Infeksi Luka Operasi pada Bekas Luka Operasi Sesar

Jimmy Sakti NB

Pembimbing: dr. T. Indang Dewi, SpOG(K)

Departemen Obstetri dan Ginekologi

Fakultas Kedokteran Universitas Indonesia
Rumah Sakit Pusat Angkatan Darat Gatot Soebroto, Jakarta
 Pendahuluan
• Infeksi Luka Operasi (ILO): infeksi yang terjadi dalam
30 hari sesudah dilakukan operasi
• ILO merupakan salah satu bentuk dari 13 jenis
infeksi nosokomial
Pendahuluan • CDC: 38% infeksi nosokomial adalah ILO
Faktor Risiko • Di Ruang Rawat Obgin RSCM pada Agustus–Oktober
2011 sebanyak 25 kasus
Klasifikasi
• Di Ruang Rawat Obgin RSPAD Gatot Subroto pada
Pencegahan tahun 2016, 11 kasus dari 304 operasi (3,6%)
• ILO menyebabkan delay recovery, prolong
Kesimpulan
hospitalizaon or outpatient treatment, may
necessitate readmission, increase hospital bills as
well as other morbidites and mortality
Pendahuluan

Faktor Risiko

Klasifikasi

Pencegahan

Kesimpulan
Pendahuluan

Faktor Risiko

Klasifikasi

Pencegahan

Kesimpulan
Pendahuluan

Faktor Risiko

Klasifikasi

Pencegahan

Kesimpulan
Pendahuluan

Faktor Risiko

Klasifikasi

Pencegahan

Kesimpulan
 Superficial Incisional SSI

Infection occurs within 30 days

after the operation and
involves only skin or
subcutaneous tissue
of the incision Skin
Superficial
incisional SSI

Subcutaneous
tissue

Mangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.

 Deep Incisional SSI
Infection occurs within 30
days after the operation if
no implant is left in place or
within 1 year if implant is in
place and the infection
appears to be related to the Superficial
incisional SSI
operation and the infection
involves the deep soft tissue
(e.g., fascia and muscle
layers)
Deep soft tissue Deep incisional SSI
(fascia & muscle)

Mangram AJ et al. Infect Control Hosp Epidemiol. 1999;20:250-278.

 Organ/Space SSI
Infection occurs within 30 days
after the operation if no implant is
Superficial
left in place or within 1 year if incisional SSI
implant is in place and the
infection appears to be related to
the operation and the infection
involves any part of the anatomy,
other than the incision, which was
opened or manipulated during the Deep incisional SSI
operation

Organ/space Organ/space SSI

Mangram AJ et al. Infect Control Hosp Epidemiol.
1999;20:250-278.
 Differences between primary and 
secondary union of wounds
PRIMARY UNION SECONDARY UNION
• Clean  • Unclean
• Generally uninfected • May be infected
• Margins surgical clean
• Irregular
• Sutures used
• Scanty granulation tissue at  • Not used
the incised gap • Exuberant granulation 
tissue to fill the gap
• Neat linear scar • Contracted irregular wound
• Complications • Common
Infrequent 
Pendahuluan

Faktor Risiko

Klasifikasi

Pencegahan

Kesimpulan
Bundle

• A grouping of best practices that

individually improve care, but when applied
together result in substantially greater
improvement
• Science behind the bundle elements is well
established – the standard of care
• Bundle element compliance can be
measured as “YES/NO” for audit
 Surgical Site Infection Prevention Bundle
Components
1. Prophylactic antibiotic given within one hour prior to
surgical incision
2. Appropriate prophylactic antibiotic selection for surgical
patients
3. Prophylactic antibiotics discontinued within 24 hours
after surgery end time (48 hours for cardiac surgery)
4. Cardiac surgery patients with controlled 6 A.M.
postoperative serum blood glucose
5. Surgery patients with appropriate hair removal
6. Surgery patients with perioperative temperature
management – maintaining normothermia
7. Urinary catheter removal on postoperative day 1 or 2
with day of surgery being day zero
 Other SSI Prevention Measures

• Protect closed incision with sterile

dressing for 24-48 hours
postoperatively

• Maintain adequate/recommended
ventilation processes in the
operating rooms
 Operative Antibiotic Prophylaxis
• Decreases bacterial counts at surgical site
• Given within 60 minutes prior to starting
surgery (knife to skin)
• Repeat dose for longer surgery (T 1/2)
• Do not continue beyond 24 hours
• Determinants – prevailing pathogens,
antibiotic resistance, type of surgery
• Not a substitute for aseptic surgery or good
technique
 Timing of Prophylaxis

• Intravenous antibiotics should be given within 60 minutes

before skin incision and as close to time of incision as practically
possible
(N Engl J Med 1992; 326:281 – 6 & Ann Surg 2008; 247: 918–
926)
• For caesarian section it can be given pre-incision or after cord
clamping
• Single dose with long-enough half-life to achieve activity for
duration of operation
 Post Operative Care

• Use sterile saline for wound cleansing up to 48 hours after surgery.

• Advise patients that they may shower safely 48 hours after surgery.

• Do not use topical antimicrobial agents for surgical wounds that are healing by
primary intention to reduce the risk of surgical site infection.

• Dressing to manage surgical wounds that are healing by secondary intention.

• When surgical site infection is suspected consider local resistance patterns

and the results of microbiological tests in choosing an antibiotic
 Kesimpulan
• ILO menyebabkan delay recovery, prolong
hospitalizaon or outpatient treatment, may
Pendahuluan necessitate readmission, increase hospital bills as
Faktor Risiko well as other morbidites and mortality
• Pencegahan ILO dapat dilakukan pada masa
Klasifikasi
perioperatif, intraoperatif, dan postoperatif
Pencegahan

Kesimpulan
Safe Surgery Saves Lives

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