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INTISARI

Latar Belakang:
Infeksi nosokomial hingga saat ini masih merupakan salah satu penyebab
meningkatnya angka kesakitan (morbility) dan angka kematian (mortality) serta
meningkatkan biaya kesehatan disebabkan terjadi penambahan waktu
pengobatan dan perawatan di rumah sakit, hal ini dapat menjadi masalah
kesehatan di negara berkembang maupun negara maju. Negara berkembang,
antara 5%-10% pasien mendapat satu atau lebih infeksi dan 15%-40% pasien yang
masuk ke ruangan kritis diperkirakan terkena infeksi. Hasil survei DEPKES 2008,
didapatkan angka infeksi nosokomial untuk ILO (Infeksi Luka Operasi) 18,9%,
ISK (Infeksi Saluan Kemih) 15,1%, IADP (Infeksi Aliran Darah Primer) 26,4%,
pneumonia 24,5% dan infeksi saluran napas lain 15,1% serta infeksi lain 32,1%.
Saat ini angka INOS telah dijadikan salah satu tolak ukur mutu pelayanan rumah
sakit, yakni angka kejadian INOS tidak boleh lebih dari 1,5%. Negara maju, izin
operasional rumah sakit bisa dicabut karena tingginya angka infeksi nosokomial.
Data surveilans World Health Organization (WHO) dinyatakan bahwa angka
kejadian INOS sebesar 5% pertahun. Kebiasaan mencuci tangan merupakan
perilaku mencegah infeksi nosokomial yang harus dilakukan oleh petugas
kesehatan. Implementasi hand hygiene di ICU oleh petugas kesehatan masih
rendah. Secara umum, tingkat pemenuhan hand hygiene sesuai prosedur oleh
petugas kesehatan masih dibawah 50%. Pelaksanaan cuci tangan di ICU sekitar 4-
50% pada petugas kesehatan.
Metode: Penelitian ini merupakan penelitian deskriptif kualitatif. Subjek
penelitian yang diobservasi berjumlah 8 orang perawat, sedangkan wawancara
dengan Kepala Ruang ICU, Perawat, dan Petugas Pencegahan dan Pengendalian
infeksi Rumah Sakit. Pemilihan subjek penelitian menggunakan tekhnik
pengambilan sampel yaitu purposive sampling. Pengumpulan data dengan lembar
checklist, panduan wawancara dan dokumen. Analisa data menggunakan reduksi
data, penyajian data, dan verifikasi.
Hasil: Perawat dalam Implementasi hand hygiene berdasarkan pada SPO hand
hygiene, terdapat perawat yang patuh sesuai prosedur dan ada perawat yang tidak
sesuai prosedur dengan persentase 66,66%. Kepatuhan perawat dalam
melaksanakan hand hygiene berdasarkan prinsip five moment for hand hygiene
didapatkan bahwa perawat dalam melakukan hand hygiene pada moment satu
sebesar 25%, moment dua sebesar 62,5% dan moment lima sebesar 62,5%
termaksud dalam kategori kepatuhan minimal.
Kesimpulan: Proses implementasi hand hygiene di ICU Rumah Sakit PKU
Muhammadiyah Bantul berdasarkan SPO belum terpenuhi. Perawat lebih sering
mengabaikan moment satu, moment dua dan moment lima termaksud dalam
kategori kepatuhan minimal, sedangkan moment tiga dan moment empat
termaksud dalam kategori kepatuhan baik.
Kata Kunci: Infeksi nosokomial, Hand hygiene, Implementasi hand hygiene.

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Abstract
Background: Nosocomial infection until today still one of the causes increased
morbidity and mortality as well as increase the health costs caused by an
additional period of treatment and healthcare in a hospital, it can be health issue in
the developing and developed countries. The developing countries, about 5% -
10% of patients gets one or more infections and 15% -40% of patients who
entered the critical room estimated to be infected. Results of a survey
Development of Health in 2008, gained nosocomial infection rates for 18.9%
wound infection, UTI (Urinary Tract Infections) 15.1%, primary blood stream
infections) 26.4%, 24.5% pneumonia and tract infections another breath 15.1%
and other infections 32.1%. Currently the rate of nosocomial infections has been
used as one measure of the quality of hospital services, that incidence of
nosocomial infections should not be more than 1.5%. The developed countries,
the operational license of the hospital could be revoked because of the high rate of
nosocomial infections. Data surveillance World Health Organization (WHO)
stated that the incidence of nosocomial infection by 5% annually. Habit of
washing hands are behaviors prevent nosocomial infection should be done by
health workers. Implementation of hand hygiene in the Intensive Care Unit (ICU)
by health workers is still low. Generally, level of hand hygiene compliance in
accordance with procedures by health workers is still below 50%. The
implementations of washing hand in the Intensive Care Unit (ICU) about 4-50%
in healthcare workers.
Method: This research is a descriptive qualitative research. Subject of research
that observed by eight nurses, whereas interviews with the Head of Room
Intensive Care Unit (ICU), nurses, and officer prevention and control of hospital
infections. Selection of research subjects using a sampling technique is purposive
sampling. The collection of data by using checklist sheets guide interviews and
documents. Data were analyzed using data reduction, data presentation, and
verification.
Result: Nurse in the implementation hand hygiene based on the standard
operating procedures (SOP) hand hygiene, there are nurses who obediently
according to the procedure and there are nurses who are not in procedure
accordance with percentage of 66.66%. Compliance nurses in implementing hand
hygiene based on the principle of five moments for hand hygiene found that
nurses in hand hygiene at one moment by 25%, two moments of 62.5% and
62.5% in the fifth moment including in the category of minimal compliance.
Conclusion: The process of implementation hand hygiene at Intensive Care Unit
(ICU) in local hospital Muhammadiyah Bantul by the standard operating
procedures SOP) has not been fulfilled. Nurses often overlook to first moment,
second moments and fifth moments referred to in the category of minimal
compliance, whereas third and fourth moments referred to in good compliance
category.
Key Words: Nosocomial infection, Hand hygiene, Implementation hand
hygiene

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