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Hospital Acquired Infections
Agung Dwi Wahyu Widodo
Tim Dalin RSUD Dr Soetomo Surabaya
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Pokok Bahasan
• Definisi Hospital Acquired Infections
• Peran Agen, Host dan Environment
• Rantai Penularan
• Manifestasi HAI
• Dampak HAI
• Metode Memutus Rantai Penularan
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Definisi HAI dan INos
• Hospital-acquired/nosocomial infectionsadalah:
Infeksi yang terjadi di RS atau terjadi oleh karena mikroorganisme yang didapat selama MRS.
• The Centers for Disease Control and Prevention (CDC) mendefinisikan Health care Associated Infection (HAIs) sebagai :
Infeksi yang didapat Penderita selama mendapatkan pengobatan untuk kondisi lain atau
Petugas Kesehatan mendapatkan infeksi saat bertugas pada healthcare setting.
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Kriteria HAI
• Definisi: Infeksi yang didapat di Rumah Sakit oleh karena mikroba di RS
• Kriteria:
– Sebelum MRS tanda klinik negatif
– Di RS tidak dalam masa inkubasi
– Tanda klinis positif > 2 x 24 jam
– Bukan sisa infeksi sebelumnya
– Infeksi terbukti sama dg infeksi perawatan sebelumnya
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Triangle of Infectious disease (Maussner)
Host
Virus,
Bakteri,
Jamur,
Parasit
Penderita
Dokter
Perawat
Analis & sanitasi
dll
EnvironmentAgent
Alat
Bahan
Lingkungan
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Agen Infeksi
• Agen yg menyebabkan Infeksi:
• Kuman (Bakteri), Virus, Parasit dan Jamur
• Ada 2 jenis Kuman:
• Flora Normal/ Resident: menetap
• Flora Transient: pendatang
• Flora Normal dapat menjadi Patogen
(Infeksi Oportunistik- Auto infeksi)
• Kuman RS : Flora transient- Patogen (Cross
Infeksi)
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Flora normal
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Microbes from Mouth
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Mikroba RS
• Mikroba cenderung Resisten terhadap Multipel Antibiotika dan lebih Virulens
• Sekarang disebut MDRO (Multipel Drugs Resisten Organisme), contoh:
• MRSA, VISA dan VRSA (Staph.aureus)
• VRE (Enterococcus)
• ESBL (Extended Spectrum Beta Lactamase)
• Multipel R Acinetobacter.
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Agen Infeksi Nosokomial(CDC Atlanta)
• Virus Hepatitis A, B, C, D,E, G, HIV,
Influenzae, Mumps, Rubella, AI, SARS dll
• Bakteri Acinetobacter, Pseudomonas,
Klebsiella, TB, Pneumonia, MRSA, VRE,
VISA, VRSA, E. coli dll
• Jamur Candida, Aspergillus
• Parasit Amoeba, Malaria, Toxoplasma
• Prion Mad Cow (Sapi Gila)
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Host: Berisiko terinfeksi sekaligus
menularkan• Penderita
• Dokter
• Perawat
• Analis Lab
• Radiografer
• Sanitasi
• Administrasi
• Farmasist
• Cleaning servis
• Keluarga pasien
• Pengunjung RS
• Petugas Parkir
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Tertusuk Jarum
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Environment RS
• Instrumen- Stetoskop, Thermo, Tensimeter
• infus set, jarum & alat tajam yang terkontaminasi
• Kursi-Meja
• Bangunan: lantai- Sink
• Udara
• Air
• Makanan
• Sampah
• Linen
• Bangsal Perawatan
• Laboratorium
• Instalasi gawat darurat
• Kamar operasi
• Dapur
• Kamar Jenazah
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Kuman di Ujung Jarum
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Kuman di Udara
Contact with air from small
room containing 12 people.
Contact with air from clean,
empty room.
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Rantai Penularan
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The Chain of InfectionInfectious agent
Bacteria
Viruses
Fungi
Protozoa
Helminths
Means of
transmission
Direst
Contact/fomite
Injection/ingestion
Airborne/aerosols
Reservoir
People
Equipment
Water
Portals of exit
Excretions
Secretions
Droplets
Skin
Portals of entry
Broken skin
Mucous membrane
Gastrointestinal /
respiratory /
urinary tract
Susceptible host
Neonates
Diabetics
Immunosuppressed
Cardiovascular
disease
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Rantai Penularan Infeksi
• 1. Mikroorganisme: Mikroba
• 2. Reservoir: Sumber Penularan
• 3. Portal of Exit: Tempat Keluar
• 4. Transmition of Route: Rute Penularan
• 5. Portal of Entre: Tempat masuk
• 6. Susceptibility Host: Host yang Peka
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Epidemiologi HAI
• Cara Penularan HAI
• Kontak Langsung ( Berjabat Tangan)
• Kontak tidak langsung ( menyentuh permukaan yg Terkontaminasi)
• Melalui Vektor (Hewan atau Manusia)
• Droplet ( lewat percikan)
• Airborne ( lewat Udara)
• Foodborne (lewat Makanan)
• Waterborne (lewat Minuman- Air)
• Via Vehicles ( lewat Alat- Benda)
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Indirect-Contact Transmission
Beddings are an example of
a Fomite, an inanimate
object that can transmit
pathogens between people.
Methicillin-
resistant
Staphylococcus
aurius
(MRSA)?
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Airborne Transmission
Mycobacterium
tuberculosis?
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Spreading Infections by the Environment
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• Rute Penyebaran Infeksi Nosokomial
1. Self Infection (Auto-Infeksi)
2. Cross Infection (Infeksi Silang)
3. Environmental Infection (Infeksi
Lingkungan)
4. Combination Infection (Self-Cross-
Environmental Infection)
Mode of Transmission of HAI
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Mode of Transmission of HAI
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Manifestasi Klinis HAI
• Infeksi Saluran Kencing (terbanyak)
• Pneumonia (kedua)
• Infeksi sesudah Pembedahan (infeksi
Luka Operasi) / prosedur Medis Invasif
• Infeksi Darah Primer/ Bacteriemia,
Phlebitis
• INOS lain: Diare, Infeksi Maternal dan
Neonatal, Dekubitus dll.
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Kateter Uretra: Kristal dan Kuman
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IV Cathether Biofilms
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Infeksi Staph. aureus: Multi-manifestasi
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Infeksi oleh MRSA (Methicllin Resistent Staphylococcus aureus)
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Dampak HAI
• Bagi Px:
• Morbiditas dan Mortalitas
• Hospital Stay dan Cost
• Bagi Dr/ Perawat:
• Risiko Tertular HAI
• Morbiditas dan Mortalitas
• Bagi Rumah Sakit:
• Mutu Pelayanan
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Metode Memutus Rantai Penularan
K. Kendall, 2003
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Cara memutus Rantai Penularan-1
1. Mikroorganisme: IdentifikasiMikroba
2. Reservoir: Imunisasi, staff health,
Environmental cleaning, disinfection-
Sterilization
3. Portal of Exit: Protective clothing, hand
washing, Control body fluid dan waste
disposal
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Cara memutus Rantai Penularan-2
4. Transmition of Route: Isolation,
foodhandling, airflow control, hand
washing dan Sterilization
5. Portal of Entre: Aseptic procedur, Wound
care dan Catheter care
6. Susceptibility Host: Treatment,
Mobilisasi dan kenali faktor risiko
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