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
 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
 ∑ke j a d i a n i n fe k s i / ∑ h a r i p e m a s a n ga n I V L x 1 0 0 0 (‰ )
∑kej a d ia n infeksi /∑ h a r i p em a sa n ga n C V L x 1 0 0 0 (‰ )
MELAKSANAKAN SURVEILANS HAI’S

INSIDEN RATE PLEBITIS TERKAIT PEMASANGAN IVL DI RSCM TAHUN 2008-SEMESTER I 2017
INSIDEN RATE INFEKSI ALIRAN DARAH TERKAIT PEMASANGAN CVL DI RSCM TAHUN 2008- SEMESTER I 2017
120.00 25.0023.06
96.03
100.00 20.00
80.00 I ns i de n
rate (‰) 15.00 Insi den rate(‰)
60.00 Ta rget <3.5‰ Target <1‰
10.00

∑K E JA D I A N I N F E K S I / ∑ P E M A S A N G A N V E N T I L A TO R X 1 0 0 0 ( ‰ )
40.00
∑ke j a d i a n i n fe k s i / ∑ h a r i p a s i e n ti ra h b a r i n g x 1 0 0 0 (‰ )

5.00 3.40
20.00 1.66 1.08
5.37 4.08 7.40 5.49 5.18 4.61 5.82 2.00 1.63 0.82 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 2008-SEMESTER I 2017

3.00 2.79
INSIDEN RATE VENTILATOR ASSOCIATED PNEUMONIA DI RSCM TAHUN 2008- SEMESTER I 2017
2.49
2.50 2.27
35.00
31.40
2.00 I ns i de n 30.00
rate (‰)
25.00
1.50 1.25
Ta rget <1‰ I ns i de n
0.91 20.00 15.80 15.52
1.00 13.66 rate (‰)
15.00 Ta rget <5.8‰
0.43 0.37
0.50 0.25 0.18 0.18 10.00 6.31
3.68 3.40 2.18
0.00 5.00 1.40 1.97
0.00

TAHUN
TAHUN
 ∑k e j a d i a n i n fe k s i / ∑ h a r i p a s i e n ti ra h b a r i n g x 1 0 0 0 ( ‰ )
SURVEILANS HAI’S RSCM
∑ke jad ian infe ksi/ ∑ h ari p e m asan gan katete r u rin e x 1 0 0 0 (‰ )
2008-SEMESTER I 2017

INSIDEN RATE DEKUBITUS DI RSCM TAHUN 2008-SEMESTER I 2017

INSIDEN RATE INFEKSI SALURAN KEMIH TERKAIT PEMASANGAN CATETER URINE MENETAP DI RSCM TAHUN 2008-SEMESTER I 2017
4.00
3.40
6.00 3.50
4.81 3.00
5.00 2.34 I ns i de n
3.92 2.50 rate (‰)
4.00 I ns i den 2.00
1.75 Ta rget <1‰
rate (‰) 1.35
3.00 1.50
Target <4.7‰
1.76 1.00 0.74
2.00 1.44 0.54 0.54
0.50 0.12 0.15 0.22
1.00 0.68 0.61
0.36 0.22 0.21 0.00
0.07
0.00
∑ke j a d i a n i n fe ks i / ∑ o p e ra s i L x 1 0 0 (% )

TAHUN
TAHUN

INSIDEN RATE INFEKSI DAERAH OPERASI DI RSCM TAHUN 2008- SEMESTER I 2017

2.50

2.00 1.95
I ns i d e n
1.50 1.44 rate (%)
1.24 Ta rget <2%
1.00 0.96 1.00 1.00
0.62 0.72
0.50 0.43
0.33
0.00

TAHUN