8/31/2022

KONSEP KAMAR BEDAH

BAGIAN I
Dr. Ns. Heri Kristianto. SKep., MKep.,SpKep.MB

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• Kamar Operasi atau Kamar bedah
merupakan fasilitas untuk melakukan
kegiatan pelayanan operasi di rumah sakit
dan sebagai salah satu unit kerja

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Alur dan Prosedur

Ruang Serah Terima

PRE

Ruang persiapan
(Induksi)

Meja Operasi INTRA

Ruang Pulih POST

Pembagian Ruangan
• Outer zone atau tempat
administrasi/penanganan pasien
• Intermediate zone atau ruang persiapan dan
penyimpanan
• Inner zone

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Zona 1 : Zona Bebas Terbatas ditandai dengan warna hijau

Zona 2 : Zona Bersih (Clean Zone) ditandai dengan warna kuning
Zona 3 : Zona Semi steril ditandai dengan warna orange
Zona 4 : Zona Streril ditandai dengan warna merah

KM Sphk
R.INST
VK
OK 1

RR HW

R.STERILISASI

KORIDOR

R. duduk R.GP
OK 2 R.G

DPR

R. ISTIRAHAT

KM

Outer Zone (Protective Zone)

Merupakan zona terluar dari kamar operasi. Pada
umumnya, zona ini memiliki bagian ruang sebagai berikut:
• Resepsionis
• Holding Area
• Ruang Anestesi
• Post Anesthetic Care Units (PACU)
• Ruangan Staff
• Fasilitas Kamar Mandi untuk Staff
• Tempat penyimpanan gas anestesi
• Kantor untuk Perawat dan staff Anestesi
• Ruang Istirahat
• Laboratorium
• Ruang Seminar
• Scrub Room

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Intermediate Zone (Clean Zone)

Merupakan zona penghubung antara outer zone
dan inner zone. Intermediate zone memiliki
bagian ruang sebagai berikut:
• Tempat penyimpanan alat operasi
• Tempat penyimpanan alat-alat kebersihan
• Tempat alat pemadam kebakaran
• Kamar khusus untuk staff
• Pintu keluar darurat
• Pemantauan dari CCTV

Inner Zone
• Merupakan tempat dimana operasi pada
pasien berlangsung.

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Tata Ruang dan Bangunan Kamar

Operasi
• Lokasi • Sistem listrik
• Bentuk • Sistem
• Ukuran komunikasi
• Pintu • Instrumentasi
• Jendela
• Rak dan lemari
• Ventilasi
untuk menyimpan
• Sistem penerangan
reagensia siap
• Sistem gas pakai

No Variabel Zona 1 Zona 2 Zona 3 Zona 4

1. Pakaian Pakaian luar OK Pakaian luar OK Petugas OK wajib Tim operasi

masih boleh masih boleh memakai memakai jas
dipakai. dipakai. pakaian operasi.
Pakaian Tidak boleh khusus OK Petugas OK
khusus OK lebih dalam lengkap memakai
tidak boleh dari zona ini. dengan handschoen.
lebih luar dari Pergantian masker dan
zona ini. pakaian OK- head cover.
pakaian luar
OK disini.
2. Alas kaki Alas kaki luar OK Alas kaki OK Alas kaki khusus Alas kaki khusus
masih bs di harus mulai OK saja. OK saja.
pakai. Tidak dipakai.
boleh dalam
dari zona ini,
pergantian alas
kaki luar-OK
disini. Alas
kaki OK tidak
boleh luar dari
zona ini.

Zona 1 Zona 2 Zona 3 Zona 4

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3. Bed pasien Boleh masuk Hanya sampai Tidak boleh Tidak boleh
recovery masuk masuk
room boleh
masuk
4. Brankar OK Boleh masuk. Boleh masuk Boleh masuk Boleh masuk
Tidak untuk keluar
boleh luar lagi.
dari zona
ini
5. Petugas luar Boleh masuk Boleh masuk Boleh masuk Tidak boleh
OK dengan masuk
memakai
pakaian
pelindung,
masker, dan
head cover

Zona 1 Zona 2 Zona 3 Zona 4

6. Lain2 Berbatas pintu Berbatas Syarat tata

dari luar pintu ruangan
kompleks dengan sesuai
OK. zona/ standart
Berbatas ruangan
pintu dari lain
zona/
ruangan
lain

Zona 1 Zona 2 Zona 3 Zona 4

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Prosedur pelayanannya berdasarkan

periode waktunya terdiri dari:
• Prosedur Sebelum Operasi
• Prosedur tentang Ruangan
dan Alat-alat.
• Prosedur Selama Operasi
• Prosedur Sesudah Operasi
• Prosedur Pencatatan
• Prosedur Penanganan
pasien yang meninggal
selama Operasi.

Prosedur Sebelum Operasi

Petugas

Pasien

Jadwal Mencukur Edukasi

Informed Consent Lavemen Pakaian & Penutup
TTV Puasa Kepala OK

Jolivet, S., & Lucet, J. C. (2019). Surgical field and skin

preparation. Orthopaedics & Traumatology: Surgery &
Research, 105(1), S1-S6.

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Should hair removal be performed, and if so how?

• These findings were

• Clipping confirmed in 2 meta-
• Mechanical shaving analyses Lefebvre et al.’s
network meta-
• Chemical analysis combined direct
depilation and indirect evidence,
showing lower risk in
chemical depilation and
Take-home message:
• routine hair removal is not recommended clipping versus shaving
• if it is nevertheless performed, clipping
should be preferred and shaving avoided.

• A. Lefebvre, P. Saliou, J.C. Lucet, O. Mimoz, O. Keita-Perse, B. Grandbastien, et al. Preoperative hair removal and surgical site infections: network
meta-analysis of randomized controlled trialsJ Hosp Infect, 91 (2015), pp. 100-108, 10.1016/j.jhin.2015.06.020
• D. Shi, Y. Yao, W. YuComparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysisJ Clin
Nurs, 26 (2017), pp. 2907-2914, 10.1111/jocn.13661

Is skin scrubbing still considered contributive?

Preoperative shower

• In a 2015 Cochrane meta-

analysis of 7 randomized
Take-home message: studies with 10,157 patients, 3
• at least 1 preoperative shower with studies compared CHG shower
normal soap should be taken, as close to versus placebo shower, 3 CHG
surgery time as possible
versus normal soap, and 3 CHG
• antiseptic soap has no proven benefit.
versus no specific washing
instructions; no significant
differences in SSI emerged
overall.

J. Webster, S. OsbornePreoperative bathing or showering with skin antiseptics to prevent surgical site infection
Cochrane Database Syst Rev, 2 (2015), p. CD004985, 10.1002/14651858.CD004985.pub5

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PROSEDUR TENTANG
RUANGAN DAN ALAT-ALAT

• Ruangan selalu dalam keadaan bersih dan

siap pakai.
• Alat yang akan dibutuhkan diatur atau
disiapkan sedemikian rupa sesuai dengan
kebutuhan, sudah dalam keadaan steril

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Prosedur Selama Operasi

• Cuci tangan
• Gown + Penutup kepala + Sarung tangan
• Asisten instrumen
• Asisten operasi
• Operator
1. Cara memegang sikat dan sabun.
2. Sikat tangan secara sistematik; satu per satu jari dicuci.
3. Sikat kuku
4. Tutup kran dengan siku; tangan dikeringkan dengan kain handuk steril,
yang dijatuhkan segera sete¬lah menyentuh siku.
5. Tangan harus selalu lebih tinggi daripada siku.

Teknik tanpa singgung

• mengeringkan tangan dan lengan
• memasang gaun bedah
• mengambil dan memakai sarung tangan
• memasangkan gaun bedah untuk orang lain
• memasang dan melepas sarung tangan
• membuka bungkusan kain dan instrumen
• menyerahkan set instrumen
• melakukan desinfeksi kulit penderita.

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Scrubbing in the operating room

Cleansing aims to reduce skin flora and prevent endogenous
contamination. It consists in vigorous skin scrubbing with
normal or antiseptic soap.

A recent meta-analysis of 3 randomized trials assessing the impact of

scrubbing on SSI and 4 trials (2 randomized, 2 parallel series) assessing
impact on skin colonization found no significant differences according to
scrubbing or not ahead of applying an antiseptic agent; levels of evidence,
however, were weak.

Take-home message:
• it is not recommended to scrub clean skin ahead of antisepsis;
• it is, however, recommended to scrub soiled skin, although with no preference for antiseptic
soap.

A. Lefebvre, P. Saliou, O. Mimoz, J.C. Lucet, A. Le Guyader, F. Bruyère, et al.Is surgical site scrubbing before painting of value?
Review and meta-analysis of clinical studies
J Hosp Infect, 89 (2015), pp. 28-37, 10.1016/j.jhin.2014.10.004

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Dorsal recumbent/ supine Prone

Tredelenburg Litotomi

Modified Fowler Position Kraske Position

Lateral Position

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Goldberg, R.F., Bowers, S.P., Parker, M. et al. Technical and perioperative outcomes of
minimally invasive esophagectomy in the prone position. Surg Endosc 27, 553–557 (2013).
https://doi.org/10.1007/s00464-012-2479-x

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Persiapan Kulit

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What skin protection should be

used: drapes, skin sealants, etc.?
A recent meta-analysis of the impact of adhesive drapes on SSI included 5
studies with a total 3082 patients comparing adhesive drapes versus no
drape, and 2 with a total 1113 patients comparing iodine-impregnated
adhesive drapes versus no drape. SSI rates were higher in the adhesive
drape groups; iodine impregnation was not associated with any
significant difference in SSI.
Take-home message: it is recommended not to use
adhesive drapes for prevention of SSI.

J. Webster, A. AlghamdiUse of plastic adhesive drapes during surgery for preventing surgical site infection
Cochrane Database Syst Rev, 4 (2015), p. CD006353, 10.1002/14651858.CD006353.pub4

Antimicrobial skin sealants

Antimicrobial skin sealants, usually composed of cyanoacrylate, are
sterile liquids applied to the skin after skin preparation, ahead of
incision; on drying, they form a film that is meant to prevent
migration towards the surgical site for several days.

Take-home message: it is not recommended to use antimicrobial skin

sealants in prevention of SSI

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Hanada, M., Hotta, K., Furuhashi, H. et al. Intraoperative bacterial contamination

in total hip and knee arthroplasty is associated with operative duration and peeling
of the iodine-containing drape from skin. Eur J Orthop Surg Traumatol 30, 917–
921 (2020). https://doi.org/10.1007/s00590-020-02653-y

Magee, L. C., Piazza, B., Harwood, K., & Lawrence, J. T. R. (2022). C-arm
contamination of the surgical field: Can contamination be reduced with an
intervening drape?. Injury, 53(6), 1994-1998.

Abstract
Introduction
Contamination of the surgical field by the C-arm in orthopaedic procedures is a significant potential
source for surgical site infections. The purpose of this study was to explore the utility of a split sheet to aid
in prevention of secondary contamination from the C-arm on the C-arm side of the operative field.

Methods
A C-arm and a surgical table were draped by standard techniques. The surgical table was split in thirds:
the surgeon's side, the C-arm side of the operative field, and the middle for contamination analysis.
Fluorescent powder was used to simulate a contaminant and placed on the C-arm, floor and lower portions
of drapes. The C-arm was cycled between PA and Lateral positions. Powder transfer to the field was
visualized with a camera under uniform UV light. Photographs were taken to measure fluorescent pixels
prior to cycling the C-arm and at 5, 10 and 15 cycles. This protocol was repeated using a split sheet (U-
drape) to isolate the C-arm below the operative field. Image J was utilized to calculate differences in the
number of pixels brighter than the control image.

Results
Using standard draping techniques, there was contamination of the surgical field with the C-arm side of
the operative field having the highest level of fluorescent pixels. The number of fluorescent pixels was
linearly correlated with the number of PA to Lateral cycles. At the end of 15 cycles, the average number of
fluorescent pixels for the intervening draping technique was 2.9 pixels compared to the standard draping
technique of 3939 pixels (p = 0.0078).

Discussion
The addition of a U-drape between the C-arm and the table results in a statistically significant reduction in
surgical field contamination as a result of secondary transfer from the C-arm.

Level of evidence
II

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Prosedur Sesudah Operasi

• Operator
• Asisten instrumen
• Petugas OK
• Pasien
Dipindahkan ke ruang pulih sadar, diawasi
pelaksana anestesi dan petugas RR, sampai
keadaan pasien membaik

Prosedur Pencatatan
• Dokter
• Operator
• Anastesi
• Hasil lab. PA
• Administrasi OK

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Prosedur Penanganan Pasien yang

Meninggal Selama Operasi
1. Dokter operator menjelaskan kepada
keluarga sehingga dapat dimengerti dengan
jelas.
2. Jenazah disemayamkan sementara 2 jam di
ruangan khusus diwilayah OK.
3. Perawat OK memberitahukan ke petugas
kamar jenazah bahwa ada pasien
meninggal di kamar OK.
4. Jenazah dibawa ke kamar jenazah oleh
petugas OK ditimbang-terimakan dengan
petugas jenazah.

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