Strategi untuk

Meningkatkan Kepatuhan
Petugas dalam Melakukan
Hand Hygiene
Dr. Ns. Elis Puji Utami, S.Kep., MPH., FISQua
Ketua PP. HIPPII

Webinar Kesehatan, Primaya Hospital, 04 Mai 2023

Dalam rangka Memperingati “Wordl Hand Hygiene Day”
Dr.Ns. Elis Puji Utami, S.Kep., MPH., FISQua

Ketua PP. HIPPII

B e k e r j a d i RSUPN. dr. Cipto Mangunkusumo

08128402160 ayunda_elis@yahoo.co.id
 PENDAHULUAN

Health care
HEALTHCARE
infeksi yang terjadi pada pasien selama proses perawatan di rumah sakit atau
Fasilitas pelayanan kesehatan lainnya dimana tidak infeksi atau dalam masa
associated
ASSOCIATED inkubasi saat masuk rawat serta dapat muncul setelah pulang rawat juga infeksi
infection
INFECTIONS yang dapat terjadi pada petugas di fasilitas pelayanan kesehatan karena
pekerjaannya.
(HAIS)
(HAIs)

§ HAIs : 1 dari 10 pasien dirawat mengalami HAIs,

1 dari 10 psn dengan HAIs meninggal
§ 70 % diantaranya BISA DICEGAH !! (< 10%
dipengaruhi lingkungan; > 90% dipengaruhi
perilaku) 9-9,2 % petugas tidak rutin cuci tangan
( WHO,2011)
PENYEBAB TERJADINYA INFEKSI
URINARY TRACT LOWER RESPIRATORY TRACT
INFECTIONS 34% 13% INFECTIONS
Urinary catheter Mechanical ventilation
Urinary invasive Aspiration
procedures Nasogastric tube
Advanced age Severe underlying Central nervous system depressants Antibiotics
disease and anti-acids
Urolitiasis Pregnancy Diabetes Prolonged health-care facilities stay
Malnutrition Advanced age
Most common Surgery
sites of health care- Immunodeficiency
associated infection
LACK OF HAND
HYGIENE
SURGICAL SITE INFECTIONS occurrence of BLOOD INFECTIONS
Inadequate antibiotic infections Vascular catheter
prophylaxis Incorrect Neonatal age
surgical skin preparation Critical care
Inappropriate wound care Severe underlying disease
Surgical intervention duration Neutropenia Immunodeficiency
Type of wound New invasive technologies
Poor surgical asepsis Lack of training and supervision
Diabetes Nutritional state 17% 14%
Immunodeficiency
Lack of training and supervision
http://www.who.int/infection-prevention/en/
 Hand Hygiene Overview
Kebersihan tangan yang tepat mencegah INFEKSI hingga 50%
selama pemberian perawatan, termasuk yang mempengaruhi
kepatuhan petugas kesehatan.

• Perawat melakukan 52.115 pengamatan kebersihan tangan antara 2013

dan 2018.
• Kepatuhan kebersihan tangan tahunan meningkat signifikan.
• Th 2013 : 76,4%
• Th 2018 : 88,5%
• Dan pd waktu yang sama, jumlah infeksi terkait perawatan kesehatan
menurun
• Th 2012: 14,0 permil menjadi 11,7 permil

Memutus rantai Kewaspadaan Kebersihan

infeksi STANDAR Tangan
 PENYEBAB UTAMA INFEKSI
BIG CONCEPT 30-40%

Didier Pittet et al,Lancet Infect Dis 2006

STANDAR AKREDITASI RUMAH SAKIT
KEMENKES, 2022 : STANDAR PPI
FOKUS PROGRAM PPI
Standar akreditasi rumah sakit, Kementerian Kesehatan, 2022

PPI. 1
Penyelenggaraan PPI
• PJ kegiatan PPI PPI. 5 PPI. 10
• IPCN & IPCLN Kebersihan Lingkungan Penularan Infeksi

PPI. 6
PPI. 2 Manajemen Linen PPI. 11
Program PPI Kebersihan Tangan

PPI. 7
Limbah Infeksius PPI. 12
PPI.3 Peningkatan Mutu &
Pengkajian Risiko Program Edukasi
PPI. 8
Pelayanan Makanan
PPI. 13
PPI. 4 Edukasi, Pendidikan &
Peralatan Medis PPI. 9
ICRA Renovasi & Pelatihan
& BMHP
Konstruksi

9
STANDAR KEBERSIHAN TANGAN DALAM
AKREDITASI RUMAH SAKIT

Standar PPI 11
Kebersihan tangan menggunakan sabun dan desinfektan adalah sarana
efektif untuk mencegah dan mengendalikan infeksi.

Elemen Penilaian PPI 11

a) Rumah sakit telah menerapkan hand hygiene yang mencakup kapan, di mana, dan bagaimana melakukan cuci
tangan mempergunakan sabun (hand wash) dan atau dengan disinfektan (hand rubs) serta ketersediaan
fasilitas hand hygiene.
b) Sabun, disinfektan, serta tissu/handuk sekali pakai tersedia di tempat cuci tangan dan tempat melakukan
disinfeksi tangan.
c) Ada bukti pelaksanaan pelatihan hand hygiene kepada semua pegawai termasuk tenaga kontrak.
PENINGKATAN MUTU KEBERSIHAN TANGAN DALAM STARKES 2022

Standar PMKP: Rumah sakit harus memiliki program peningkatan mutu dan keselamatan
pasien (PMKP) yang menjangkau seluruh unit kerja dalam rangka meningkatkan mutu
pelayanan dan menjamin keselamatan pasien.

Standar TKRS 4. Pimpinan rumah sakit merencanakan, mengembangkan, dan

menerapkan program peningkatan mutu dan keselamatan pasien

Standar PPI 11
Kebersihan tangan menggunakan sabun
dan desinfektan adalah sarana efektif
untuk mencegah dan mengendalikan
infeksi.
Standar SKP 5
Rumah sakit menerapkan kebersihan tangan
(hand hygiene) untuk menurunkan risiko
infeksi terkait layanan kesehatan.
1
•Kepatuhan kebersihan tangan
Upaya Peningkatan Mutu
2
•Kepatuhan penggunaan APD
Rumah Sakit
3 •Kepatuhan identifikasi pasien
•Waktu tanggap Operasi Seksio
4 sesarea emergensi Registrasi & Lisensi
sesuai Regulasi
•Waktu tunggu rawat jalan 13 Insiden
5
Indikator Keselamatan
•Penundaan operasi elektif Mutu Pasien
6
RS
SARANA
•Kepatuhan waktu visite Dokter
7
•Pelaporan hasil kritis
8 laboratorium
PRASARANA Tata Kelola Penilaian
•Kepatuhan penggunaan dan Akreditasi
9 formularium nasional Kepemimpinan
•Kepatuhan terhadap alur klinis
10 (clinical pathway)
•Kepatuhan upaya pencegahan ALKES
11 risiko pasien jatuh
•Kecepatan waktu tanggap Continous
12 komplain SDM Quality
KESEHATAN Improvement
•Kepuasan pasien
13
Sumber: DirMutu Yankes Kemenkes RI, disampaikan pada pelatihan IPCN HIPPII, 2022
 Standar
ü Ditetapkan menjadi Indikator Akreditasi RS
Upaya Mutu Unit / RS/Nasional Standar PPI 11
Meningkatkan
Kepatuhan ü Regulasi
dalam
Kebersihan ü Diukur secara periodik
Tangan ü Fasilitas

ü Pelatihan
ü Dianalisa secara periodik
ü Kepatuhan
 MENGAPA
KEBERSIHAN TANGAN
PENTING?
▸ Clean hands are essential for preventing and controlling the
spread of disease.
▸ Healthcare-associated infections (HAIs), diseases caused by
bacterial spread, and the development of antibiotic resistance can
all be prevented by diligent hand washing.
▸ Worldwide, infection prevention and control (IPC) professionals
continue to face the dilemma of low patient compliance rates with
hand hygiene measures.
KENDALA KEPATUHAN
KEBERSIHAN TANGAN
q Kurangnya kesadaran akan pentingnya HH untuk
mencegah penyebaran infeksi.
q Kurangnya pengetahuan “cara yang benar” melakukan
kebersihan tangan
q Keterbatasan akses ke fasilitas HH: ketersediaan, jarak
q Kesulitan mematuhi kebijakan dan prosedur :
waktu,aktivitas kerja, beban kerja, tekanan dari rekan
kerja atau atasan.
q Menganggap “efektivitas atau kepatuhan HH” tidak
diperhatikan oleh orang lain di sekitarnya.
 BAGAIMANA STRATEGI UNTUK
MENINGKATKAN KEPATUHAN HAND
HYGIENE?

▸ Multymodal Strategy
 Multymodal strategy
dalam Hand Hygiene
Pendekatan yang diusulkan oleh
WHO untuk meningkatkan
kepatuhan petugas kesehatan
dalam melakukan praktik hand
hygiene

Based on the evidence and recommendations

from the WHO Guidelines on Hand Hygiene in
Health Care (2009),
made up of
5 core components, to improve hand
hygiene in health-care settings
Melalui bbrp intervensi yang
terintegrasi dan terkoordinasi
untuk memastikan praktik 5
hand hygiene efektif dan komponen
strategi
konsisten di lingkungan
pelayanan kesehatan
WHO Multimodal Hand Hygiene
Improvement Strategy
ONE System change
Access to a safe,
continuous water supply as
well as
to soap and towels; readily
accessible alcohol-based
handrub at the point of
care
FOUR Reminders in the
workplace
Prompting and reminding
health-care workers about the
importance of hand hygiene and
about the appropriate indications
and procedures for performing it.
Source WHO: Education Session for Trainers, Observers and Health-Care Workers
TWO Training /
Education
Providing regular training to all
THREE Evaluation and
health-care workers: based on the feedback
“My 5 Moments for Hand
Hygiene” approach, the correct
Monitoring hand hygiene
practices, infrastructure,
procedures for handrubbing and
handwashing, perceptions and
knowledge, while providing
results feedback to health-
FIVE Institutional
care workers
safety climate
Creating an environment
and the perceptions that
facilitate awareness-
raising about patient
safety issues
 1. System Change
ABHR di
fasilitas Ratio TT: Fasilitas cuci
perawatan Wastafel tangan Anggaran
kesehatan

ABHR 1: 1 di Alcohol-
tersedia Ratio 1:10 ruang Sabun cuci Pengering Rencana based
dengan Uji efficacy Ketersediaan tangan tangan
di seluruh isolasi dan realistic utk Handrub
pasokan and air bersih dan
meningkatk
berkelanjutan fasilitas dan di unit berkelnjutan selalu selalu Planning
tolerability perawatan tersedia an startegi and Costing
di setiap titik ruangan tersedia
perawatan intensif Tool
ONE System change
Ketersediaan & Kemudahan akses ALKOHOL Based Hand Rub

Memilih produk handrub berbasis alkohol

Kapan harus menggunakan handrub berbasis alkohol

Penyerapan alkohol pada kulit

Penempatan handrub berbasis alcohol

Penempatan handrub berbasis alkohol yang aman

Batasan handrub berbasis alkohol

System Change

Schedule of
maintain for
Tolerability& Ward infra Schedule of
Hand supply of
acceptibility structur maintain HH
Hygiene clean,
ABHR survey every facilities
policy running
(N=40) 6 month quarterly
water
montly
 FASILITAS
KEBERSIHAN TANGAN

LIFT WASTAFEL DI AREA DI SETIAP BED WASTAFEL

INTENSIVE
 2. Training / Education
Tersedi pedoman HH sesuai
Pelatihan
Pelatihan WHO atau pedoman lokal
oleh petugas
Nakes yang mudah untuk semua
Profesional
petugas kesehatan

Profesional
Pelatihan wajib
proses untuk dengan sistem untuk
untuk semua The WHO keterampilan
kategori memastikan The ‘WHO The WHO pelatihan dan
‘Hand The WHO yang memadai
profesional di bahwa semua Guidelines on ‘Hand Hygiene validasi
petugas Hygiene: Why, ‘Glove Use untuk menjadi pengamat
dimulainya Hand Hygiene Technical How and
in Health-care: Reference Information’ pelatih aktif
pekerjaan, kesehatan Leaflet dalam program kepatuhan
kemudian mendapatkan When’ kebersihan
A Summary’ Manual’ Brochure
pelatihan pendidikan tangan
berlanjut kebersihan
secara teratur tangan
2. Training / Education

Hand
HH training & Hygiene Sticker in
Technical E learning
education PortFolio Staff’s ID
HH module
schedule reference card
manual
 Edukasi staf, peserta
didik dan pengunjung

EDUKASI STAF OLEH EDUKASI PASIEN EDUKASI PEDOMAN HH

IPCN OLEH PERAWAT PENGUNJUNG
 3. Evaluation and feedback

Evaluasi Pengetahuan
petugas dinilai Audit Kebersihan
Indirect Monitoring of Hand
setidaknya setiap tahun tangan dengan 5 Umpan Balik
(misalnya setelah sesi Hygiene Compliance
momen
pendidikan)

3.3a Is umpan balik

Data indikator
consumption 3.3b Is 3.3c Is alcohol yang diberikan
kepada HH
of alcohol- consumption based Audit dilaporkans
Indikasi Tehnik based petugas
of soap handrub kepatuhan etiap 6 bulan
Frekuesi audit kesehatan di
kebersihan kebersihan handrub monitored consumption
5 momen HH
menggunakan akhir setiap kepada
tangan tangan monitored regularly (at at least 20L formulir WHO sesi observasi pimpinan
regularly (at least every 3 per 1000 Hand Hygiene unit/Det dan
months)? patient-days? kepatuhan
least every 3 kebersihan petugas
months)? tangan kesehatan
How to Handrub?
RUB HANDS FOR HAND HYGIENE! WASH HANDS WHEN VISIBLY SOILED
How to Handwash?
WASH HANDS WHEN VISIBLY SOILED! OTHERWISE, USE HANDRUB
Duration of the entire procedure: 20-30 seconds
Duration of the entire procedure: 40-60 seconds

1a 1b 2 0 1 2

Wet hands with water; Apply enough soap to cover Rub hands palm to palm;
all hand surfaces;

Apply a palmful of the product in a cupped hand, covering all surfaces; Rub hands palm to palm;
3 4 5

3 4 5
Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;

6 7 8
Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;

Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water;
6 7 8 clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;

9 10 11

Rotational rubbing of left thumb Rotational rubbing, backwards and Once dry, your hands are safe. Dry hands thoroughly Use towel to turn off faucet; Your hands are now safe.
with a single use towel;
clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind,
either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material. May 2009
May 2009
 Kepatuhan HH Berdasarkan Profesi Di RS
X, Januari - Maret 2021
Observation Form
Facility: Period Number*:
Session
Number*: 100
Service:
Date:
(dd/mm/yy)
/ /
Observer:
(initials)
80
Ward:
Start/End time:
: / : Page N°: 60

%
(hh:mm)

Department: Session duration:

(mm)
City**: 40
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20
0
Prof.cat
Code
Prof.cat
Code
Prof.cat
Code
Prof.cat
Code
Januari Februari Ma re t
N° N° N° N°
Dokter 73,2 73,4 74,6
Persiapan,
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* To be completed by the data manager.
** Optional, to be used if appropriate, according to the local needs and regulations.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty
Capaian 70,2 70,8 68 68,9 70,2 73,2 73,9 74,1 75 76,2 77 78,2
of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising
from its use.
WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
Revised August 2009
Indikator 80 80 80 80 80 80 80 80 80 80 80 80
 4. Reminders in the workplace
(Sistem Pengingat)

Reminder
Tampilan atau Sistem audit
secara terus
system pengingat Fasilitas HH
menerus

Penggunaan
Poster tehnik fasilitas
Poster Fasilitas Keutuhan Ketersedia
Cuci tangan Poster Kampanye audio,visual
indikasi HH dengan air tehnik HH Air kondisi an Leaflet mis screen
dis etiap area mengalir dan yang benar poster HH saver
perawatan mengalir HH
hand rub computer, pin
dll
 Sistem Pengingat

TERSEDIA DAN POSTER POSTER POSTER

MUDAH DIFAHAMI
 PENGINGAT DI AREA
PERAWATAN

PENGINGAT RANAP PENGINGAT POLI PENGINGAT POLI PENGINGAT MEDSOS

AREA PELAYANAN
PASIEN

NURS STATION RUANG PERIKSA RUANG TUNGGU PINTU MASUK R.

DOKTER PERIKSA
 INOVASI DIGITALISASI

Lomba HH Campign 2023

https://www.instagram.com/reel/CdKbeuZJAhj/?igshid=MDJmNzVk
MjY= https://www.instagram.com/reel/CrpN3
tPNFh4/?igshid=MDJmNzVkMjY=
 5. Institutional safety climate
(Budaya Keselamatan)

Komitmen dan Rencana HH

Tim HH dukungan pimpinan dan Kampanye
manajemen RS setiap tgl 5 Mei

Promosi
memiliki waktu Kesehatan Sustaining
Template Letter
khusus untuk Tugas melatih, yang Improvement -
Template Letter to Save Lives
melakukan memantau dilaksanakan Additional
promosi to Advocate communicate Activities for Clean Your
kinerja, oleh seluruh Hand Hygiene
mengatur Hand Hygiene Hands Annual
kebersihan petugas to Managers Consideration Initiative
tangan secara Kesehatan, scr Initiatives to by Health-Care
kegiatan baru Managers
aktif ertulis atau Facilities
lisan untuk
 5. Budaya Keselamatan -HH
Sistem
mematikan HH
Keterlibatan Sistem dan fasilitas mensuport HH
dilaksanakan
Pasien berkelanjutan
setiap Leader
di Unit

5.4b A Guidance on
5.4a A system for Engaging Sistem
system for recognition Program Patients and Target HH penghargaa Komunikasi
designation and HH Patient HH E- disetiap n terhadap
regular HH
Per
of Hand utilisation of melibatkan Organization Learning bulan di inovasi dan
newsletter individu
Hygiene Hand pasien s in Hand setiap Unit berbagi
champions11 Hygiene role Hygiene capian
models12 Initiatives
 “ World Hand Hygiene Day is a global healthcare
event observed on the 5th of May every year,
intending to unite people worldwide to increase
awareness about hand hygiene standards in
healthcare facilities, thereby protecting healthcare
workers and civilians from infections.
 05.05. 2023

"Accelerate action together.

SAVE LIVES - Clean Your Hands" emphasises accelerating
the needed actions by working together and reducing the
spread of infection and antimicrobial resistance in
healthcare settings.
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 KESIMPULAN
▸ Dalam rangka meningkatkan kepatuhan petugas kesehatan
dalam melakukan hand hygiene, audit hand hygiene perlu
dilakukan secara teratur dan berkala, shg dapat membantu
memantau tingkat kepatuhan petugas dan membantu
mengevaluasi efektivitas program hand hygiene.
▸ Ketidakpatuhan petugas dalam melakukan hand hygiene,
maka perlu diambil tindakan untuk memastikan kebersihan
dan keamanan lingkungan kerja dan pasien terjaga melalui 5
komponen kunci strategi (Multymodal strategy, WHO 2009)
Hand Hygiene Day Campaign by
HIPPII
https://vt.tiktok.com/ZS8Tw1kLm/

🔉ANNOUNCEMENT🔉

HalOoo Sahabat IPCN❤

To celebrate Hand Hygiene Day

Campaign 2023

Himpunan Perawat Pencegah dan

Pengendali Infeksi Indonesia
(HIPPII) will hold Video Competition
🎊"Lets Accelerate Action
Together"🎊

Come On Join 😉🔥🔥🔥

#HIPPIIHANDHYGIENEDAY2023