HASIL TESIS

PENGEMBANGAN BASIS DATA SURVEILANS HEALTH CARE

ASSOCIATED INFECTIONS (HAIS) DI RUMAH SAKIT IBU DAN ANAK
KENDANGSARI MERR SURABAYA

OLEH :
ANJAS DWI PURWANTO
NIM. 101614553009

UNIVERSITAS AIRLANGGA
FAKULTAS KESEHATAN MASYARAKAT
PROGRAM MAGISTER
PROGRAM STUDI EPIDEMIOLOGI
SURABAYA
2018
 HASIL TESIS

Diajukan Sebagi Salah Satu Syarat Untuk Memperoleh Gelar

Magister Epidemiologi ( M.Epid)
Minat Studi Manajemen Surveilans Epidemiologi dan Informasi Kesehatan
Program Studi Epidemiologi
Fakultas Kesehatan Masyarakat
Universitas Airlangga

Oleh:
ANJAS DWI PURWANTO
NIM. 101614553009

Menyetujui,
Surabaya, Juni 2018

Pembimbing Ketua Pembimbing

Dr. Hari Basuki Notobroto, dr., M.Kes Dr. Annis Catur Adi, Ir., M.Si
NIP 196506251992031002 NIP 196903011994121001

Mengetahui,
Koordinator Program Studi Epidemiologi

Prof. Dr. Chatarina U. W., dr., M.S., M.PH

NIP 195409161983032001

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 DAFTAR ISI

Halaman
HALAMAN JUDUL................................................................................... i
HALAMAN PERSETUJUAN .................................................................... ii
DAFTAR ISI ............................................................................................... iii
DAFTAR TABEL ....................................................................................... vi
DAFTAR GAMBAR .................................................................................. vii
DAFTAR LAMPIRAN ............................................................................... viii
DAFTAR ARTI LAMBANG DAN SINGKATAN ................................... ix

BAB I PENDAHULUAN
1.1 Latar Belakang Masalah ...................................................... 1
1.2 Kajian Masalah .................................................................... 7
1.3 Rumusan Masalah ............................................................... 11
1.4 Tujuan Penelitian ................................................................. 11
1.4.1 Tujuan Umum .......................................................... 11
1.4.2 Tujuan Khusus ......................................................... 11
1.5 Manfaat Penelitian ............................................................... 12
1.5.1 Bagi Peneliti............................................................. 12
1.5.2 Bagi Fakultas Kesehatan Masyarakat ...................... 12
1.5.3 Bagi Institusi RSIA Kendangsari Merr Surabaya .... 12

BAB II TINJAUAN PUSTAKA

2.1 Health Care Associated Infections (HAIs) .......................... 14
2.1.1 Pengertian HAIs....................................................... 14
2.1.2 Penularan HAIs ........................................................ 15
2.1.3 Batasan HAIs ........................................................... 18
2.1.4 Indikator HAIs ......................................................... 19
2.1.5 Klasifikasi HAIs ...................................................... 20
2.1.6 Gejala Klinis HAIs .................................................. 36
2.1.7 Sumber Infeksi HAIs ............................................... 37
2.1.8 Faktor Risiko HAIs .................................................. 37
2.1.9 Dampak HAIs .......................................................... 38
2.1.10 Pencegahan HAIs..................................................... 39
2.2 Surveilans HAIs................................................................... 41
2.2.1 Pengertian Surveilans HAIs ..................................... 41
2.2.2 Tujuan Surveilans HAIs .......................................... 43
2.2.3 Metode Surveilans HAIs.......................................... 43
2.2.4 Kegiatan Surveilans HAIs ....................................... 44
2.3 Basis Data ............................................................................ 48

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 2.3.1 Pengertian Basis Data .............................................. 48
2.3.2 Manfaat Basis Data .................................................. 48
2.3.3 Sistem Manajemen Basis Data ................................ 50
2.3.4 Komponen Sistem Basis Data ................................. 51
2.3.5 Siklus Hidup Basis Data .......................................... 53
2.3.6 Perancangan Basis Data ........................................... 56
2.4 Epi Info ................................................................................ 64

BAB III KERANGKA KONSEPTUAL

3.1 Kerangka Konseptual Penelitian ......................................... 67

BAB IV METODE PENELITIAN

4.1 Jenis Penelitian .................................................................... 71
4.2 Rancang Bangun Penelitian ................................................. 71
4.3 Lokasi dan Waktu Penelitian................................................ 71
4.3.1 Lokasi Penelitian ..................................................... 71
4.3.2 Waktu Penelitian...................................................... 72
4.4 Subyek Penelitian ................................................................ 72
4.5 Kerangka Operasional Penelitian ........................................ 72
4.6 Komponen Penelitian, Definisi Operasional dan Cara
Pengukuran .......................................................................... 79
4.7 Teknik dan Prosedur Pengumpulan Data ............................ 85
4.8 Langkah Pengembangan Basis Data Surveilans HAIs ........ 86
4.8.1 Analisis Sistem Surveilans HAIs yang Sedang
Berjalan .................................................................... 86
4.8.2 Perancangan Model Basis Data Surveilans HAIs .... 86
4.8.3 Uji Coba dan Evaluasi Basis Data Surveilans HAIs 87
4.9 Pengolahan dan Analisis Data ............................................. 87

BAB V HASIL DAN ANALISIS DATA

5.1 Gambaran Umum RSIA Kendangsari Merr Surabaya ........ 89
5.1.1 Sejarah Berdirinya RSIA Kendangsari Merr
Surabaya .................................................................. 89
5.1.2 Struktur Organisasi RSIA Kendangsari Merr
Surabaya .................................................................. 91
5.1.3 Gambaran Organisasi Pencegahan dan Pengendalian
Infeksi (PPI) RSIA Kendangsari Merr Suarabaya ... 92
5.1.4 Struktur Komite Pengendalian Penyakit Infeksi (PPI)
RSIA Kendangsari Merr Surabaya .......................... 93
5.2 Analisis Sistem Surveilans HAIs yang Sedang Berjalan
di RSIA Kendangsari Merr Surabaya ................................... 101
5.2.1 Deskripsi Komponen Input yang sedang Berjalan .. 101
5.2.2 Deskripsi Proses yang Sedang Berjalan .................. 105

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 5.2.3 Deskripsi Output ...................................................... 106
5.2.4 Aliran Data Sistem Informasi yang Sedang
Berjalan .................................................................... 107
5.2.5 Masalah Sistem Informasi HAIs di RSIA
Kendangsari Merr Surabaya .................................... 108
5.3 Identifikasi Kebutuhan Data dan Informasi.......................... 109
5.4 Pengembangan Desain Basis Data HAIs di RSIA
Kendangsari Merr Surabaya ................................................. 111
5.4.1 Desain Diagram Konteks ......................................... 112
5.4.2 Normalisasi Data ..................................................... 116
5.4.3 ERD ......................................................................... 131
5.4.4 Kamus Data ............................................................. 133
5.4.5 Hasil Pengembangan Basis Data ............................. 144
5.4.6 Bentuk Output .......................................................... 156
5.4.7 Kelebihan dan Keterbatasan Basis Data HAIs yang
Dikembangkan ......................................................... 161
5.5 Uji Coba dan Evaluasi Basis Data HAIs di RSIA
Kendangsari Merr Surabaya ................................................. 162
5.5.1 Persiapan Uji Coba .................................................. 162
5.5.2 Pelaksanaan Uji Coba .............................................. 163
5.5.3 Evaluasi Basis Data HAIs........................................ 167
5.5.4 Rekomendasi Basis Data HAIs ................................ 169

BAB VI PEMBAHASAN
6.1 Analisis Sistem yang Sedang Berjalan di RSIA Kendangsari
Merr Surabaya ...................................................................... 170
6.2 Kebutuhan Data dan Informasi Pengembangan Basis Data
HAIs di RSIA Kendangsari Merr Surabaya ......................... 177
6.3 Pengembangan Desain Basis Data HAIs di RSIA
Kendangsari Merr Surabaya ................................................. 178
6.4 Aplikasi Pengembangan Model Basis Data HAIs ................ 180
6.5 Uji Coba dan Evaluasi Basis Data HAIs di RSIA
Kendangsari Merr Surabaya ................................................ 183

BAB VII KESIMPULAN

7.1 Kesimpulan ........................................................................... 186
7.2 Saran ..................................................................................... 188

DAFTAR PUSTAKA ................................................................................. 190

LAMPIRAN ................................................................................................ 191

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 DAFTAR TABEL

Nomor Judul Tabel Halaman

Tabel 2.1 Simbol Data Flow Diagram (DFD)....................................... 58

Tabel 4.1 Komponen Penelitian, Definisi Operasional dan Cara
Pengukuran ............................................................................ 80
Tabel 5.1 Pola Tenaga Panitia PPI......................................................... 101
Tabel 5.2 Kuantitas dan Karakteristik Tim PPI di RSIA Kendangsari
Merr Surabaya........................................................................ 103
Tabel 5.3 Masalah Sistem Informasi HAIs di RSIA Kendangsari Merr
Surabaya................................................................................. 108
Tabel 5.4 Kebutuhan Informasi Baru, Data dan Sumber Data .............. 109
Tabel 5.5 Bentuk Normal Tahap Kedua ................................................ 128
Tabel 5.6 Kamus Data Tampilan Menu Utama ..................................... 133
Tabel 5.7 Kamus Data Identitas Pasien ................................................. 134
Tabel 5.8 Kamus Data Pelayanan Ruangan Rawat Inap ........................ 135
Tabel 5.9 Kamus Data Tindakan ........................................................... 136
Tabel 5.10 Kamus Data Identifikasi ISK ................................................. 137
Tabel 5.11 Kamus Data Identifikasi Flebitis ........................................... 138
Tabel 5.12 Kamus Data Identifikasi IDO ................................................ 139
Tabel 5.13 Kamus Data Identifikasi Dekubitus ....................................... 140
Tabel 5.14 Kamus Data Identifikasi HAP ............................................... 141
Tabel 5.15 Kamus Data Identifikasi VAP ............................................... 142
Tabel 5.17 Tugas Pengguna Basis Data HAIs di RSIA Kendangsari
Merr Surabaya........................................................................ 157
Tabel 5.18 Waktu Pelaksanaan Uji Coba ................................................ 161
Tabel 5.19 Jenis Informasi (Output) Basis Data HAIs di RSIA
Kendangsari Merr Surabaya .................................................. 163
Tabel 5.20 Hasil Evaluasi Uji Coba Berdasarkan Atribut Sistem
Surveilans............................................................................... 165

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 DAFTAR GAMBAR

Nomor Judul Gambar Halaman

Gambar 1.1 Kejadian HAIs di RSIA Kendangsari Merr Tahun 2017 ....... 4
Gambar 2.1 Siklus Hidup Basis Data ........................................................ 54
Gambar 3.1 Kerangka Konsep Pengembangan Basis Data Surveilans
HAIs di RSIA Kendangsari Merr Surabaya .......................... 68
Gambar 4.1 Kerangka Operasional Penelitian........................................... 74
Gambar 5.1 Struktur Organisasi RSIA Kendangsari Merr Surabaya ........ 91
Gambar 5.2 Struktur Komite PPI............................................................... 94
Gambar 5.3 Diagram Konteks Sistem Informasi yang sedang Berjalan ... 107
Gambar 5.4 Diagram Konteks Sistem Informasi HAIs ............................. 112
Gambar 5.5 Pengembangan Sistem Informasi HAIs di RSIA Kendangsari
Merr Surabaya........................................................................ 115
Gambar 5.6 ERD basis data surveilans HAIs di RSIA Kendangsari Merr
Surabaya................................................................................. 133
Gambar 5.7 Tampilan Menu Epi Info 7..................................................... 145
Gambar 5.8 Halaman Utama Basis Data HAIs di RSIA Kendangsari
Merr Surabaya........................................................................ 146
Gambar 5.9 Tampilan Data Identitas Pasien ............................................. 147
Gambar 5.10 Tampilan Form Pelayanan Rawat Inap .................................. 148
Gambar 5.11 Tampilan Data Tindakan Pasien ............................................ 149
Gambar 5.12 Tampilan Data ISK ................................................................ 150
Gambar 5.13 Tampilan Data Flebitis........................................................... 152
Gambar 5.14 Tampilan Data IDO ............................................................... 153
Gambar 5.15 Tampilan Data Dekubitus...................................................... 154
Gambar 5.16 Tampilan HAP....................................................................... 155
Gambar 5.17 Tampilan Data VAP .............................................................. 156
Gambar 5.18 Tampilan Form Rekapan Data Surveilans HAIs ................... 156

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 DAFTAR LAMPIRAN

Nomor
1. Informed Consent Penjelasan Sebelum Persetujuan (PSP) Informasi esensial
untuk calon peserta penelitian(WHO-CIOMS 2016)
2. Informed Consent Pernyataan Persetujuan Ikut Penelitian
3. Pedoman Wawancara Pengembangan Basis Data Surveilans HAIs di RSIA
Kendangari Merr Surabaya
4. Kuisoner Uji Coba Pengembangan Basis Data Surveilans Infeksi Nosokomial di
RSIA Kendangari Merr Surabaya
5. Surat Ijin Penelitian Tesis

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 DAFTAR ARTI LAMBANG DAN SINGKATAN

Daftar Arti Lambang

- = sampai dengan
% = persen
& = dan
> = lebih dari
< = kurang dari
≥ = lebih dari sama dengan
≤ = kurang dari sama dengan

Daftar Singkatan

BCNF = Boyce Code Normal Form

CAUTI = Catheter Associated Urinary Tract Infection
CDC = Centers for Disease Control and Prevention
CLABSI = Central Line Associated Blood Stream Infections
DBMS = Data Based Management System
Depkes = Departemen Kesehatan
DFD = Data Flow Diagram
ERD = Entity Relationship Diagram
HAIs = Health Care Associated Infections
IADP = Infeksi Aliran Darah Primer
IDO = Infeksi Daerah Operasi
IPCLN = Infection Prevention and Control Link Nurse
IPCN = Infection Prevention and Control Nurse
IPCO = Infection Prevention and Control Officer
ISK = Infeksi Saluran Kemih
KLB = Kejadian Luar Biasa
LOS = Length of Stay
NF = Normal Form
PPI = Pencegahan dan Pengendalian Infeksi
PPIRS = Pencegahan dan Pengendalian Infeksi Rumah Sakit
RDBMS = Relational Database Management System
RSIA = Rumah Sakit Ibu dan Anak
SNARS = Standar Akreditasi Nasional Rumah Sakit
SPM = Standar Minimal Pelayanan

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SQL = Structured Query Language
SSI = Surgical Site Infection
VAP = Ventilator Associated Pneumonia
WHO = World Health Organization