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

Limbah ,scapel,lancet

General (non hazard) 85 %

Tidak
Pembungkus jarum,
kontaminasi
cairan,pempers,topi,mas
3R darah
&cairan
ker,sarung tangan,
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

Dibuang dalam tempat

Chemical radioactive 5 %
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 Waste suspected to contain pathogens and that poses
infeksius 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 needed; items
contaminated by or
& Sitotoxik 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. laboratory
reagents; flm developer;
khemikal 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. unused
radioaktif 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
pharmaceutical Non-hazardous
Sumber Sharps pathological
and or general waste
waste
cytotoxic waste

Hypodermic Dressings, bandages, Packaging, food

needles, gauze and cotton Broken thermometers scraps, paper, flowers,
Medical intravenous set contaminated with
blood or body fluids;
and blood
pressure gauges, spilt
empty saline bottles,
non-bloody diapers,
ward needles, broken gloves and masks medicines, non-bloody
vials contaminated with spent disinfectants intravenous tubing
blood or body fluids and bags
and ampoules

Blood and other body

fluids; suction
canisters; gowns,
Needles,
gloves, masks, gauze Packaging;
Operating intravenous and Spent disinfectants uncontaminated
sets, scalpels, other waste Waste anaesthetic 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
pharmaceutical Non-hazardous
Sharps pathological
Tipe and or general waste
waste
Sumber cytotoxic waste

Blood and body fluids,

Fixatives; formalin;
Needles, broken microbiological
xylene, toluene,
glass, cultures and stocks,
methanol, methylene
Petri dishes, slides tissue, infected Packaging, paper,
Laboratory and animal carcasses,
chloride
and other solvents;
plastic containers
cover slips, broken tubes and containers
broken lab
pipettes contaminated with
thermometers
blood or body fluids

Packaging,
Pharmacy Expired drugs,
paper, empty
store spilt drugs
containers
Silver, fxing and
developing
Packaging,
Radiology solutions; acetic
paper
acid;
glutaraldehyde
 Major sources (hospitals and medical centres)

Chemical,
Infectious and
pharmaceutical Non-hazardous
Tipe Sharps pathological
and or general waste
Sumber waste
cytotoxic waste

Bulk
chemotherapeutic
waste;
vials, gloves and
Chemothera Needles and other material Packaging,
contaminated with
py syringes cytotoxic
paper
agents; contaminated
excreta and
urine

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

Cleaning
solvents, oils,
lubricants, Packaging,
thinners, construction or
Engineering asbestos, demolition
broken waste,
mercury wood, metal
devices,
batteries
Food scraps;
plastic, metal
Food
and glass
services containers;
packaging
 Major sources (hospitals and medical centres)
Sumber/Tipe Chemical,
Infectious and Non-hazardous
pharmaceutical
Sharps pathological or general
and
waste waste
cytotoxic waste
Needles and Cotton, gauze, Broken Packaging, ofce
dressings, gloves, thermometers and
syringes, paper, newspapers,
Physicians’ masks
blood magazines,
broken and other materials
pressure gauges, uncontaminated
ofces ampoules and
contaminated with
gloves and
blood or other body expired drugs,
masks
vials fluids spent disinfectants

Cotton, gauze,
Needles and Packaging, ofce
gloves, masks and
Dental paper, newspapers,
syringes, other
magazines,
Dental ofces materials amalgam, spent uncontaminated
broken contaminated with
disinfectants gloves and
ampoules blood and
masks
other body fluids

Lancets and Bandages and other

Home health insulin material
contaminated with
Broken
Domestic waste
care injection blood or other body thermometers
needles fluids
Table 1; Daily data-collection form
Date ________________________________
Name of data collector ________________________________
Name of health facility ________________________________
Number of occupied beds ________________________________
Number of outpatients ________________________________

Type of Volume
Department Weight (kg) Notesb
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 Quantity of waste generated per day (weight and volume)
department/ (specify)
location

Monday Tuesday
Wednesday Thursday
Friday Sunday

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

 chemicaland 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