FKUI, 1992
– Master of Tropical Pediatrics, School of Tropical Medicine, Liverpool
University, United Kingdom 1995
– Konsultan Penyakit Infeksi dan Pediatri Tropis, Kolegium IDAI, 2002
– Doktor dalam Bidang Ilmu Kedokteran, FKUI, 2012
• Organisasi
• Anggota, Komite Pencegahan dan Pengendalian Ressitensi Antimikroba,
Kemkes RI, 2015 – sekarang
• Anggota Komite Ahli TBC, KemKesRI, 2016-sekarang
• Email: hsatari@ikafkui.net
 PROSES PENYAKIT INFEKSI
TERKAIT PELAYANAN KESEHATAN
HINDRA IRAWAN SATARI
PERDALIN
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
 The prevalence of HAIs in developed countries
varies between 3.5% and 12%

• The European Centre for Disease Prevention and Control

– 7.1% in European countries
– 4 131 000 patients are affected
– 4 544 100 episodes of HAIs every year in Europe

• The incidence rate in USA

– 4.5% in 2002, corresponding to 9.3 infections per 1 000 patient-days
– 1.7 million affected patients

• European multicentre study

– The proportion of HAIs patients in ICU : 51%
– 30% of patients in ICUs are affected by at least one episode of HAIs
– The cumulative incidence of infection in adult high-risk patients is
17.0 episodes per 1000 patient- days. Associated with the use of
invasive devices, in particular central lines, urinary catheters, and
ventilators.
 HAIs in low- and middle-income
countries: 5.7% - 19.1%
• The proportion of patients with ICU-acquired infection
– From 4.4% to 88.9% with a frequency of overall infections as high as
42.7 episodes per 1000 patient- days.
– Almost three times higher than in high-income countries
– Associated with the use of central lines and ventilators and other
invasive devices can be up to 19 times higher than those reported
from Germany and the USA.
• Newborns,
– Infection rates 3-20 times higher than in high-income countries.
– Responsible for 4% to 56% of all causes of death in the neonatal
period, and
– 75% in South-East Asia and Sub-Saharan Africa.
• Surgical site infection is the leading infection,
– Two third of operated patients
– Frequency up to nine times higher than in developed countries.
 What is the impact of health care-associated infections?

• Annual financial losses :

– Europe :€7 billion, reflecting 16 million extra days of
hospital stay,
– USA :US$ 6.5 billion.
– Brazil: US$ 18 million (1992).
– Mexican ICUs, the overall cost of one single HAIs
episode: US$ 12 155.
– Argentina ICUs, extra-cost estimates for catheter-
related bloodstream infection and health care-
associated pneumonia averaged US$ 4 888 and US$ 2
255 per case, respectively.
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
 PENGERTIAN
• Health care-associated infection (HCAI), also
referred to as "nosocomial" or "hospital"
infection, is an infection occurring in a patient
during the process of care in a hospital or other
health care facility which was not present or
incubating at the time of admission. HCAI can
affect patients in any type of setting where they
receive care and can also appear after discharge.
Furthermore, they include occupational
infections among staff.
 Every day, HCAI results in

– prolonged hospital stays,

– long-term disability,
– increased resistance of microorganisms to
antimicrobials,
– massive additional costs for health systems,
– high costs for patients and their family,
– unnecessary deaths.
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
 TUJUAN
• Mencegah terjadinya infeksi serta mengurangi
risiko transmisi infeksi
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
 INDIKASI
• Adanya tanda infeksi
– Tumor
– Calor
– Dolor
– Rubor
– Functio laesa
• Bukan kolonisasi
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
 PELAKSANAAN
• Mengulas dan menyetujui rencana tahunan program PPI
• Mengulas dan menyetujui kebijakan PPI
• Mendukung dan menjadi narasumber dalam identifikasi dan mengatasi
masalah
• Memastikan ketersediaan kelengkapan peralatan PPI
• Mengulas data surveilans epidemiologi dan mengidentifikasi area yang
akan intervensi
• Menelusur dan mempromosikan praktek PPI paca semua level di RS
• Memastikan semua staf dilatih PPI dan keselamatan pasien
• Mengulas risiko infeksi berkaitan dengan teknologi baru dan memantau
risiko alat dan produk baru sebelum disetujui untuk digunakan
• Mengulas dan memberikan asupan pada investigasi KLB
• Mengulas dan menyetujui proyek konstruksi/renovasi terkait pencegahan
infeksi
• Komunikasi dan bekerja sama dengan komite terkait, seperti komite
PPRA, Komite tenaga kesehatan dll.
 BACKGROUND
CORE COMPONENT OF IPC
WHO 2017
1.Program: health facility and national level
2.Guidance/manual book
3.Education and training
4.Surveillance
5.Strategi multimodal
6.Monitoring, evaluation and feedback
NATIONAL GUIDELINE
• IPC committee in the
hospital should be
direct under control of
the Director
• Full time IPCN
MANUAL BOOK MANAJERIAL AND GUIDANCE PCI
RSCM

2011 (4th edition) 2015 (5th edition)

+ BACTERIAL AND ANTIBIOTICS SUSCEPTIBILITY PROFILE
CIPTO MANGUNKUSUMO HOSPITAL 2007-2017
(six monthly)

• 2009-2012
 ANTIBIOTIC GUIDANCE
RSCM
SURGERY DEPARTMENT HOSPITAL
• PENDAHULUAN
• PENGERTIAN
• TUJUAN
• INDIKASI
• PELAKSANAAN
• FAKTOR-FAKTOR RISIKO
• KESIMPULAN
 What factors put patients at risk of
infection in health-care settings?
• Some of these factors are present regardless of the resources available:
– prolonged and inappropriate use of invasive devices and antibiotics;
– high-risk and sophisticated procedures;
– immuno-suppression and other severe underlying patient conditions;
– insufficient application of standard and isolation precautions.

• Some determinants are more specific to settings with limited resources:

– inadequate environmental hygienic conditions and waste disposal;
– poor infrastructure;
– insufficient equipment;
– understaffing;
– overcrowding;
– poor knowledge and application of basic infection control measures;
– lack of procedure;
– lack of knowledge of injection and blood transfusion safety;
– absence of local and national guidelines and policies.
FAKTOR FAKTOR RISIKO
• http://image.slidesharecdn.com/healthcareas
sociatedinfections-150807085541-lva1-
app6891/95/health-care-associated-
infections-46-638.jpg?cb=1438938023
 What are the solutions to this problem?
• Many infection prevention and control measures, such as appropriate
hand hygiene and the correct application of basic precautions during
invasive procedures, are simple and low-cost, but require staff
accountability and behavioural change.
• The main solutions and perspectives for improvement are:
– identifying local determinants of the HCAI burden;
– improving reporting and surveillance systems;
– ensuring minimum requirements in terms of facilities and dedicated
resources available for HCAI surveillance at the institutional level,
including microbiology laboratories' capacity;
– ensuring that core components for infection control are in place at the
health-care setting levels;
– implementing standard precautions, particularly best hand hygiene
practices at the bedside;
– improving staff education and accountability;
– conducting research to adapt and validate surveillance protocols
based on the reality;
– conducting research on the potential involvement of patients and
their families in HCAI reporting and control.
 UPAYA PENCEGAHAN MENGURANGI
RISIKO INFEKSI
• MELAKSANAKAN KEWASPADAAN ISOLASI
– KEWASPADAAN STANDAR
– KEWASPADAAN BERDASARKAN TRANSMISI
 SURVEILANS
• BLOOD STREAM INFECTION
– CLABSI
• PNEUMONIA
– HAP
– VAP
• URINARY TRACT INFECTION
– CA-UTI
• SURGICAL SITE INFECTION
 MELAKSANAKAN SURVEILANS HAI’S

INSIDEN RATE INFEKSI ALIRAN DARAH TERKAIT PEMASANGAN INSIDEN RATE PLEBITIS TERKAIT PEMASANGAN IVL DI RSCM TAHUN
CVL DI RSCM TAHUN 2008- SEMESTER I 2017 2008-SEMESTER I 2017
∑kejadian infeksi/∑hari pemasangan CVL x 1000

∑kejadian infeksi/∑ hari pemasangan IVL x 1000

120.00
25.00 23.06
100.00 96.03
20.00
80.00 Insiden rate(‰)
15.00 Insiden rate(‰)
60.00 Target <3.5‰
(‰)

Target <1‰

(‰)
10.00
40.00
3.40
20.00 5.00 1.66 1.08 0.82
5.37 7.40 5.49 5.18
4.08 4.61 5.82 2.00 1.63 0.27 0.26 0.09 0.07 0.02
0.00 0.31 0.00

TAHUN
TAHUN

INSIDEN RATE HOSPITAL ACQUIRED PNEUMONIA DI RSCM TAHUN

INSIDEN RATE VENTILATOR ASSOCIATED PNEUMONIA DI RSCM
2.79 2008-SEMESTER I 2017
∑kejadian infeksi/∑hari pasien tirah baring x 1000

TAHUN 2008- SEMESTER I 2017

∑KEJADIAN INFEKSI/∑PEMASANGAN VENTILATOR

3.00
2.49 35.00
2.50 2.27 31.40
30.00
2.00 1.25 Insiden rate(‰) 25.00
1.50 20.00 Insiden rate(‰)
X 1000 (‰)

Target <1‰ 15.80 15.52

13.66
(‰)

0.91 15.00 Target <5.8‰

1.00
0.43 0.37 10.00 6.31
0.50 0.25 0.18 0.18 3.68 3.40
5.00 1.40 2.18 1.97
0.00 0.00

TAHUN TAHUN
 SURVEILANS HAI’S RSCM
2008-SEMESTER I 2017
INSIDEN RATE INFEKSI SALURAN KEMIH TERKAIT PEMASANGAN
INSIDEN RATE DEKUBITUS DI RSCM TAHUN 2008-SEMESTER I 2017
CATETER URINE MENETAP DI RSCM TAHUN 2008-SEMESTER I 2017
∑kejadian infeksi/∑ hari pemasangan kateter urine x

4.00

∑kejadian infeksi/∑hari pasien tirah baring x 1000

6.00 3.40
4.81 3.50
5.00 3.00
3.92 2.34 Insiden rate(‰)
4.00 2.50
Insiden rate(‰)
2.00 Target <1‰
3.00 1.75 1.35
1000 (‰)

Target <4.7‰ 1.50

(‰)
1.76
2.00 1.44 0.74
1.00 0.54 0.54
1.00
0.68 0.61
0.36 0.22 0.21 0.50 0.12 0.15 0.22
0.07
0.00
0.00

TAHUN TAHUN

INSIDEN RATE INFEKSI DAERAH OPERASI DI RSCM TAHUN 2008-

SEMESTER I 2017
∑kejadian infeksi/∑operasiL x 100 (%)

2.50

2.00 1.95

1.50 Insiden rate(%)

1.44
1.24 Target <2%
1.00 0.96 1.00 1.00
0.72
0.62
0.50 0.43
0.33
0.00

TAHUN
 KEPATUHAN KEBERSIHAN TANGAN RSCM
2011- SEMESTER I 2017

KEPATUHAN PETUGAS MELAKUKAN KEBERSIHAN TANGAN KEPATUHAN PENGUNJUNG MELAKUKAN KEBERSIHAN TANGAN
PETUGAS DI RSCM TAHUN 2011-SEMESTER I 2017 DI RSCM TAHUN 2012-SEMESTER I 2017
tangan/∑kesempatan melakukan kebersihan tangan

90.0%

∑pengunjung yang patuh dalam kebersihan

100.0%
90.0% 86.4% 87.9%
87.9%
∑kepatuhan melakukan kebersihan

80.0% 85.0%
82.4%

tangan/∑petugas (%)
70.0% 76.7% 76.2% % Kepatuhan 82.2%
70.2% 72.7% 80.0%
60.0% % Kepatuhan
50.0% Target > 85% 76.6% 77.9%
75.0% Target > 85%
(%)

40.0%
72.2% 71.8%
30.0% 70.0%
20.0%
10.0% 65.0%
0.0%

TAHUN TAHUN
 KEPATUHAN PEMAKAIAN APD RSCM, 2015-SEMESTER I 2017 &
KEJADIAN TERTUSUK BENDA TAJAM RSCM, 2011-SEMESTER I 2017

KEPATUHAN PEMAKAIAN ALAT PELINDUNG DIRI DI RSUPN JUMLAH KEJADIAN PEGAWAI TERTUSUK BENDA
DR.CIPTO MANGUNKUSUMO TAHUN 2015-SEMESTER I 2017 TAJAM/TERPAJAN CAIRAN TUBUH DI RSCM TAHUN 2011 -
SEMESTER I 2017
98.5% 80 76 75
98.0% 98.0%

∑ kejadian
97.5% 60 52
44
%KEPATUHAN

97.0%
96.5% 96.6% %KEPATUHAN 40 46
96.0%
95.5% Target ≥97% 37
20
95.0% 95.2% 15
94.5% 0
94.0% 2011 2012 2013 2014 2015 2016 JAN-JUN
93.5%
2017
2015 2016 JAN-JUN 2017
TAHUN TAHUN
 KESIMPULAN
• Pasien yang menjalani Pelayanan kesehatan
mempunyai risiko untuk terkena penyakit
infeksi
• Program PPI bertujuan untuk mencegah
terjadinya infeksi serta mengurangi risiko
transmisi infeksi dengan melakukan surveilans
serta pelaksanaan kewaspadaan isolasi
• Melaksanakan program PPI secara konsisten
akan menyelamatkan pasien
TERIMA KASIH