Tujuan
Melihat epidemiologi infeksi luka
operasi
Mendiskusikan pencegahan
infeksi luka operasi
Pendahuluan
GEJALA INFEKSI :
Tanda INFLAMASI :
Kalor,
Rubor,
Dolor,
Functio laesa
Pus
LAB :
Angka leukosit
pmn
Petugas kesehatan
(Dokter/perawat/staff)
Escherichia
coli
10%
Staphylococcus
Pseudomonas
aureus
aeruginosa
20%
8%
Enterococcus
spp.
12%
Coagulase neg.
staphylococci
12%
EscherichiaCoagulase neg.
coli
staphylococci
8%
14%
Kuman pathogen
Rhizopus oryzea - elastoplast
adhesive bandage
Clostridium perfringens - elastic
bandages
Rhodococcus bronchialis petugas
kesehatan
Legionella dumoffii and pneumophila
- tap water
Pseudomonas multivorans disinfectant solution
Usia
Kegemukan
Diabetes
Malnutrisi
Prolonged
preoperative stay
Infeksi yang ada
sebelumnya
Penggunaan steroid
sebelumnya
Penggunaan nikotin
Pencukuran rambut
Lamanya operasi
Teknik operasi
Adanya drain
Penggunaaan
antimicrobial
prophylaxis yang
tidak adekuat
Yang mempengaruhi
penyembuhan luka operasi :
1.
2.
3.
4.
Daerah operasi
Kondisi lingkungan lokal
Daya immunitas tubuh
jumlah & jenis mikroba kontaminan
Perlengkapan operasi
Scrub suits
Cap/hoods
Shoe covers
Masks
Gloves
Gowns
Teknik pembedahan
Optimalisasi sterilitas
Mengeliminasi fokus infeksi sebelum op
Mencegah operasi pada penderita dengan
depressi immunitas
Pemberian antibiotik profilaksis
Memakai implant berkualitas
Memastikan implant terpasang baik tepat
aman
Mencegah & menangani infeksi lambat
Dipakainya unidirectional laminar airflow
di OK
Antibiotika pre Op
Kesadaran Petugas
Impact of Prolonged
Surgical Prophylaxis
DESIGN: Prospective
POPULATION: CABG patients
(N=2641)
Group 1: pts who received < 48
hours of
AP
Group 2: pts who received > 48
hrs of AP
OUTCOMES
Incidence of SSI
Isolation of a resistant pathogen
RESULTS: 43% of patients received AP >
48 hr
SSI Incidence
<48 hrs group: 8.7% (131/1502) vs
>48 hrs group: 8.8% (100/1139), p=1.0
Antimicrobial resistant pathogen
OR 1.6 (95% CI 1.1-2.6)
OUTCOMES
Blood glucose <200 mg/dl in first
two days postop
Incidence of deep sternal SSI
RESULTS
SQI group: 2.0% (19/968) vs
IVI group: 0.8% (12/1499),
p=0.01
Furnary AP; Ann Thorac Surg, 2000
Supplemental Perioperative
O2
Pre-operative Antiseptic
Showers/Baths
Most studies examine effects on skin colony
counts
antiseptic showering decreases colony
counts
Few studies examine effect on SSI rates
No Shower Shower
Cruse, 1973
2.3%
1.3%
Ayliffe, 1983
4.9%
5.4%
Rooter, 1988
2.4%
2.6%
Pre-operative Shaving/Hair
Removal
Seropian, 1971
Method of hair removal
Razor
= 5.6% SSI rates
Depilatory
= 0.6% SSI rates
No hair removal = 0.6% SSI rates
Timing of hair removal
Shaving immediately before = 3.1% SSI
rates
Shaving 24 hours before
= 7.1% SSI
rates
Shaving >24 hours before
= 20% SSI
rates
Pre-operative Shaving/Hair
Removal
Multiple studies show
- Clipping immediately
before operation
associated with lower SSI risk
than
shaving or
clipping the night before
operation