PERSI

Disampaikan pada acara Pelatihan Tingkat Dasar

Pencegahan dan Pengendalian Infeksi di RS
Hotel Pomelotel
Jakarta, 25 – 28 Juni 2018
 PENDAHULUAN
Healtcare Associated Infections
( HAIs)
Penanganan
Limbah

Masalah

Pencegahan dan Pengendalian Infeksi (PPI)

 PROGRAM PENCEGAHAN DAN HH
APD
PENGENDALIAN INFEKSI (PPI) Lingkungan

HAIs Limbah
Peralatan Perawatan Ps
PPRA Penanganan Linen
Kes. Karyawan
Penempatan Pasien
Etika batuk
Penyuntikan yang aman
Praktil lumbal punksi

VAP,IADP
ILO,ISK

Airborne
Droplet
Contact
Menerapkan
Bundles of
HAIs
Komite PPI
Tim PPI
IPCN
Audit
IPCN
ICRA
 LATAR BELAKANG

Penanganan Banyak persepsi

Limbah

IPCN Bingung
?

Regulasi
General defnition
and classifcation
 Infeksius (hazard) 10 %

Patho Kontaminasi darah &

logical cairan tubuh

Penanganan Sharp Jarum suntik ,scapel,lancet

Limbah
General (non hazard) 85 %
Tidak
Pembungkus jarum,
kontaminasi
3R cairan,pempers,topi,ma
darah
sker,sarung tangan,
&cairan
plabot,tubing set
tubuh
REUSE
RE DUCE Chemical radioactive 5 %
RECYCLE Gas anaesthesi,limbah
chemotherapi,air raksa
 Masuk kantong plastik
kuning dalam kontainer
Infeksius (hazard) 10 % limbah infeksius diberi label,
¾ penuh dibuang ,dibakar
dalam insenerator

Masuk kantong plastik hitam

General (non hazard) 85 % dalam kontainer limbah non
infeksius diberi label, ¾
penuh dibuang pada tempat
pembuangan akhir

Chemical radioactive 5 % Dibuang dalam tempat

khusus

Limbah Cair Dibuang dalam saluran

limbah cair (IPAL)
 KATEGORI LIMBAH LAYANAN
KESEHATAN
Kategori limbah Diskripsi dan contoh
Hazard/bahaya
Limbah tajam Intravenous or other needles; auto-disable
syringes; syringes with attached needles;
infusion sets; scalpels; pipettes; knives; blades;
broken glass)
Limbah infeksius Waste suspected to contain pathogens and that
poses a risk of disease transmission (e.g.
waste contaminated with blood and other body
fluids; laboratory cultures and microbiological
stocks; waste including excreta and other
materials that have been in contact with
patients infected with highly infectious diseases
in isolation wards)
 KATEGORI LIMBAH LAYANAN
KESEHATAN
Kategori limbah Diskripsi dan contoh

Hazard/bahaya
Limbah patologi Human tissues, organs or fluids; body parts; fetuses;
unused blood products
Limbah farmasi Pharmaceuticals that are expired or no longer
& Sitotoxik needed; items contaminated by or
containing pharmaceuticals
Cytotoxic waste containing substances with
genotoxic properties (e.g. waste containing
cytostatic drugs – often used in cancer therapy;
genotoxic chemicals)
Limbah Waste containing chemical substances (e.g.
khemikal laboratory reagents; flm developer;
disinfectants that are expired or no longer needed;
solvents; waste with high content of
heavy metals, e.g. batteries; broken thermometers
and blood-pressure gauges)
 KATEGORI LIMBAH LAYANAN
KESEHATAN
Kategori Diskripsi dan contoh
limbah
Hazard/bahaya
Limbah Waste containing radioactive substances (e.g.
radioaktif unused liquids from radiotherapy or
laboratory research; contaminated glassware,
packages or absorbent paper; urine and
excreta from patients treated or tested with
unsealed radionuclides; sealed sources)
Non hazard Waste containing radioactive substances (e.g.
unused liquids from radiotherapy or
laboratory research; contaminated glassware,
packages or absorbent paper; urine and
excreta from patients treated or tested with
unsealed radionuclides; sealed sources)
 Major sources (hospitals and medical
centres)
Tipe Chemical,
Infectious and pharmaceutica Non-hazardous
Sumber Sharps pathological l and or general
waste cytotoxic waste
waste
Hypodermic Dressings, Packaging, food
bandages, gauze scraps, paper,
needles, and cotton
Broken
flowers,
thermometers and
Medical intravenous
set
contaminated with
blood or body
blood
empty saline
bottles, non-bloody
ward needles, fluids;
gloves and masks
pressure gauges,
spilt medicines,
diapers,
non-bloody
broken vials contaminated with
spent disinfectants
intravenous tubing
and ampoules blood or body fluids and bags

Blood and other

body fluids; suction
canisters; gowns,
Needles, gloves, masks,
Packaging;
gauze and
Operating intravenous
sets, scalpels,
other waste
Spent disinfectants
Waste anaesthetic
uncontaminated
gowns, gloves,
theatre blades,
contaminated with
blood and
gases masks, hats and
shoe covers
saws body fluids; tissues,
organs, fetuses,
body
parts
 Major sources (hospitals and medical
centres)
Chemical,
Infectious and pharmaceutic Non-
Tipe Sharps pathological al and hazardous or
Sumber waste cytotoxic general waste
waste
Blood and body
fluids,
microbiological Fixatives; formalin;
Needles, broken
cultures and xylene, toluene,
glass,
Laborator Petri dishes, slides
stocks, tissue,
infected
methanol,
methylene chloride
Packaging, paper,

y and
cover slips, broken
animal carcasses,
tubes and
and other solvents;
broken lab
plastic containers

pipettes
containers thermometers
contaminated with
blood or body fluids

Packaging,
Expired
Pharmac drugs, spilt
paper,
y store empty
drugs
containers
Silver, fxing
and
developing
Packaging,
Radiology solutions;
paper
 Major sources (hospitals and medical
centres)
Chemical,
Infectious and pharmaceutic Non-
Tipe Sharps pathological al and hazardous or
Sumber waste cytotoxic general waste
waste
Bulk
chemotherapeutic
waste;
vials, gloves and
Needles
Chemother other material Packaging,
and contaminated with
apy cytotoxic paper
syringes agents;
contaminated
excreta and
urine

Needles
Vaccination Bulk vaccine Packagin
and waste, vials,
campaigns
syringes gloves g
Packaging, flowers,
Disinfectants newspapers,
Environme
Broken (glutaraldehyde, magazines,
ntal phenols, etc.), cardboard, plastic
glass cleaners, spilt and glass
services mercury, pesticides containers, yard
and plant waste
 Major sources (hospitals and medical
centres)
Tipe Infectious and Chemical,
pathological pharmaceutical Non-hazardous
Sharps
waste and or general waste
Sumber cytotoxic waste

Cleaning
solvents,
oils, Packaging,
lubricants, construction
Engineerin thinners, or
g asbestos, demolition
broken waste,
mercury wood, metal
devices,
batteries
Food scraps;
plastic,
Food metal and
services glass
containers;
packaging
 Major sources (hospitals and medical
centres)
Sumber/Tipe Chemical,
Infectious and pharmaceutic Non-
Sharps pathological al and hazardous or
waste cytotoxic general waste
waste

Needles and Broken

Cotton, gauze,
dressings, gloves, thermometers Packaging, ofce
syringes, masks and blood paper,
Physicians’ broken and other pressure newspapers,
magazines,
ofces ampoules materials
contaminated with
gauges, expired uncontaminated
drugs,
and blood or other
spent
gloves and
masks
vials body fluids
disinfectants
Cotton, gauze, Packaging, ofce
Needles and gloves, masks and Dental paper,
Dental syringes, other
materials
amalgam, newspapers,
magazines,
ofces broken contaminated with spent uncontaminated
ampoules blood and disinfectants gloves and
other body fluids masks

Lancets and Bandages and

Home other material
insulin contaminated with Broken
health injection blood or other thermometers
Domestic waste

care needles
body
fluids
Table 1; Daily data-collection form
Date ________________________________
Name of data collector ________________________________
Name of health facility ________________________________
Number of occupied beds ________________________________
Number of outpatients ________________________________

Departmen Type of Volume

Weight (kg) Notesb
t waste (litre)
I
Dampak limbah infeksius
dan benda tajam
 Pada tahun 2000, injuri limbah benda
tajam pada petugas kesehatan mencapai ;
 66 000 hepatitis B (HBV),
 16 000 hepatitis C (HCV),
 200 – 5000 HIV (Prüss-Ustun et al.,2005).
Prinsip pedoman
manajemen limbah

Ada lima prinsip pedoman manajemen

limbah
1.The “polluter pays” principle
2.The “precautionary” principle
3.The “duty of care” principle
4.The “proximity” principle
5.The “prior informed consent principle”
 Table 2. Sample sheet for assessing waste
generation
Name of the health-care facility: ..................
Week: ..............
Waste
collection
Waste
point:
category
departmen (specify) Quantity of waste generated per day (weight and volume)
t/
location

Monday Tuesday Wednesda

Thursday Friday Sunday
y

kg litre kg litre kg litre kg litre kg litre kg litre

a Infectious waste, pathological waste, sharps, pharmaceutical waste, cytotoxic waste, waste with high heavy metal content, radioactive waste
Source: adapted from Christen (1996)
Segregation system/system
pemisahan
 Pemisahan limbah pelayanan kesehatan yang benar
adalah tanggungjawab setiap individu yang
menghasilkan limbah, apapun posisinya di organisasi
 Tanggungjawab manejemen fasilitas pelayanan
kesehatan, meyakinkan bahwa pemisahan sudah
benar,transport dan storage system benar dan semua
staf patuh terhadap prosedur yang benar,
 Pemisahan limbah umum/non hazardous waste,
potensial infectious waste dan sharp/benda tajam
kedalam kontainer yang berbeda (‘ three-bin-system”)
Segregation system/system
pemisahan
 Three-bin-system
 non-hazardous waste,
 potentially infectious waste
 sharps
 Lainnya adalah seperti
 chemical and pharmaceutical wastes,
 pathological waste,
Penyimpanan limbah di
area medikal

 Limbah hazard yang berasal dari area medikal

sebaiknya disimpan di ruang utility (jika
memungkinkan) yang diperuntukan untuk
peralatan kebersihan , linen kotor dan limbah
 Jika ruang utility tidak ada, limbah dapat
ditempatkan di area medikal tetapi jauh dari
pasien dan akses umum.
 Kontainer penyimpanan untuk limbah infeksius
sebaiknya diberi label dan tertutup
Transportasi limbah

 Transportasi limbah sebaiknya pada waktu kegiatann

kurang sibuk jika memungkinkan
 Tata rute untuk mencegah terpapar kepada staf dan
pasien dan meminimalkan melalui area perawatan pasien
dan area bersih
 Transportasi limbah jika memungkinkan dipisahkan dari
area umum
 Staf yang mengangkut limbah harus menggunakan alat
pelindung diri sarung tangan sepatu yang kuat dan
tertutup dan masker
 Pengangkutan limbah hazard dan non hazard sebaiknya
terpisah
System transportasi
 Trolley transportasi limbah non hazard di cat warna merah
diberi label “General waste” or “Non-hazardous waste”.
 Limbah infeksius dapat diangkut bersama-sama dengan
limbah benda tajam di cat warna kuning diberi label “Infectius
waste”
 Limbah hazard lain (chemical and pharmaceutical ) sebaiknya
pengangkutan terpisah dari limbah infeksius diangkut
menggunakan boks ke lokasi pusat penyimpanan
 Penggunaan peluncuran limbah di pelayanan kesehatan tidak
direkomendasikan krn dapat meningkatkan risiko transmisi
airborne.
Rekomendasi fasilitas
penyimpanan limbah
pelayanan kesehatan
 Tertutup rapat
 Drainase baik
 Lantai mudah dibersihkan dan di diisnfeksi
 Terpisah penyimpanan limbah umum/non hazard
dari infeksius dan limbah hazard lain
 Ada sumber air untuk pembersihan
 Mudah dicapai staf yang menangani limbah
 Dapat dikunci mencegah akses individu yang liar
Rekomendasi fasilitas
penyimpanan limbah
pelayanan kesehatan
 Mudah dicapai untuk mobil pengangkut limbah
 Tidak dapat dicapai binatang,insert burung
 Penerangan baik dan ventilasi passive
 Tidak dekat ke bagian penyimpanan makanan
,persiapan makanan
 Ada peralatan pembersihan, Alat Pelindung Diri
 Ada wastafel dengan air mengalirdan
ketersediaan sabun
 Pembersihan secara teratur setiap minggu
 Ada spil kit
Fasiltas penyimpanan limbah di
labeling
 Umumnya ada 4 jenis area penyimpanan limbah
 non-hazardous or general waste
 hazardous waste
 infectious and sharps waste
 chemical and hazardous pharmaceutical waste
 radioactive waste.
Limbah farmasi non
hazardous
 Limbah farmasi non hazard dapat disimpan di
area limbah non hazard
 ampoules with non-hazardous content (e.g. vitamins);
 fluids with non-hazardous contents, such as vitamins,
salts (sodium chloride), amino salts;
 solids or semi-solids, such as tablets, capsules,
granules, powders for injection, mixtures, creams,
lotions, gels and suppositories;
 aerosol cans, including propellant-driven sprays and
inhalers.
Limbah farmasi Hazardous
 Limbah hazardous disimpan sesuai dengan
karakteristik nya seperti obat genotoxic atau
controlled drugs or antibiotics)
 controlled drugs (should be stored under
government supervision);
 disinfectants and antiseptics;
 anti-infective drugs (e.g. antibiotics);
 genotoxic drugs (genotoxic waste);
 ampoules with, for example, antibiotics.
Pembersihan kontainer
pengangkut sampah
 Kontainer dan pengangkut limbah
dibersihkan setiap hari setelah dipakai
 Pembersihan manual dengan sabun dan
detergen
 SPO pembersihan harus disosialisasikan
kepada staf
Tehnologi treatmen limbah

 Thermal processes
 Chemical processes
 Irradiation technologies
 Biological processes
 Mechanical processes
Treatment infectious
waste
 Steam treatment technologies
 Autoclaves
 Integrated steam-based treatment systems
 Microwave treatment technologies
 Dry-heat treatment technologies
 Chemical treatment technologies
 Internal shredding of waste
 Chemical disinfectants
 Microbial resistance
 Alkaline hydrolysis
 Alkaline hydrolysis
 Incineration
KESIMPULAN
 Penatalaksanaan limbah RS merupakan hal yang
sangat perlu diperhatihan untuk mencegah
paparan kepada individu di RS atau fasilitas
pelayanan kesehatan lainnya
 Limbah RS dan Fasyankes meliputi limbah non
hazard, limbah infeksius /hazard, benta tajam dan
limbah lainnya ,chemikal, Farmasi dan radiologi
 Treatmen Limbah sesuai dengan karakteristik
limbah
costypandjaitan@gmail.com