2. PENDAHULUAN
Pasien dan nakes berisiko mendapatkan infeksi jika tidak
melaksanakan tindakan pencegahan infeksi
Infeksi nosokomial (Healthcare Associated Infection / HAI)
dapat dicegah / dikendalikan dengan beberapa strategi
pencegahan infeksi
Strategi pencegahan infeksi adalah dekontaminasi,
pembersihan, disinfeksi dan sterilisasi
(Sumber : Materi Pelatihan Desinfeksi dan Sterilisasi Instrument, Depkes RI tahun 2008)
3. Most frequent sites of infection
and their risk factors
LOWER RESPIRATORY TRACT INFECTIONS
Mechanical ventilation
Aspiration
Nasogastric tube
Central nervous system depressants
Antibiotics and anti-acids
Prolonged health-care facilities stay
Malnutrition
Advanced age
Surgery
Immunodeficiency
13%
BLOOD INFECTIONS
Vascular catheter
Neonatal age
Critical care
Severe underlying disease
Neutropenia
Immunodeficiency
New invasive technologies
Lack of training and supervision
14%
SURGICAL SITE INFECTIONS
Inadequate antibiotic prophylaxis
Incorrect surgical skin preparation
Inappropriate wound care
Surgical intervention duration
Type of wound
Poor surgical asepsis
Diabetes
Nutritional state
Immunodeficiency
Lack of training and supervision
17%
URINARY TRACT INFECTIONS
Urinary catheter
Urinary invasive procedures
Advanced age
Severe underlying disease
Urolitiasis
Pregnancy
Diabetes
34%
Most common
sites of health care-
associated infection
and the risk factors
underlying the
occurrence of
infections
LACK OF
HYGIENE
4. “Sumber kontaminasi di rumah sakit yang berasal dari :
1.Semua peralatan operasi
2.Equipment medis (pasien monitor, bed pasien dll)
3.Tangan petugas rumah sakit
4.Seluruh surfaces (lantai, dinding dll)
yang dapat menyebabkan terjadinya infeksi bagi
petugas rumah sakit (perawat, dokter pekarya)
atau pasien.”
Pengertian
KONTAMINAN
10. Tujuan dekontaminasi alat yang
aman
Memutus mata rantai penularan infeksi dari
peralatan medis kepada pasien, petugas kesehatan,
pengunjung dan lingkungan rumah sakit
Perlakuan dekontaminasi :
Cleaning
Disinfection
Sterilization
11. Alur Dekontaminasi Alat Kesehatan
Setelah Pakai
PRE-CLEANING (Pembersihan Awal)
Mengunakan enzymatic + desinfektan
Pembersihan
(Cuci bersih, tiriskan, keringkan)
Sterilisasi
(peralatan kritis)
Masuk dalam
pembuluh
darah/jaringan tubuh
Instrumen bedah
Disinfeksi tingkat
rendah
(peralatan non kritikal)
Hanya pada
permukaan tubuh yang
utuh
Tensi meter (manset),
termometer
Disinfeksi tingkat
tinggi
(peralatan semi
kritikal)
Masuk dalam mucosa
tubuh
Endotracheal tube,
NGT, Endoskopi
13. 1/22/2024 BWaluyo/IX/06 13
ANIOSYME DD1
Kegunaan :
Membersihkan dan mendesinfeksi instrument dan
endoscopy.
Mengandung 3 enzym :
Protease Protein
Lypase Lemak
Amylase Karbohadirat
14. 1/22/2024 BWaluyo/IX/06 14
Competitor products ANIOS Products
Check-
sample
Proteasic activity of products – analysis by electrophoresis
ANIOSYME DD1 at 0.5%
Human
Albumin
A. DLT at 0.5%
ENDOZYME 1%
ORTHOZYME 1%
ENDOZYME AW+ 1%
17. 1/22/2024 BWaluyo/IX/06 17
ANIOSYME DD1
Kemampuan Mikrobiologi :
Bakterisidal NF EN 1040, NF EN 13727 & NFT 72-170 (dirty
cond.)
Aktif terhadap Candida albicans NF EN 1275
Aktif terhadap M. tuberculosis (T.B)
Aktif terhadap HIV-I , BVDV (Hep. C), PRV (Hep.
B)
18. What is biofilm ?
Isolated cells and microcolonies of evolving cells,
associated each others and/or to surfaces and interfaces
and included in a matrice constituted of bacterial
exopolymers, organic and non organic materials and
macromolecula catched out from environment.
« Sel-sel terisolasi dan sel-sel microcolonies yang
berkembang, berhubungan satu sama lain dengan
permukaan dan tercakup di satu matrice yang berasal dari
exopolymers bakteri, bahan organik dan bukan organik
serta macromolecula yang tertangkap dari lingkungan »
19. BIOFILM
Ada 5 tahap pembentukan biofilm yaitu:
Pelekatan awal: mikrob melekat pada permukaan suatu benda dan dapat
diperantarai oleh fili (rambut halus sel) contohnya pada P.aeruginosa.[15]
Pelekatan permanen: mikrob melekat dengan bantuan eksopolisakarida (EPS).[16]
Maturasi I: proses pematangan biofilm tahap awal.[16]
Maturasi II: proses pematangan biofilm tahap akhir, mikrob siap untuk
menyebar.[16]
Dispersi: Sebagian bakteri akan menyebar dan berkolonisasi di tempat lain
20. Alur Sterilisasi Alat Bedah Paska
Dekontaminasi
Pembersihan + dekontaminasi
(Cuci bersih, tiriskan, keringkan)
Sterilisasi
(Pastikan instrumen sudah bebas dari
kotoran)
Sterilisasi Panas / Hot Sterilization
(peralatan Thermostabil)
Tahan panas dan tekanan tinggi
Sterilisasi Dingin / Cold Sterilization
(peralatan Thermolabil)
Tidak tahan panas dan tekanan
tinggi
21. 4 Senyawa Kimia dipakai sebagai HLD
1. Hidrogen Peroksida (H2O2)
2. Orthoptaldehida (OPA)
3. Peracetic Acid (As. Perasetik)
4. Glutaraldehida
24. 1/22/2024 BWaluyo/IX/06 24
STERANIOS 2%
Kegunaan :
Sterilisasi instrument dan
endoscopy
Dosis : Siap pakai tanpa pengenceran
dan tanpa aktivator
Lama perendaman : maksimal 1 jam
Life time : 30 hari
Kemasan : Gallon 5 liter
25. 1/22/2024 BWaluyo/IX/06 25
STERANIOS 2%
produk unggulan
composition
◦ Surfactant
Sporicidal in
60min.
Glutaraldehyde Glutaraldehyde
+ surfactant
26. 1/22/2024 BWaluyo/IX/06 26
STERANIOS 2%
Kemampuan Mikrobiologi :
Bakterisidal (5 menit)
Fungicidal (10 menit)
Aktif terhadap Helicobacter pylori
Aktif terhadap M. tuberculosis (T.B)
Aktif terhadap Cryptococus neoformans
Aktif terhadap Urogenital mycoplasma
Virucidal (5 menit) : HIV-I , HBV , Herpesvirus
Sporicidal (1 jam).
27. In the Community : Macrolide resistance
32 % 20-90 %
Streptococcus pneumoniae Helicobacter pylori
Streptococcus pyrogenes Haemophilus influenzae
Up to 70 % Ineffective
30. AREA MRSA
High risk areas :
ICU, NICU, Surgical room, Burn Unit, Transplation unit,
Cardiothoracic unit, Orthopaedic unit
Medium risk area :
Surgical wards, admission wards, Paeditric wards,
Medical wards.
Low risk area :
Psychiatric area, Psychogeriatric areas.
31. WHAT IS CLEANLINESS?
In hospitals, it is essential to distinguish between visual and
microbial cleanliness.
Visual or macroscopic cleanliness is the absence of dirt visible in
cracks, joints, crevices, etc.
Microbial cleanliness cannot be perceived visually and is viewed
under microscope using samples that allow the present germs to be
identified and quantified.
A surface can be macroscopically clean,
and yet show a high microbial contamination.
32. Biocleaning
Treatment grouping cleaning and disinfection
Reinforces qualitative action of cleaning
Visual cleanliness
+
Microbiological cleanliness
Disinfectant properties
Choice of disinfectant product
Selection of antimicrobial active ingredients
41. Surfa’safe
Bactericidal
activity
tests in dirty
conditions
Additional strains
Active
concentration
Contact
time
Acinetobacter baumannii (EN 13697) 50% 2 min.
Enterobacter aerogenes BLSE (EN 13697) 100% 2 min.
Enterobacter cloacae BLSE (EN 13697) 25%
2 min.
Enterococcus faecium ERV
- prEN 13727 (av. 2009)
- EN 13697
80%
< 25%
1 min.
2 min.
Escherichia coli BLSE (EN 13697) 100% 2 min.
Klebsiella pneumoniae BLSE (EN 13697) 100% 2 min.
Legionella pneumophila (EN 1276) 5% < 5 min.
Listeria monocytogenes 50% 2 min.
Salmonella enteritidis < 25% 2 min.
Serratia marcescens 50% 2 min.
Staphylococcus aureus SARM < 25% 2 min.
41
44. Surfa’safe
Activity
on viruses
Methods
Active
concentration
Contact
time
Specific
conditions
HIV-1 (NF T 72-180) 60% 1 min.
PRV (EN 14476) 20% 1 min.
BVDV (EN 14476) 20% 1 min.
Vaccinia virus (EN 14476) 60% 1 min.
Rotavirus (EN 14476) 20% 1 min.
Norovirus 80% 15 min.
Herpesvirus HSV1 (EN 14476) 80% 1 min.
Respiratory Syncythial Virus (RSV)
(EN 14476)
40% 1 min.
H5N1 25% 1 min. Dirty
conditions
H1N1 (EN 14476) 80% 2 min.
44
59. Most common mode of
transmission of pathogens
is via hands!
Infections acquired in
healthcare
Spread of antimicrobial
resistance
So Why All the Fuss About Hand
Hygiene?
61. 1843 Oliver Wendel Holmes
Puerperal fever disebarkan dari pasien ke pasien melalui tangan & baju
dokter/ perawat
1847 Ignaz Semmelweis
Menemukan kasus demam pada ibu-ibu melahirkan yang ditolong oleh dokter &
mahasiswa kedokteran tanpa mencuci tangan setelah melakukan bedah mayat.
Seorang temannya meninggal ketusuk mata pisau setelah melakukan bedah
mayat
Ditemukan bahwa penyebab kematian temannya sama dengan kasus demam
pada ibu-ibu melahirkan.
19 th century Pasteur & Lister contamination of pathogenic
microorganisme
62. 1986, the centre of Desease control : Guidelines for hand
washing and Hospital enviroment.
1994. FDA ( Food and Drug Administration )
Menetapkan produk perawatan kesehatan/ obat dibagi
dalam 3 kategori: patient preoperative skin preparation,
Anti septic handwash or HCW handwash, surgical hand
scrub.
2000 Didier pittet
Peningkatan kepatuhan cuci tangan/ hand hygiene akan
menurunkan hospital acquired infection
63. Hand transmission: Step 1
Germs are present on patient skin
and
surfaces in the patient surroundings
Germs (S. aureus, P. mirabilis, Klebsiella spp.
and Acinetobacter spp.) present on intact
areas
of some patients’ skin: 100-1 million colony
forming units (CFU)/cm2
Nearly 1 million skin squames containing
viable
germs are shed daily from normal skin
Patient immediate surroundings
(bed linen, furniture, objects) become
contaminated (especially by staphylococci
and enterococci) by patient germs
Pittet D et al. The Lancet Infect Dis 2006
64. Hand transmission: Step 2
By direct and indirect contact, patient germs
contaminate health-care workers' hands
Nurses could contaminate their hands with 100–1,000
CFU
of Klebsiella spp. during “clean” activities (lifting
patients,
taking the patient's pulse, blood pressure,
or oral temperature)
15% of nurses working in an isolation
unit carried a median of 10,000 CFU
of S. aureus on their hands
In a general health-care facility, 29%
nurses carried S. aureus on their hands
(median count: 3,800 CFU) and 17–30%
carried Gram negative bacilli
(median counts: 3,400–38,000 CFU)
Pittet D et al. The Lancet Infect Dis 2006
65. Hand transmission: Step 3
Germs survive and multiply on health-care workers' hands
Following contact with patients and/or contaminated environment, germs
can survive on hands for differing lengths of time (2–60
minutes)
In the absence of hand hygiene action, the longer the duration of care, the
higher the degree of hand contamination
Pittet D et al. The Lancet Infect Dis 2006
66. Hand transmission: Step 4
Defective hand cleansing results in hands remaining
contaminated
Insufficient amount of product and/or insufficient duration of
hand hygiene action lead to poor hand decontamination
Transient microorganisms are still recovered on hands following
handwashing with soap and water, whereas handrubbing with an
alcohol-based solution has been proven significantly more effective
Pittet D et al. The Lancet Infect Dis 2006
67. Hand transmission: Step 5
Germ cross-transmission between patient A and patient
B via health-care worker's hands
Pittet D et al. The Lancet Infect Dis 2006
68. Hand transmission: Step 5
Manipulation of invasive devices with contaminated
hands determines transmission of patient's germs to
sites at risk of infection
Pittet D et al. The Lancet Infect Dis 2006
72. 1/22/2024 BWaluyo/IX/06 72
DERMANIOS
Scrub Chlorhexidine
Kegunaan : Cairan desinfeksi tangan dan Surgical Washing
Komposisi : Chlorhexidine Gluconate 4%.
Dosis :
o Desinfeksi tangan : 3 ml dipakai selama 1,5
menit
o Surgical : 3 ml dipakai selama 1,5
menit diulang sekali lagi
dengan jumlah dan
waktu yang sama.
73. 1/22/2024 BWaluyo/IX/06 73
DERMANIOS SCRUB
Chlorhexidine
Kemampuan Mikrobiologi :
Bakterisidal EN 1040, pr EN 12054 MRSA
Fungisidal EN 1275 – C albicans
Lipophilik Virus
“Memiliki efek persistence 6 jam”
76. Mengapa kepatuhan mencuci tangan
masih kurang ?
• Skin irritation/ Iritasi kulit
• Inaccesible handwashing supplies/
ketersediaan sabun kurang
• Wearing gloves/ sudah pakai sarung tangan
• Being too busy / terlalu sibuk
• Not thingking about it / tidak mau tahu
CUCI TANGAN
sederhana & murah
Pittet et al,2000
77. Tehnik Cuci Tangan yang Efektif
Telapak dg telapak
Telapak kanan diatas
punggung tangan kiri
dan telapak kiri diatas
punggung tangan kanan
Telapak dg telapak & jari
saling terkait
Letakkan punggung jari
pada telapak satunya
dengan jari saling
mengunci
78. Tehnik Cuci Tangan yang
Efektif
Jempol kanan digosok
memutar oleh telapak kiri,
& sebaliknya
Jari kiri menguncup, gosok
memutar, ke kanan & ke
kiri pada telapak kanan, &
sebaliknya
Pegang pergelangan
tangan kiri dengan tangan
kanan & sebaliknya,
gerakan memutar
79.
80. Handgel or Handrub
composition
Alcohols
ethanol
Isopropanol (IPA)
n-propanol
Alone or in variable mixings
From 60% to 85% (v/v)
81. Transcutaneous path!
LogP also named Log Kow, is a measure of the differential solubility of chemical compounds
in two solvants (dividing coefficient octanol/water).
LogP is egual to the logarithme of the ratio between concentrations of the substance analysed
in octanol and in water. LogP = Log(Coct/Cwater). This value allows to comprehend the
hydrophilic or hydrophobic (lipophilic) character of molecula. Indeed, if LogP is positive and
very high, that means that the molecula is so much more soluble in octanol than in water,
which shows its lipophilic character, and inversely. When LogP=0 that means that the
molecula divides into both phases similarly and Coct=Cwater.
Log P ethanol = - 0.32
Log P isopropanol = 0.34
Log P n-propanol = 0.25
water fats
0
Penetrasi ke kulit lebih baik
82. Classification!
Ethanol
No classification
« irritating for eyes »
Isopropanol
Classified « R 38 :
irritating for eyes » from
15%
Pictogram
Iritasi minimal !
83. Handgel or Handrub
comparative toxicology of alcohols
Ethanol Isopropanol N-propanol
N° CAS 64-17-5 67-63-0 71-23-8
DL 50 oral administration 5 to 10 g/kg 3.6 to 7.8 g/kg 1.9 to 8 g/kg
CL 50 inhalation
20 000 to 30 000 ppm
/
4 to 8 hours
20 000 ppm / 8 hours 4 000 ppm /4 hours
DL 50 20g/kg 13g/kg 5 to 10 g/kg
Exposure limits (15 minutes
exposure) 5000 ppm 400 ppm
Average exposure limits (8 hours
exposure) 1000 ppm 200 ppm
Toxic risk
R 36 : Xi eye irritant
R 41 : Xi risk of
serious injury to
eyes
R 67 : Inhalation of
vapours can lead
to drowsiness
and dizziness
R 67 : Inhalation of
vapours can
lead to
drowsiness and
dizziness
Toksisitas rendah !
98. ASEPTANIOS HP 50
strategy
Aldehyde Free product
Product without heavy metals
Terminal disinfection without human presence
Broad compatibility
101. ASEPTANIOS HP 50
Efficiency
Bactericidal
EN 1040, EN 1276, EN 13697 in 15’
Fungicidal
EN 1275, EN 1650, EN 13697 in 15’
Active according to EN 14476 against Herpesvirus, PRV
(HBV) and BVDV (HCV) in 15’
Application standard NF T 72-281 (process validation)
Bactericidal, fungicidal and sporicidal
105. 1/22/2024 BWaluyo/IX/06 105
STERILINGE SA
Kegunaan : Cairan desinfeksi linen kotor sebelum
dicuci, dengan memakai mesin atau
dengan tangki statis
Dosis :
1% di dalam air panas atau air dingin
Kemasan :
Gallon 5 liter dengan dosing cup
106. Cara pakai :
1. Campurkan 1 Liter Sterilinge SA ke
dalam 100 liter air atau 20 kg linen
2. Rendam selama minimal 15 menit
3. Bilas dengan air panas atau air dingin
STERILINGE SA
112. 1/22/2024 BWaluyo/IX/06 112
Apa keuntungan memakai airborne
?
Proses desinfeksi maksimal tidak ada sudut di dalam
ruangan yang luput dari proses desinfeksi karena di
mana udara dapat masuk maka cairan airborne akan
masuk mendesinfeksi.
Proses desinfeksi cepat.
Cairan airborne tidak toksik (beracun) dan tidak
korosif (merusak ) benda yang terkena cairan
airborne.
113. Hand transmission: Step 1
Germs are present on patient skin
and
surfaces in the patient surroundings
◦ Germs (S. aureus, P. mirabilis, Klebsiella spp.
and Acinetobacter spp.) present on intact
areas
of some patients’ skin: 100-1 million colony
forming units (CFU)/cm2
◦ Nearly 1 million skin squames containing
viable
germs are shed daily from normal skin
◦ Patient immediate surroundings
(bed linen, furniture, objects) become
contaminated (especially by staphylococci
and enterococci) by patient germs
Pittet D et al. The Lancet Infect Dis 2006
114. Hand transmission: Step 2
By direct and indirect contact, patient germs
contaminate health-care workers' hands
◦ Nurses could contaminate their hands with 100–
1,000 CFU
of Klebsiella spp. during “clean” activities (lifting
patients,
taking the patient's pulse, blood pressure,
or oral temperature)
◦ 15% of nurses working in an isolation
unit carried a median of 10,000 CFU
of S. aureus on their hands
◦ In a general health-care facility, 29%
nurses carried S. aureus on their hands
(median count: 3,800 CFU) and 17–30%
carried Gram negative bacilli
(median counts: 3,400–38,000 CFU)
Pittet D et al. The Lancet Infect Dis 2006
115. Hand transmission: Step 3
Germs survive and multiply on health-care workers' hands
Following contact with patients and/or contaminated environment, germs
can survive on hands for differing lengths of time (2–60
minutes)
In the absence of hand hygiene action, the longer the duration of care, the
higher the degree of hand contamination
Pittet D et al. The Lancet Infect Dis 2006
116. Hand transmission: Step 4
Defective hand cleansing results in hands remaining
contaminated
Insufficient amount of product and/or insufficient duration of
hand hygiene action lead to poor hand decontamination
Transient microorganisms are still recovered on hands following
handwashing with soap and water, whereas handrubbing with an
alcohol-based solution has been proven significantly more effective
Pittet D et al. The Lancet Infect Dis 2006
117. Hand transmission: Step 5
Germ cross-transmission between patient A and patient
B via health-care worker's hands
Pittet D et al. The Lancet Infect Dis 2006
