Surveilans PPI

di FKTP
 LATAR BELAKANG
SURVEI PPI-HAIs Surveilans Pasif
Orang ruangan
Tidak kompeten
Sambilan

Fenomena gunung es

Tidak ada
IPCN Purnawaktu

NO CARE
Pengertian surveilans
• Surveilans kesehatan adalah kegiatan pengamatan yang sistematis
dan terus menerus terhadap data dan informasi tentang kejadian
penyakit atau masalah kesehatan dan kondisi yang mempengaruhi
terjadinya peningkatan dan penularan penyakit atau masalah
kesehatan untuk memperoleh dan memberikan informasi guna
mengarahkan tindakan pengendalian dan penanggulangan secara
efektif dan efisien
Surveilans ITPK
• Surveilans infeksi terkait pelayanan kesehatan (Health Care
Associated Infections/HAIs) adalah suatu proses yang dinamis,
sistematis, terus menerus dalam pengumpulan, identifikasi, analisis
dan interpretasi data kesehatan (ITPK) yang penting di fasilitas
pelayanan kesehatan pada suatu populasi spesifik dan
didiseminasikan secara berkala kepada pihak-pihak yang memerlukan
untuk digunakan dalam perencanaan, penerapan, serta evaluasi suatu
tindakan yang berhubungan dengan kesehatan.
Tujuan surveilans PPI
• 1. Tersedianya informasi tentang situasi dan kecenderungan kejadian
HAIs di fasilitas pelayanan kesehatan dan faktor risiko yang
mempengaruhinya.
• 2. Terselenggaranya kewaspadaan dini terhadap kemungkinan
terjadinya fenomena abnormal (penyimpangan) pada hasil
pengamatan dan dampak HAIs di fasilitas pelayanan kesehatan.
• 3. Terselenggaranya investigasi dan pengendalian kejadian
penyimpangan pada hasil pengamatan dan dampak HAIs di fasilitas
pelayanan kesehatan.
Metoda surveilans
• Surveilans Komprehensif: Hospital wide, Traditional Surveillance
• Periodic Surveillance – sebulan sekali, dsb
• Prevalence Surveillance – juml infeksi aktif dlm suatu periode
• Target Surveillance - fokus pd pasien dg inf spesifik di ruang rawat
Metoda surveilans (Australian guideline)
• It is not feasible to conduct facility-wide surveillance for all events;
therefore surveillance is often targeted, with a focus on specific
events, processes, organisms, medical devices or high-risk patient
populations. Healthcare-associated infections surveillance programs
may focus on:
• specific sites of infection (e.g. bloodstream, surgical sites)
• specific populations (e.g. neonates, healthcare worker occupational exposure
to blood and body substances)
• specific organisms or types of organisms (e.g. MRO, C.difficile, RSV, rotavirus)
• specific locations in the healthcare facility or community (e.g. intensive care
unit, neonatalintensive care unit, long-term care facility).
Metoda surveilans (Australian Guideline)
•Process Surveillance
•Outcome Surveillance
Metoda surveilans (Australian guideline)
• Process surveillance:
• Process measurements are usually easier to measure, less ambiguous and
more widely applicable than outcome indicators.
• Process surveillance may be an adjunct to outcome surveillance; alternatively,
it can entirely replace outcome surveillance for practices or
locations that have too few adverse outcomes for statistical
analysis
• Process surveillance involves auditing practice against a certain standard,
guideline or policy. As no single intervention will prevent any healthcare-
associated infection, packages of evidencebased interventions have been
developed and are increasingly being used in process surveillance (e.g. care
bundles)
• Process measures that are linked by evidence to important outcomes
(McKibben et al 2005):
• do not require risk adjustment
• can predict outcomes
• can easily be acted on because potential improvements are usually the
responsibility of the clinical service
• can be captured quickly
• are sensitive because many episodes of inappropriate care do not cause
harm.
• Examples of process surveillance (published process
indicators of high value) include:
• aseptic insertion and management of peripheral or central
intravascular devices (audit)
• healthcare workers’ compliance with hand hygiene and the
techniques they used (audit)
• perioperative and intraoperative practice such as antibiotic
prophylaxis, normothermia, normoglycaemia and appropriate hair
removal (audit)
• healthcare workers’ uptake of immunisation (audit)
Metoda surveilans (Australian guideline)
• Outcome surveillance:
• Outcome surveillance involves measuring adverse events, a
proportion of which are preventable.
• The sensitivity and specificity of event definitions and the reliability of data
collection need to be considered when developing methods to detect adverse
events.
• It is important to create a balance between avoiding false positives
(specificity) and picking up true positives (sensitivity), given thattrue positives
are rare events in the overall patient population.
• Examples: surveillance of the Surgical Site Infection (SSI), Central Line
Associated Blood Stream Infections (CLABSI), Catheter Associated
Urinary Tract Infection (CAUTI), Ventilator Associated Pneumonia
(VAP)
TAHAPAN SURVEILANS HAIs

Perencanaan

Buat definisi Pengumpulan

ISK,IADP,VAP,IDO
Evaluasi Data

Buat Setiap hari dg

perbaikan waktu sama

Komunikasikan Analisa Data

Yang Hitung Insiden

berkepentingan Interpretasi rate &
Stratifikasi
Trend naik
atau turun
Contoh surveilans proses:
• audit hand hygiene:
• Audit terhadap pelaksanaan hand hygiene di ruang rawat
• Mengamati apakah hand hygiene dilakukan dengan benar
• Apakah dilakukan hand hygiene 5 moment
• Dapat menggunakan instrument dari WHO
• Audit pelaksanaan bundles pada pemasangan kateter urine untuk
mencegah ISK
• Audit pelaksanaan bundles pada pemasangan kateter intravena
(perifer) untuk mencegah CLABSI
ANALISA DATA

Cara perhitungan :
 Insiden Rate IDO = Jumlah kasus IDO
------------------------- X 100
Jumlah kasus operasi

 Insiden Rate IADP = Jumlah kasus IADP

--------------------------- X 1000
Jumlah hari pemakaian CVL

 Insiden Rate ISK = Jumlah kasus ISK

-------------------------- X 1000
Jumlah hari pemakaian UC

 Insiden Rate VAP = Jumlah kasus VAP

---------------------------- X 1000
Jumlah hari pemakaian ventilator
Contoh Kasus

Pada bulan Maret 2017 di ruang rawat puskesmas.

-Pasien A mendapat infus iv 5 hari Cateter urine menetap 4 hari
-Pasien B Cateter urine menetap 5 hari
-Pasien C mendapat infus iv 6 hari Cateter urine menetap 5 hari
-Pasien D mendapat infus iv 4 hari Cateter urine menetap 3 hari
-Pasien E mendapat infus iv 5 hari
-Pasien F mendapat infus iv 3 hari Cateter urine menetap 3 hari
-Pasien G Cateter urine menetap 4 hari
-Pasien A mengalami ISK, Pasien C mengalami IADP , Pasien D
mengalami ISK

-Denominator IADP = 5 + 6 + 4 + 5 + 3 = 23
-Denominator ISK = 4 + 5 + 5 + 3 + 3 + 4 = 24

- Rate IADP = 1 / 23 x 1000 = 43,5/ 1000 hari pemasangan infus

-- Rate ISK = 2/24 x 1000 = 86,95/ 1000 hari pemasangan Kateter Urine
Terimakasih