New Strategies

Infection Prevention Control

(IPC)
Dr.dr.Hindra Irawan Satari, SpA(K), M.Trop Paed
Chief, Infection Control Committee RSCM
Chief, Indonesia Society of Infection Control, Jakarta Branch
Chief, Infectious Diseases and Tropical Pediatrics Division, Ciptomangunkusumo Hospital-FKUI, Jakarta

CONTENTS
Goal
Program
Measureable
Conclusion

elements

What is the goal of an IPC

organizations
to

identify and to reduce the risks of acquiring and

transmitting infections among

patients,

staff,

health care professionals,

contract workers,

volunteers,

students,

visitors.

Who are the leader the PCI

program ?
Leaders
Qualified

in infection prevention and control

practices through education, training, experience, or
certification.

Well-trained
IPCN
IPCN-link

staff

How to have an effective

programs and how ?

Methods to identify and to proactively address infection

risks,

Appropriate policies and procedures,

Program is based on current scientific knowledge,

accepted practice guidelines, applicable laws and
regulations, and standards for sanitation and cleanliness.

Staff education

Coordination through-out the organization.

Coordination mechanism that involves physicians, nurses,

and others.

RSCM : Pelatihan PPI rutin 4 kali/thn

untuk petugas kesehatan lama (inservice training)

Orientasi PPI bagi karyawan baru di

RSCM 2 kali setahun

METODE PERENCANAAN
PDSA

ACT
Tentukan perubahan
apa yang diinginkan

STUDY
A
Simpulkan dari apa
yang dapat dipelajari

PLAN
Perubahan atau uji

DO
Pelaksanaan
kegiatan

SIKLUS PDSA
Pengumpulan data audit
lokal

Tindakan yang dilakukan / perubahan

Analisis data audit dan

umpan balik pada tenaga
medis

Who are involves in the PCI program

coordination ?

Physicians, including ICU, ICCU, PICU, NICU

Nurses

IPC professionals

Laboratory

Clinical Microbiologist, Clinical Pathologist

Housekeeping and laundry Unit

Central Supply Sterile Installation

Food production Unit

Engineering Installation

Pharmacy Department

Pharmacology Department

Sanitation and environment Unit

Others, based on the size and complexity of the organization.

Struktur organisasi
Direktur Utama

Komite PPIRS

Sekretaris

Dep/Unit/Instalasi/Bidang
IPCN

IPCO/IPCN Link
Dep/Unit/Instalasi/Ruangan

Anggota

SK Dirut No :
8978/TU.K/34/V/
2011

What the PCI program based

on ?

Current
knowledge.

scientific

Accepted
guidelines.

practice

Applicable
laws
regulations.

Standards from national

or local agencies for
sanitation
and
cleanliness.

and

What the PCI program focus

of ?
All

patient, staff, and visitor areas of the organization

are included in the infection prevention and control
program.

Risk-based

approach identifies the procedures and

processes associated with the risk of infection and
implements strategies to reduce infection risk.

What is an comprehensive PCI

program ?
Systematic

and proactive surveillance activities

(Endemic) Rates of infection.

Systems

to

investigate

outbreaks

of

infectious

diseases.
Guided

by appropriate policies and procedures.

Risk-reduction
Regularly

goals and measurable objectives.

reviewed.

DOCUMENTS
Policy
Standard
Working

Operational Procedure

Instruction

What are areas of the PCI Program

included ?
All

patient care areas

All

staff areas

All

visitor areas

What is the measuring

elements in Surveillance
Program of PCI ?

a) Respiratory tract

b) Urinary tract

The insertion and care of central venous catheters, peripheral

venous lines, and so on

d) Surgical sites

Associated with indwelling urinary catheters, urinary drainage

systems, and so on

c) Intravascular invasive devices

Associated with intubation, mechanical ventilatory support,

tracheostomy, and so on

Dressing and associated aseptic procedures

e) Epidemiologically significant diseases and organisms

Multi drug resistant organisms, highly virulent infections

INSIDEN RATE IAD RSCM, JANUARI-JUNI

TINDAK LANJUT

2012 SERTA

INSIDEN RATE IAD RSCM, JANUARI-JUNI

2012 SERTA TINDAK LANJUT
7.00
6.00
1. EDUKASI PPI
5.00
2. PREPARASI KULIT DENGAN CHORHEXIDINE
ALKOHOL 2% : KERING
4.00
3. KEBERSIHAN TANGAN
4. RONDE 3x /mgg& SUPERVISI

JML HARI PEMASANGAN CVL/1000

3.00
2.00

Insiden rate
Baik (<3.5)
Kurang(>6.16)

1.99
1.67
1.64
1.00
0.91
0.86
0.40
0.00

BUKU PETA BAKTERI DAN KEPEKAAN

TERHADAP ANTIBIOTIK

GAMBARAN SENSITIF (%S) TERHADAP

ANTIBIOTIK
RSCM Juli-Desember 2010
100
90
80
70
60
50
40
30
20
10
0

SISTIM PENGENDALIAN RESISTENSI ANTI MIKROBA

Unit Farmasi dan

Terapi
m
do
o
Pe
bi
an ti
an k
ti

Komite PPIRS

ta e
a
D rv
Su
ns

illa

Po
Ba la
kt
er
i

Tim
Lab/Mikrobiologi

PPRA

Tim PPRA +
Pokja PPRA

Laporan

Da
An ta
k tib
io
t

DIREKTUR

Tim
Farmakologi
Klinik

ANTIBIOTIC GUIDANCE PATHWAY

PPAB Team
Dept/UPT/Inst
Team
Medical Committee
Cq Pharmacy
Therapy Unit
Workgroup PPRA
Dept/Inst/UPT

Draft

Guidance ab

Clinical
Microbiology Team

PPRA Team

Director

PENGGUNAAN ANTIBIOTIK
DI RSUPN DR CIPTO MANGUNKUSUMO TAHUN 2011
45000
40000
35000
30000
25000
20000
JUMLAH 15000
10000
5000
0

41359

19292
8197
2510

2120

What is the measurable elements

in the Surveillance Program?
The

data collected in a) through f) are evaluated /

analyzed.

Based

on data evaluation/analysis, actions are taken

to focus or to refocus the organizations infection
prevention and control program.

Assesses
The

these risks at least annually.

assessment is documented.

CSSD and management of

laundry and linen in PCI
programs

Ensuring adequate equipment cleaning and sterilization and the proper

management of laundry and linen.

There is a policy and procedure in place that identifies the process for
managing expired supplies and defines the conditions for reuse of singleuse devices when laws and regulations permit.

Proper disposal of waste.

Policy and procedure on the disposal of sharps and needles should available.

Reduces the risk of infections in the facility associated with operations of

the food service and of mechanical and engineering controls.

Reduces the risk of infection in the facility during demolition, construction,

and renovation.

MANAJEMEN LINEN DAN LAUNDRI

What are the measurable

elements in the
CSSD, Laundry and linen
management
Equipment

cleaning, disinfection and sterilization

methods in a central sterilization service and outside
(satellites) are appropriate for the type of equipment.

Laundry

and linen management are appropriate to

minimize risk to staff and patients.

There

is a coordinated oversight process that ensures

all cleaning, disinfection, and sterilization methods
are the same throughout the organization.

How to manage the expired supplies

and single-use reused devices in CSSD ?
There

is a policy and procedure consistent with national

laws and regulations and professional standards in
place that identifies the process for managing expired
supplies.

When

single-use devices and materials are reused, the

policy includes items a) through e) in the intent
statement.

The

policy is implemented.

The

policy is monitored.

What is the measurable elements in infectious

waste and body fluids, mortuary and
postmortem area management ?
Disposal

of infectious waste and body fluids are

managed to minimize transmission risk.

The

handling and disposal of blood and blood

components are managed to minimize transmission
risk

Operation

of the mortuary and postmortem area are

managed to minimize transmission risk.

What is the measurable elements

in the
Disposal of sharps and needles
management
Collected

in dedicated, puncture-proof containers that

are not reused.

The

hospital disposes of sharps and needles safely or

contracts with sources that ensure the sharps
containers are disposed of in dedicated hazardous
waste sites or as determined by national laws and
regulations.

Consistent

with infection prevention

policies of the organization.

and

control

WASTE MANAGEMENT
Waste type
SOLID:
Infectious
Non infectious

LIQUID
Infectious
Non infectious

SHARP DEVICES

SOLID:
Infectious and non
infectious

SHARP DEVICES

WASTE MANAGEMENT

What are the Measurable Elements of

Kitchen Sanitation and Food
Preparation and handling management
Kitchen

sanitation and food preparation and handling

are appropriate to minimize infection risk.

Eg. Personal Protective Device

Engineering

controls are implemented to minimize

infection risk in appropriate areas of the organization.

Eg.Ventilation

What is the measurable elements

to asses the impact of renovation or
new construction

Uses
risk
criteria
(Infection
Control
Risk
Assessment / ICRA)

Including on air quality

Assessed

Managed.

What is the measurable

elements in the Isolation
Precaution Program

Patients with known or suspected contagious diseases are isolated

Policies and procedures address

Separation of patients with communicable diseases from patients and staff who are
at greater risk due to immunosuppression or other reasons.

Manage patients with airborne infections for short periods of time when negative
pressure rooms are not available.

Strategy of dealing with an influx of patients with contagious diseases.

Negative pressure rooms are available and monitored routinely for infectious
patients who require isolation for airborne infections; when negative
pressure rooms are not immediately available, rooms with approved HEPA
filtration systems may be used.

Staff are educated in the management of infectious patients.

KEWASPADAAN ISOLASI
KEWASPADAAN STANDAR
1.

Hand hygiene

2.

Personal protective device (PPD)

3.

Sharp devices and waste management

4.

Isolation procedure

5.

Environment control

6.

Linen management/laundry

KEWASPADAAN BERDASAR
TRANSMISI

BERBASIS
KONTAK:

DROPPLET:

7.

Disinfection and sterilization

8.

Health care worker safety

9.

Lumbal puncture procedure

10.

Cough etiquette

11.

Safety injection

MRSA
Pneumonia
UDARA:

TBC

What is the measurable elements in the

Personal Protective Equipment and Hand
hygiene program ?

Identifies those situations for which

gloves
and/or
masks
or
eye
protection are required.

Gloves
and/or
masks
or
protection are correctly used

The organization identifies those

situations for which hand washing
and hand disinfection or surface
disinfecting procedures are required.

Handwashing and hand disinfection

procedures are used correctly in
those areas. The organization has
adopted
hand-hygiene
guidelines
from an authoritative source.

eye

KEPATUHAN PETUGAS MELAKUKAN KEBERSIHAN TANGAN

RSCM JANUARI - JUNI 2012

100%
80%

82%

60%

66%

68%

69%

76%

78%

% Kepatuhan
Target(> 85%)
Kurang(<75%)

40%
20%
0%

What is the information

management systems role in
PCI program ?
Information

management
systems
support
infection prevention and control program.

the

Measurable Elements
Personal Protective Equipment and
Hand Hygiene
The

organization identifies those situations for which

gloves and/or masks or eye protection are required.

Gloves

and/or masks or eye protection are correctly

used in those situations.

Handwashing

and hand disinfection procedures are

used correctly in those areas. The organization has
adopted
hand-hygiene
guidelines
from
an
authoritative source.

The 5 moments for Hand Hygiene

The organization identifies those situations for which hand washing

and hand disinfection or surface disinfecting procedures are required.

Measurable Elements
Integration of the Program with Quality Improvement
and Patient Safety

Health

careassociated infection risks are tracked.

Infection

measured.

prevention

The
measures
infections.

and

identify

control

activities

epidemiologically

are

important

Processes

are redesigned based on risk, rate, and

trend data and information.

Processes are redesigned to reduce infection risk to the

lowest levels possible.

Health

careassociated infection rates are compared

to other organizations rates through comparative
databases. Compares its rates to best practices and
scientific evidence.

Measurement

results are communicated to medical

staff, nursing staff and to management.

Infection

prevention and control program results are

reported to public health agencies as required.

What are the measurable

elements in the
Education Program of PCI ?
Education

about infection prevention and control to

All staff and other professionals.

All staff are educated on the policies, procedures, and

practices of the infection prevention and control
program.

Periodic staff education is provided in response to

significant trends in infection data.

Patients and families.

CONCLUSION
Goal

PCI : to identify and to reduce the risks

of acquiring and transmitting infections
among
patients,
staff,
health
care
professionals, contract workers, volunteers,
and visitors

Standards:

Leadership and
program and coordination

Focus

organization,

of the Program

Isolation

Procedures, including Barrier Technique

THANK YOU