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Environment
Patient
Antimicrobials Hands
Rantai kejadian infeksi
PENDAHULUAN
Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010
MODES OF TRANSMISSION OF HAI
PATHOGENS(2)
Mode of transmission Reservoir/source Examples of pathogens
Medication-related Water/iv fluids Burkholderia cepacia
disinfectants Acinetobacter spp.
Serratia marcescens
Transfusion, Patients/blood Hepatitis B virus, hepatitis C
needlestick virus, HIV, etc.
Transplantation Patients/donor tissue Cytomegalovirus
Toxoplasma gondii
Creutzfeld-Jacob agent
Airborne Patients Mycobacterium tuberculosis
Hot water/showers Legionella spp.
Soil/dust Aspergillus spp.
Foodborne Animals/food products Salmonella spp.
Water/enteral feeding 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 TACT
COMMON ADVANCED AGE
NASOGASTRIC TUBE
INFECTION SITES AND SURGERY
IMMUNODEFICIENCY
SURGICAL-SITE
INFECTIONS
RISK LUNG
INFECTIONS
INADEQUATE ANTIBIOTICS
FACTORS
PROPHYLAXIS BLOOD
INCORRECT SURGICAL SKIN INFECTIONS
PREPARATION
SURGICAL INTERVENTION DURATION VASCULAR CATHETER
TYPE OF WOUND NEONATAL OR ADVANCED AGE
INAPPROPRIATE WOUND CARE SEVERE UNDERLYING DISEASE
POOR SURGICAL ASEPSIS NEUTROPENIA
DIABETES IMMUNODEFICIENCY
NUTRITIONAL STATE WHO Global Patient NEW INVASIVE TECHNOLOGY
IMMUNODEFICIENCY Safety Challenge, CRITICAL CARE
LACK OF TRAINING & SUPERVISION LACK OF TRAINING & SUPERVISION
2007
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
Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 2010
MICROORGANISM WITH DRUG RESISTANCE THAT ARE MAJOR
PROBLEMS IN HOSPITALS
Struelens MJ : Hosp. Infec. Control, in Amstrong & Cohen : Infect. Dis, 1999
The Awareness of HAI/HCAI
Infection Control
DW
The Critical Importance of
HAI/HCAI Infections 1
– 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 control goals
DW
Monitoring the Achievement
of Infection Control Goals 2
DW
The Essential of Hospital
Infection Control Program
DW
Paradigm in Infection Control
= Quality improvement
programs
DW
HAI/HCAI INFECTION CONTROL
PROGRAM
Target for HCW
The save delivery of health care
Hospitals
Should do the sick no harm
ORGANIZATION OF HOSPITAL
INFECTION CONTROL
departments
Bennett & Brachman's Hospital Infections, 5th Ed, 2007 Lippincott Williams & Wilkins
A RATIONAL CLASSIFICATION OF HOSPITAL
INFECTION PREVENTION STRATEGIES(2)
Bennett & Brachman's Hospital Infections, 5th Ed, 2007 Lippincott Williams & Wilkins
10 Kewaspadaan standar terdiri dari
45
Kewaspadaan berdasarkan Transmisi
Transmisi
46
Resume 1
DW
Resume 2
DW
TERIMA KASIH