KEEFEKTIFAN PENINGKATAN KEMAMPUAN PERAWAT DALAM PENCEGAHAN INFEKSI NOSOKOMIAL PADA BAYI DI RUANG NEONATAL INTENSIVE CARE UNIT

RUMAH SAKIT UMUM DAERAH WATES KULON PROGO

Ringkasan

Untuk Memenuhi Sebagian Persyaratan Mencapai Derajat Sarjana S-2 Minat Kesehatan Ibu dan Anak Kesehatan Reproduksi Program Studi Ilmu Kesehatan Masyarakat

Diajukan Oleh: Siti Maryati NIM: 09/293390/PKU/10923

Kepada PROGRAM PASCASARJANA FAKULTAS KEDOKTERAN UNIVERSITAS GADJAH MADA YOGYAKARTA 2011

BAB I PENDAHULUAN World Health Organization (WHO) memperkirakan kematian neonatus sebanyak 298.000 atau 49 per 1000 kelahiran hidup. Tiga perempat dari kematian neonatal terjadi pada minggu pertama, dan lebih dari seperempat terjadi pada 24 jam pertama kehidupan. Penyebab kematian neonatal bervariasi sesuai dengan ketersediaan dan kualitas perawatan kesehatan dari setiap negara, sedangkan kematian neonatal karena infeksi 36%, kelahiran prematur 28% dan 23% asfiksia lahir.(1) Di Indonesia setiap tahun sekitar 20 bayi per 1.000 kelahiran hidup meninggal dalam rentang waktu 0-12 hari pasca kelahirannya. Adapun penyebab kematian terbanyak periode ini disebabkan oleh sepsis (infeksi sistemik), kelainan bawaan, dan infeksi saluran pernapasan atas.(2) Berdasarkan hasil laporan tahunan pelayanan perawatan di ruang NICU RSUD Wates Kulon Progo dan hasil pemantauan berkala pengendalian infeksi nosokomial. Pada tahun 2009 kejadian sepsis mencapai kenaikan dua kali lebih banyak dibandingkan tahun sebelumnya dan infeksi merupakan 3 besar penyebab kematian neonatal di RSUD Wates Kulon Progo. Untuk menekan kejadian infeksi nosokomial dan jumlah kematian neonatal, kemampuan pencegahan infeksi perawat perlu ditingkatkan dengan cara melakukan pelatihan pencegahan infeksi pada perawat. Tujuan penelitian ini adalah untuk meningkatkan kemampuan perawat dalam pencegahan infeksi noskomial pada bayi melalui pelatihan pencegahan infeksi di ruang NICU RSUD Wates Kulon Progo. BAB II TINJAUAN PUSTAKA
Sebagai upaya untuk meningkatkan pengetahuan dan keterampilan perawat dalam pencegahan infeksi nosokomial adalah dengan memberikan pelatihan kewaspadaan universal pencegahan infeksi. Metode pelatihan ini dipilih untuk meningkatkan kemampuan perawat karena infeksi nosokomial

berhubungan dengan beban kerja dari sumberdaya atau tenaga kesehatan serta

tingkat pelatihan perawat, beban kerja yang tinggi terkait dengan tindakan pengendalian infeksi seperti kebersihan tangan dan kepatuhan dalam tindakan pencegahan infeksi. Cross-transmisi mikroorganisme ditularkan terutama oleh tangan-tangan perawat itu sendiri. Pelatihan dapat diartikan sebagai proses mengajarkan pengetahuan dan keahlian tertentu serta sikap agar karyawan semakin trampil dan mampu dalam melaksanakan tanggung jawabnya dengan semakin baik sesuai dengan standart. Pelatihan lebih merujuk pada pengembangan keterampilan bekerja (vocational) yang dapat digunakan dengan segera.(3) Pelatihan terdiri dari: On the job

trainning, Vestibule trainning, Apprenticeship, Kursus-kursus khusus. Infeksi adalah invasi mikroorganisme patogen kedalam jaringan tubuh. Infeksi neonatorum merupakan infeksi pasca lahir yang didapat setelah kelahiran selama 28 hari pertama. Hampir semua infeksi neonatus mulai-awal didapat pada intrapartum, Infeksi nosokomial adalah infeksi yang didapat di rumah sakit yang terjadi lebih lambat dari 48-72 jam setelah lahir.(4) Sepsis mengimplikasikan suatu pola klinis khas atas perubahan susunan hemodinamik dan metabolik yang terjadi akibat infeksi. Sepsis adalah respons inflamatorik sistemik akibat infeksi.(5) Pemantauan praktik pencegahan infeksi dengan cara melakukan observasi pelaksanaan praktik pencegahan infeksi dan mencatat infeksi yang terjadi di rumah sakit dan klinik setelah pelaksanaan program. Hasil pemantauan ini merupakan salah satu indikator keberhasilan program yang dilaksanakan oleh pengelola pelayanan keperawatan. (6) BAB III METODE PENELITIAN Rancangan penelitian Pre eksperimental dengan One group pre and post design dengan pendekatan cohort. Rancangan ini sebelum diberi intervensi dilakukan pretest (O1) diikuti intervensi (X) setelah beberapa waktu dilakukan posttest (O2)
(7)

. Subjek yang diteliti dalam penelitian ini

adalah perawat dengan populasi dan sampel seluruh perawat yang bertugas di ruang NICU RSUD Wates Kulon Progo yang hadir saat

pelatihan, dengan pengambilan data pada bulan Juni 2011. Instrumen yang digunakan untuk pengumpulan data kuantitatif berupa lembar observasi atau daftar check list dan kuesioner untuk penilaian

pencegahan infeksi (PI). Melakukan pretest untuk menguji praktik perawat dalam melakukan pencegahan infeksi, mengadakan pelatihan tentang pencegahan infeksi nosokomial pada subjek penelitian (perawat). Jenis pelatihan berupa On the job trainning, selanjutnya melakukan pemantauan/observasi setiap satu minggu sekali selama 2 minggu. Evaluasi dilakukan dengan melihat; kemampuan praktik perawat dalam melaksanakan pencegahan infeksi. Aspek yang di observasi meliputi kebiasaan cuci tangan, memakai sarung tangan, memakai baju pelindung, memproses alat bekas pakai,

menangani peralatan tajam dengan aman dan membuang sampah di ruang NICU RSUD Wates. BAB IV HASIL PENELITIAN DAN PEMBAHASAN Berdasarkan pendidikan perawat diperoleh hasil bahwa semua subyek penelitian berasal dari pendidikan tinggi yang terdiri dari hampir semua subyek penelitian berasal dari pendidikan D3 Keperawatan sebanyak 14 orang 93,33% dan S1 Keperawatan hanya 1 orang 6,67%. Jenjang pendidikan yang tinggi menyebabkan perawat memiliki rasa tanggung jawab yang besar terhadap tugas. Perawat yang mempunyai jenjang pendidikan yang lebih tinggi yang diikuti pengalaman yang lebih banyak serta mendapatkan informasi tentang teori-teori baru mengenai pencegahan infeksi nosokomial diharapkan perawat semakin mampu melakukan upaya pencegahan infeksi nosokomial. Pada

penelitian ini tidak bisa menunjukkan efek pendidikan terhadap praktik pencegahan infeksi karena responden mempunyai tingkat pendidikan yang homogen. Responden dengan tingkat pendidikan D III Keperawatan belum mampu mengubah praktik pencegahan infeksi secara konsisten

dibuktikan dengan setelah diberi pelatihan hanya mampu meningkatkan praktik pencegahan infeksi sampai minggu pertama saja kemudian terjadi penurunan pada minggu kedua(8) Ada hubungan antara pelatihan dan pemahaman dengan kinerja perawat dalam pengendalian infeksi nosokomial dan tidak ada hubungan yang bermakna antara faktor pendidikan dan fasilitas rumah sakit dengan kinerja perawat dalam pengendalian infeksi nosokomial.(9) Kontribusi kepatuhan pencegahan infeksi terhadap kejadian infeksi pada bayi baru lahir sebesar 6,8%. Kontribusi variabel kepatuhan pencegahan infeksi dan pendidikan bidan terhadap kejadian infeksi pada bayi sebesar 9,9%.(10) Hasil uji pretest praktik didapatkan nilai mean 15,4 dengan standart deviasi 4,89. Penilaian praktik pencegahan infeksi terdiri dari 5 aspek meliputi; aspek melakukan cuci tangan mean 6,33, memakai sarung

tangan 1,47, memakai baju pelindung 0,8, memproses alat bekas pakai 2,8, menangani peralatan tajam dengan aman dan membuang sampah 4. Ranah psikomotor merupakan ranah yang berkaitan dengan ketrampilan (skill) atau kemampuan bertindak setelah seseorang menerima

pengalaman belajar tertentu yang berhubungan dengan aktifitas fisik. Hasil belajar psikomotor ini merupakan kelanjutan dari hasil belajar kognitif. Hasil belajar kognitif dan hasil belajar afektif akan menjadi hasil belajar psikomotor.(11) Hasil pretest semua subyek penelitian tidak melakukan praktik pencegahan infeksi sesuai standart terutama pada aspek memproses alat bekas pakai sebanyak 0%. Setelah diberi pelatihan hasil posttest minggu kedua menunjukkan sebagian besar subyek penelitian melakukan praktik pencegahan infeksi sesuai standart posttest minggu 1 sebanyak 8 orang 53,33%, dan minggu ke 2 sebanyak 7 orang 46,67%, setelah diberikan pelatihan aspek yang paling banyak dilakukan sesuai standart adalah aspek memakai sarung tangan sebanyak 11 orang 73,33% sedangkan yang paling sedikit dilakukan adalah aspek melakukan cuci tangan sebanyak 9 orang 60%. Namun pada aspek menangani peralatan tajam

dengan aman dan membuang sampah menunjukkan hasil pretest dan posttest cenderung tetap semua subyek penelitian menangani peralatan tajam dengan aman dan membuang sampah sesuai standart sebanyak 15 orang 100%. Hasil penelitian ini menunjukkan bahwa praktik pencegahan infeksi dari ke 5 aspek yaitu yang paling sedikit dilakukan dan paling rendah terjadi peningkatan adalah aspek melakukan cuci tangan. Hal itu terjadi karena jumlah alat untuk melakukan cuci tangan terbatas sehingga akses cuci tangan jauh, jika sudah menggunakan sarung tangan menganggap cuci tangan tidak begitu penting, beban kerja perawat yang tinggi karena dengan adanya program jaminan persalinan terjadi pelonjakan jumlah pasien hingga 16,29%. Sebanyak 413 subyek penelitian yang mempunyai pengetahuan tentang pencegahan infeksi dinyatakan baik sebanyak 96,8% dan dari pengetahuan yang baik tersebut mempunyai sikap positif terhadap kebiasaan cuci tangan sebanyak 86,2%. Kebiasaan cuci tangan yang mereka lakukan terdapat 60% melakukan cuci tangan sebelum masuk ruangan dan 72,5% melakukan cuci tangan sebelum dan sesudah kontak dengan pasien.(10) Adanya prosedur tetap pencegahan infeksi dan dukungan kelembagaan yang diikuti dengan observasi secara terus menerus dan umpan balik kinerja perawat dapat meningkatkan 97,3% praktik cuci tangan .(12) Perawat yang mempunyai sikap positif juga memiliki pengetahuan yang baik dengan nilai p: 0,0001 demikian pula cakupan pelatihan yang lebih baik dapat meningkatkan praktik pencegahan infeksi dengan nilai p: 0,0001 (13) Tidak ada perbedaan yang significant pendidikan perawat terhadap upaya peningkatan pengendalian infeksi.(14) Pendidikan saja tidak mungkin terkait dengan perubahan perilaku cuci tangan, dengan kata lain tidak ada hubungan tingkat pendidikan dengan kebiasaan cuci tangan.(15)Terdapat hubungan yang signifikan pengetahuan lebih tinggi

terdapat pada mereka yang berasal dari tingkat pendidikan yang tinggi pula, perawat dengan pendidikan tinggi lebih mungkin melakukan tindakan antisepsis yang tepat pada luka bedah dan melakukan cuci tangan sebelum dan sesudah melakukan tindakan.
(16)

Alasan mengapa petugas

kesehatan tidak melakukan cuci tangan adalah: Keyakinan bahwa: tindakan cuci tangan tidak perlu dilakukan jika perawat memakai sarung tangan.(17) Tindakan pencegahan infeksi untuk menghindari pemajanan terhadap cairan tubuh adalah dengan mengenakan sarung tangan bila kontak dengan darah, selaput lendir, kulit terluka, sekresi dan bahan yang terkontaminasi. Namun memakai sarung tangan tidak memberikan perlindungan penuh terhadap kontaminasi tangan. Misalnya bakteri dari pasien ditemukan hingga 30% petugas yang memakai sarung tangan sewaktu merawat pasien. Dokter spesialis bedah dan gigi yang mengenakan sarung tangan dan perangkat perlindungan lainnya terinfeksi dengan hepatitis B. Sejumlah bakteri yang cukup banyak pada kedua tangan petugas yang tidak mengganti sarung tangan diantara pasien satu dengan lainnya tetapi hanya cuci tangan memakai sarung tangan.(6) Sebanyak 216 perawat hampir semua menyadari bahwa praktik desinfeksi dan sterilisasi yang tidak benar meningkatkan risiko infeksi nosokomial sehingga semua sepakat bahwa pedoman desinfeksi dan sterilisasi diterapkan, sedangkan untuk penggunaan alat pelindung diri dari 216 perawat hanya 38% secara rutin menggunakan alat pelindung diri tanpa melihat tingkat pendidikan.(18) BAB V KESIMPULAN DAN SARAN Karakteristik pendidikan dan praktik perawat sebelum diberikan pelatihan adalah homogen. Pelatihan pencegahan infeksi nosokomial efektif dapat meningkatkan kemampuan praktik perawat dalam melakukan pencegahan infeksi nosokomial, aspek yang paling banyak dilakukan

adalah memakai sarung tangan dan yang paling sedikit melakukan cuci tangan. Paling tinggi peningkatannya adalah memproses alat bekas pakai dan paling rendah adalah melakukan cuci tangan. Bagi rumah sakit untuk rekruitmen tenaga perawat dengan latar belakang apapun pendidikannya baik dari D 3 Keperawatan maupun S1 Keperawatan yang terpenting adalah kemampuan dan kepatuhan melakukan praktik pencegahan infeksi untuk menekan kejadian infeksi nosokomial. Perlu adanya ketersediaan alat pelindung diri dan alat cuci tangan yang lengkap demi menunjang pelaksanaan pencegahan infeksi nosokomial. Perlu adanya pengawasan secara terus menerus dan sanksi yang tegas dari atasan terhadap petugas yang lalai dalam melaksanakan tindakan-tindakan pencegahan infeksi nosokomial, begitu pula sebaliknya reward diberikan pada petugas yang patuh melaksanakan tindakantindakan pencegahan infeksi nosokomial.

DAFTAR PUSTAKA 1. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, et al. Neonatal mortality, risk factors and causes: A prospective population-based cohort study in urban Pakistan. Bull World Health Organ. 2009;87(2):130-8. 2. Depkes RI. Riset Kesehatan Dasar tahun 2007. Jakarta: Depkes RI; 2007. 3. Mangkuprawiro. Manajemen Sumber Daya Manusia Stratejik. Jakarta: PT Ghalia Indonesia; 2003. 4. Nelson, W. (2000) Ilmu Kesehatan Anak, Jakarta: EGC 5. Rudolph, A. M. (2006) Buku Ajar Pediatri Jakarta: Penerbit Buku Kedokteran EGC. 6. JNPK-KR (2004) Panduan Pencegahan Infeksi Untuk Fasilitas Pelayanan Kesehatan dengan Sumber Daya Terbatas, Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo. 7. Notoatmodjo, S. (2005) Metodologi Penelitian Kesehatan, Jakarta: Rineka Cipta. 8. Mangkuprawiro. Manajemen Sumber Daya Manusia Stratejik. Jakarta: PT Ghalia Indonesia; 2003. 9. Marwoto B. Analisis Kinerja Sumber Daya Manusia (Perawat) dalam Pengendalian Infeksis Nosokomial di IRNA I RSUP Dr. Sardjito Yogyakarta. Yogyakarta: Fakultas Kedokteran, Universitas Gadjah Mada; 2007.

10. Rere HV. Kepatuhan Bidan Melakukan Pencegahan Infeksi Terhadap Kejadian Infeksi pada Bayi Baru Lahir di Rumah Sakit Umum Daerah Dok II Jayapura Papua. Yogyakarta: Fakultas Kedokteran, Universitas Gadjah Mada; 2009. 11. Djiwandono SEW. Psikologi Pendidikan. Jakarta: PT. Gramedia Widiasarana Indonesia; 2006. 12. Khaled M, Elaziz A, Imam M. Assesment of Knowledge, attitude and practice of hand washing among health care workers in Ain Shams University Hospitals in Cairo. The Egyptian Journal of Community Medicine. 2008;2(26). 13.Askarian M, Shiraly R, Louise M. An investigation of nurses knowledge, attitudes, and practices regarding desinfection procedure in Italy. Shiraz University of Medical Science. 2005;81(1412). 14. Stein A, Makarawo T, Ahmad M. A survey on doctors and nurses knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching Hospitals. Journal of Hospital Infection. 2003;54:68-73. 15. Martha S, Alvaran, Larson E. Brief report opinions, knowledge, and self-reported practices related in infection control among nursing personnel in long-term care setting. The Association for Professionals in Infection Control Epidemiology. 1994;17(47):566-77. 16. Sessa A, Giuseppe G, Albano L, Angelillo I. An investigation of nurses knowledge, attitudes, and practices regarding desinfection procedures in Italy. BMC Infectiouse Diseases. 2011;11(148). 17. Angelillo I, Mazziota A, Nocotera G. Nurses and hospital infection control: Knowledge, attitude and behavior and behaviour of Italian operating theatre staff. Journal of Hospital Infection. 1999;42:105-12.

EFFECTIVENESS OF NURSES ABILITY IN PREVENTION OF NOSOCOMIAL INFECTION AMONG INFANTS IN NEONATAL INTENSIVE CARE UNIT (NICU) AT WATES DISTRICT HOSPITAL OF KULON PROGO

Summary

To Fulfil a Partial Requirement To Obtain a Masters Degree

Maternal and Child Health Reproductive Health Study Program of Public Health Sciences

Siti Maryati NIM: 09/293390/PKU/10923

POST GRADUATE PROGRAM FACULTY OF MEDICINE GADJAH MADA UNIVERSITY YOGYAKARTA 2011

APPROVAL SHEET

Summary

EFFECTIVENESS OF NURSES ABILITY IN PREVENTION OF NOSOCOMIAL INFECTION AMONG INFANTS IN NEONATAL INTENSIVE CARE UNIT (NICU) AT WATES DISTRICT HOSPITAL OF KULON PROGO

Submitted by

Siti Maryati NIM: 09/293390/PKU/10923

Has been approved by

Main advisor

dr. Ova Emilia, Sp.OG, M.M.Ed, PhD

approval date, .....................

Co advisor

dr. Tunjung Wibowo, MPH, Sp.A

approval date, .....................

CHAPTER I INTRODUCTION

World Health Organization (WHO) estimates that neonatal deaths have reached 298,000 cases or 49 per 1000 live births. Three-quarters of neonatal deaths occur in the first week, and more than a quarter occur in the first 24 hours of life. Causes of neonatal death vary according to the availability and quality of health care from every country, whereas neonatal mortality happens due to some reason such as infection (36%), premature births (28%) and neonatal asphyxia (23%).
(1)

In Indonesia every year

about 20 infants per 1,000 live births die in the span time of 0-12 days after birth. The causes of most deaths during this period are due to sepsis (systemic infection), congenital abnormalities, and upper respiratory tract infections. (2) Based on the results of the annual reports of care services in the NICU at Wates Local Hospital of Kulon Progo and periodically monitoring results of nosocomial infection control, in 2009 the incidence of sepsis increased two times more than the previous year and the infection has been the third major cause of neonatal deaths in the hospital. To suppress the incidence of nosocomial infections and the number of neonatal deaths, the skills of nurses infection prevention needs to be increased by performing training on infection prevention. The purpose of this study was to improve the skill of nurses in the prevention of infection in infants through training on prevention of nosocomial infection in the NICU at Wates Local Hospital of Kulon Progo. CHAPTER II LITERATURE REVIEW In an effort to improve knowledge and skills of nurses in the prevention of nosocomial infections, it is done by providing training in universal precautions of infection prevention. This training method is

chosen to enhance the skills of nurses due to nosocomial infections related to the workload of the resources or health personnel and nurses' training level, the high workload associated with infection control measures such as hand hygiene and compliance in infection prevention measures. Cross-transmission of microorganisms is transmitted mainly by the hands of nurses themselves. Training can be interpreted as a process to teach knowledge and specific skills and attitudes that employees will increasingly be skilled and capable in carrying out their responsibilities in accordance with the better standard. Training refers more to the development of work skills (vocational) which can be used immediately.
(3)

Training consists of: On

the job training, Vestibule training, Apprenticeship, and specialized courses. Infection is the invasion of pathogenic microorganisms into the body tissues. Neonatal infection is an infection acquired after birth during the first 28 days. Almost all early neonatal infection is acquired in the intrapartum. Nosocomial infections are infections acquired in hospitals occurring more slowly than 48-72 hours after birth.
(4)

Sepsis implies a

typical clinical pattern of hemodynamic and metabolic changes in composition that occurs as a result infection. Sepsis is a systemic inflammatory response due to infection. (5) Monitoring of infection prevention practices is done through observing the implementation of infection prevention practices and noting that infections occur in hospitals and clinics after the implementation of the program. The results of this monitoring are one indicator of the success of programs implemented by nursing care staff. (6) CHAPTER III RESEARCH METHOD It was a pre-experimental research with One group pre and post design and a cohort approach. The design was in form of giving an

intervention of a pretest (O1) followed by the next intervention (X) and after some time the posttest (O2) was conducted.
(7)

Subjects examined in

this study were nurses with population and sample that were all nurses who served in the NICU at Wates Hospital of Kulon Progo present during training, with data collection in June 2011. The instrument used for quantitative data collection was observation sheet or check list and questionnaire for the assessment of prevention of infection (PI). The pretest was conducted to examine the practice of nurses in the prevention of infection, providing training on the prevention of nosocomial infections on the research subject (nurse). Types of training were in form of On-the-job training, further performing monitoring / observation every single week for 2 weeks. Evaluation was done by observing the nurses ability practice in implementing prevention of infection. Aspects of the observation involved the habit of washing hands, wearing gloves, wearing protective clothing and processing of used equipment and sharp tools safely as well as disposing wastes in the NICU at Wates Hospital. CHAPTER IV RESULTS AND DISCUSSION Based on the nurses education, the results showed that all study subjects came from higher education, that is, almost all subjects were from the D3 Nursing education as many as 14 people or 93.33% and only 1 person holding S1 education of nursing or 6.67%. The high level of education encourages nurses to have high

responsibility to their duty. Nurses with higher level of education, a lot of experiences and new theories of preventing Nosokomial infection are expected to have higher ability to make efforts in preventing the Nosokomial infection. The effects of education to the practice of preventing infection cannot be shown in this research since the

respondents for this research have homogenous education level. The respondents of DIII of nursery have not been able to change the practice

of preventing infection consistently. This can be seen

that they can

improve the practice of preventing infection only on the first week after being given a training. The decreasing on the practice of preventing infection occurs on the following weeks (8) There was a relationship between training and understanding of the nurses performance in the control of nosocomial infections and no significant association between factors of education and hospital facilities and the nurses performance in the control of nosocomial infections. (9) The contribution of infection prevention compliance to the incidence of infection in newborn was 6.8%. The contribution of infection prevention compliance and education of midwives to the incidence of infection in infants was 9.9%. (10) Pretest practice test results presented a mean of 15.4 with standard deviation of 4.89. Assessment of infection prevention practices consisted of five aspects that included aspects of hands washing by 6.33, wearing gloves by 1.47, wearing protective clothing by 0.8, processing a used tool by 2.8, handling sharp tools safely handle and disposing wastes by 4. A psychomotor domain is associated with the domain of skills or the ability to act after a person receives a certain learning experiences associated with physical activity. Psychomotor learning outcomes are a continuation of cognitive learning outcomes. The results of cognitive learning and affective learning outcomes will be the result of psychomotor learning. (11) Pretest results showed that all study subjects did not perform practices according to standard infection prevention practices, especially in the aspect of processing used tools (0%). Once given training, the results revealed that the majority of study subjects perfomed practices according to standard infection prevention practices shown in the week 1 posttest reaching 8 people or 53.33% and in the second week of training posttest reaching 7 people or 46.67%. After being given the training, the aspect which was most widely performed in accordance standard was the aspect of wearing gloves as many as 11 people or 73.33% while the least

to do was to wash the hands as many as 9 people or 60%. However, in the aspect of handling sharp tools safely and disposing wastes, the pretest and posttest results tended to remain the same that all study subjects did the aspects according to the standards as many as 15 people or 100%. The results of this study indicated that the least performed and the lowest increased infection prevention practices of the five aspects was the aspect of hands washing. It happened because the number of sinks to perform hand-washing access was limited, if they had used gloves, handwashing was not considered so important. A total of 413 study subjects who had good knowledge about the prevention of infection were 96.8% and, of the nurses with good knowledge, those who had a positive attitude toward hand-washing were 86.2%. The habit of hands washing that they did was 60% before entering the room and 72.5% before and after contacting with patients.(10) The existing standard procedure on the prevention of infection and the institutional support which was followed by continuous observation and feedback on the nurses performance could improve hand washing practices by 97.3%. (12) Nurses who have a positive attitude also had a good knowledge with a value of p: 0.0001 and coverage of better training could improve infection prevention practices with a value of p = 0.0001. (13) There was no significant difference between nurse education and effots to improve infection control.
(14)

Education was not likely associated

(15)

with changes in hand washing behavior, in other words, there was no association between education level and hand-washing habits. There

was a significant association in higher knowledge nurses in which those from higher education were more likely to take action of appropriate antisepsis in surgical wounds and to wash hands before and after the action. (16) The result of this research proves that the most common aspect done as the standard is the aspect of wearing gloves. It happens since 1)

there is a thought that it is not necessary to wash hands when wearing gloves.2) gloves give enough protection of being contaminated by the bodys liquid of the patient. The belief that the act of washing hands is not needed when wearing gloves is the reason why the health workers do not wash their hands.(17) The act of preventing infection to avoid of being contagious by the bodys liquid of the patient is by wearing gloves when contacting blood, mucous membrane, injured skin, feces and contaminated material. However, wearing gloves does not fully give protection from hand contamination. For the example of this case is that the bacteria of the patient is found up to 30% on the health worker who wears gloves when taking care of the patient. Surgeons and dentists who wear gloves and other means of protection are infected by B-hepatitis. A quite amount of bacteria is on both hands of the health worker who does not change the gloves on each patient. Instead of changing the gloves, he or she only wash the hands without putting off the gloves.(6) A total of 216 nurses realized that the practice of incorrect disinfection and sterilization was actually increasing the risk of nosocomial infection so that all agreed that the disinfection and sterilization guidelines were applied, while for the use of personal protective equipment, of 216 nurses, was performed by only 38% routinely regardless of the level of education. (18) CHAPTER V CONCLUSIONS AND SUGGESTIONS The characteristic of the nurses education and practice before the training provided was homogeneous. Nosocomial infection prevention training could effectively improve the ability of nurses practice in the prevention of nosocomial infection. The aspect which was mostly done was to wear gloves and least performed was hand- washing. The highest

improvement was to process used tools and the lowest was to wash hands. In the future, the hospital shall recruit nurses with good Nursing educational background either D 3 or S1 and the most important is their skills and compliance to infection prevention practices to reduce the incidence of nosocomial infections. There is a need for the availability of personal protective equipment and complete tools for hand-washing to support the implementation of nosocomial infection prevention. There is also a need for continuous supervision and strict sanctions against the negligent officers in carrying out measures to prevent nosocomial infections, and vice versa those who dutifully carry out practices of nosocomial infection prevention are given rewards. REFERENCES 1. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, et al. Neonatal mortality, risk factors and causes: A prospective population-based cohort study in urban Pakistan. Bull World Health Organ. 2009;87(2):130-8. 2. Depkes RI. Riset Kesehatan Dasar tahun 2007. Jakarta: Depkes RI; 2007. 3. Mangkuprawiro. Manajemen Sumber Daya Manusia Stratejik. Jakarta: PT Ghalia Indonesia; 2003. 4. Nelson, W. (2000) Ilmu Kesehatan Anak, Jakarta: EGC 5. Rudolph, A. M. (2006) Buku Ajar Pediatri Jakarta: Penerbit Buku Kedokteran EGC. 6. JNPK-KR (2004) Panduan Pencegahan Infeksi Untuk Fasilitas Pelayanan Kesehatan dengan Sumber Daya Terbatas, Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo. 7. Notoatmodjo, S. (2005) Metodologi Penelitian Kesehatan, Jakarta: Rineka Cipta. 8. Mangkuprawiro. Manajemen Sumber Daya Manusia Stratejik. Jakarta: PT Ghalia Indonesia; 2003. 9. Marwoto B. Analisis Kinerja Sumber Daya Manusia (Perawat) dalam Pengendalian Infeksis Nosokomial di IRNA I RSUP Dr. Sardjito Yogyakarta. Yogyakarta: Fakultas Kedokteran, Universitas Gadjah Mada; 2007. 10. Rere HV. Kepatuhan Bidan Melakukan Pencegahan Infeksi Terhadap Kejadian Infeksi pada Bayi Baru Lahir di Rumah Sakit Umum Daerah Dok II Jayapura Papua. Yogyakarta: Fakultas Kedokteran, Universitas Gadjah Mada; 2009.

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