Keselamatan dan kesehatan kerja merupakan bagian terpenting dalam hal memberikan perlindungan terhadap pekerja. Dengan perkembangan teknologi yang semakin pesat menimbulkan potensi yang dapat mengancam keselamatan dan kesehatan kerja. Salah satu contoh yaitu industri Rumah Sakit. Saat ini Rumah Sakit sudah didukung dengan alat-alat yang canggih dan modern untuk menunjang pelayanan kesehatan yang diberikan kepada pasien. Rumah Sakit merupakan industri pelayanan kesehatan atau tempat kerja yang memiliki risiko tinggi terhadap keselamatan dan kesehatan sumber daya manusia rumah sakit seperti pasien, pengunjung, maupun lingkungan rumah sakit. Dalam hal ini sumber daya manusia rumah sakit salah satunya yaitu Perawat. Tesis ini akan mengkaji pengaturan perlindungan hukum terhadap perawat yang terkena penyakit akibat kerja berdasarkan peraturan perundang-undangan yang berlaku di Indonesia, penerapan sistem manajemen keselamatan dan kesehatan kerja, serta bagaimana pelaksanaan keselamatan dan kesehatan kerja di Rumah Sakit X. Metode penelitian yang digunakan yaitu yuridis normatif, menggunakan data sekunder melalui studi dokumen dan dianalisis secara kualitatif. Dari hasil penelitian, Pemerintah telah memberikan perlindungan hukum terhadap perawat yang terkena penyakit akibat kerja. Kemudian sistem manajemen keselamatan dan kesehatan kerja harus diterapkan di Rumah Sakit agar tercipta lingkungan rumah sakit yang sehat, aman, selamat dan nyaman, dengan begitu dapat menurunkan angka kecelakaan kerja dan menurunkan prevalensi penyakit akibat kerja. Rumah Sakit X harus membuat prosedur atau pedoman terkait penanganan perawat yang terkena penyakit akibat kerja. Pengkajian lebih lanjut terhadap data karyawan yang berobat dan data penyakit karyawan di unit kerja yang berisiko mengalami penyakit akibat kerja belum dilakukan oleh Komite K3RS. Diperlukan peran pemerintah dalam melakukan pembinaan dan pengawasan secara berkala agar pelaksanaan keselamatan dan kesehatan kerja khususnya dirumah sakit dapat terpantau dengan baik.
Occupational safety and health are the most important part of providing protection to workers. With the rapid development of technology raises the potential to threaten occupational safety and health. One example is the Hospital industry. At present the Hospital has been supported by sophisticated and modern tools to support the health services provided to patients. Hospital is a health service industry or workplace that has a high risk to the safety and health of hospital human resources such as patients, visitors, and the hospital environment. In this case the hospital human resources, one of them is Nurse. This thesis will examine the legal protection arrangements for nurses affected by occupational diseases based on applicable laws and regulations in Indonesia, the application of occupational safety and health management systems, as well as how the implementation of occupational safety and health in Hospital X. The research method used is juridical normative, using secondary data through document studies and analyzed qualitatively. From the results of the study, the Government has provided legal protection for nurses affected by occupational diseases. Then the occupational safety and health management system must be implemented in hospitals to create a healthy, safe and comfortable hospital environment, thereby reducing work accident rates and reducing the prevalence of occupational diseases. Hospital X must make procedures or guidelines related to the handling of nurses affected by occupational diseases. Further assessments of employee medical data and data on employee illness in work units at risk of occupational diseases have not been conducted by the K3RS Committee. The role of government is needed in conducting guidance and supervision on a regular basis so that the implementation of occupational safety and health, especially in hospitals can be monitored properly.
"ABSTRAK
Nama : Yenny Rachmawati
Program studi : Dermatologi dan Venereologi
Judul : Perbandingan Efektivitas serta Keamanan antara Krim Pelembap Niasinamid 4% dan Virgin Coconut Oil 30% untuk Pencegahan Sekunder Dermatitis Tangan Akibat Kerja pada Perawat Intensive Care Unit : Uji Klinis Acak Tersamar Ganda
Latar belakang: Dermatitis tangan akibat kerja (DTAK) sering terjadi pada perawat Intensive Care Unit (ICU) terutama pada individu yang rentan akibat pajanan iritan berupa hand rub alcohol dan aktivitas cuci tangan berulang. Penggunaan pelembap adalah salah satu rekomendasi untuk perawatan kulit pada DTAK. Niasinamid memiliki efek antiinflamasi dan dapat memperbaiki fungsi sawar kulit. Vigin coconut oil (VCO) kaya akan kandungan lipid dan asam laurat, serta memiliki efek oklusif. Sampai saat ini belum ada panduan dan referensi jenis pelembap untuk pencegahan sekunder pada DTAK.
Tujuan: Mengetahui perbandingan efektivitas serta keamanan antara krim pelembap niasinamid 4% dan VCO 30% untuk pencegahan sekunder dermatitis tangan akibat kerja pada perawat ICU.
Metode: Penelitian ini merupakan uji klinis acak tersamar ganda terhadap perawat ICU dengan DTAK pada bulan September hingga Oktober 2019. Pasien yang memenuhi kriteria penerimaan dan bersedia mengikuti penelitian, mendapat niasinamid 4% atau VCO 30% sesuai dengan randomisasi blok. Pengolesan pelembap dilakukan dua kali sehari selama 28 hari. Perbaikan klinis dinilai dengan parameter skor Hand Eczema Scoring Index (HECSI) dan penilaian sawar kulit dinilai dengan transepidermal water loss (TEWL) serta hidrasi kulit dengan skin capasitance (SCap) pada hari ke-14 dan hari ke-28. Keamanan dinilai berdasarkan efek samping selama penelitian.
Hasil: Didapatkan 46 SP pada masing-masing kelompok niasinamid 4% dan VCO 30%. Terdapat penurunan skor HECSI pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28. Median skor HECSI di kelompok niasinamid 4% dan VCO 30% pada hari ke-14 yaitu 6,5 dan 6 (p 0,160), serta pada hari ke-28 yaitu 4 dan 3 (p 0,046). Pada hari ke-28, perbedaan skor HECSI kedua kelompok secara statistik bermakna, namun secara klinis tidak bermakna. Terdapat penurunan nilai TEWL pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28 dibandingkan baseline, namun pada area palmar di kelompok niasinamid 4% terdapat sedikit peningkatan nilai TEWL pada hari ke-28. Terdapat peningkatan nilai SCap pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28 dibandingkan baseline. Kedua pelembap dapat ditoleransi dengan baik dengan efek samping minimal.
Kesimpulan: Niasinamid dan VCO efektif memperbaiki klinis DTAK pada perawat ICU, walaupun tidak terdapat perbedaan bermakna antara krim pelembap niasinamid 4% dengan VCO 30% untuk pencegahan sekunder dermatitis tangan akibat kerja pada perawat ICU
Kata kunci: dermatitis tangan akibat kerja, efektivitas, keamanan, pelembap, niasinamid 4%, VCO 30%
ABSTRACT
Name : Yenny Rachmawati
Study Program : Dermatologi dan Venereologi
Title : Comparison of the Effectiveness and Safety between Moisturizing Cream Containing Niacinamide 4% and Virgin Coconut Oil 30% for Secondary Prevention of Occupational Hand Dermatitis in Intensive Care Unit Nurses: a Double Blind Randomized Clinical Trial
Background: Occupational hand dermatitis (OHD) often occurs in intensive care unit (ICU) nurses, especially in individuals who are vulnerable due to irritant exposure e.g. hand rub alcohol and repeated hand washing activities. The use of moisturizer is one of the recommendations for skin care in OHD. Niacinamide which has anti-inflammatory effects and can improve the skin sawar function. Virgin coconut oil (VCO) is rich in lipids and lauric acid, and has an occlusive effect. Until now there are no guidelines and reference types of moisturizers for secondary prevention in OHD.
Objective: To assess the difference of effectiveness and safety between moisturizing cream containing niacinamide 4% and VCO 30% for secondary prevention of occupational hand dermatitis in ICU nurses
Methods: A double blind randomized controled trial was performed in ICU nurses with OHD during September–October 2019. Patients who fulfilled inclusion criteria and willing to be involved in the study were allocated to niacinamide 4% or VCO 30% based on block randomization. Moisturizer were applied twice daily for 28 days. Measurement of Hand Eczema Scoring Index (HECSI) scores were conducted to evaluate the clinical improvement . Measurement of transepidermal water loss (TEWL) were conducted to evaluate the barrier skin and skin capacitance (SCap) values were conducted to evaluate skin hydration on 14th and 28th day. Safety were assessed based on side effects during research.
Results: There were 46 subjects in each arms of intention, the niacinamide 4% arm and in the VCO 30% arm. There were a decrease in HECSI scores in both treatment groups on 14th and 28th day. The median score of HECSI in niacinamide 4% and VCO 30% on 14th day were 6.5 and 6 (p 0.160), and on 28th day were 4 and 3 (p 0.046). On 28th day, the difference in HECSI scores of the two groups were statistically significant, but clinically not significant. There were a decrease in TEWL values in both treatment groups on 14th and 28th day compared to baseline, but there were a slight increase in TEWL values in the palmar area in the niacinamide group on 28th day. There were an increase in SCap values in both treatment groups on 14th and 28th day compared to baseline. Both moisturizers were well tolerated with minimal side effects.
Conclusion: Niacinamide 4% and VCO 30% were effective in improving clinical OHD in ICU nurses, although there were no significant difference between moisturizing cream containing niacinamide 4% and virgin coconut oil 30% for secondary prevention of occupational hand dermatitis in ICU nurses.
Keywords: occupational hand dermatitis, effectiveness, safety, moisturizer, niacinamide 4%, VCO 30%
"Tujuan penelitian ini yaitu mengetahui bagaimana proses penerapan SMK3 di PT. X saat ini, mengevaluasi penerapan SMK3 di PT. X berdasarkan PP 50 2012 dan PERMENPU 21 2019, dan juga memberikan saran beserta rekomendasi perbaikan jika tejadi ketidaksesuaian dengan peraturan yang sudah dijelaskan. Penelitian ini adalah penilitian ini dilakukan secara kualitatif yang mana pada umumnya penelitian kualitatif didesain secara deskriptif.
Hasil penelitian ini yaitu kinerja K3 yang ada di PT. X berupa gambaran pelaksanaan SMK3 di PT. pada saat ini serta pemenuhan penerapan SMK3 di PT. X berdasarkan PP 50 2012 dan PERMENPU 21 2019.
The purpose of this study is to find out how the current process of applying SMK3 in PT. X, evaluating the application of SMK3 in PT. X based on PP 50 2012 and PERMENPU 21 2019, and also to provide suggestions and recommendations for improvement if there are non-conformities with the regulations that have been described. This research was conducted in a qualitative manner which in general qualitative research was designed descriptively. The results of this study are the K3 performance in PT. X in the form of an overview of the implementation of SMK3 in PT at this time and the fulfillment of the application of SMK3 in PT. X based on PP 50 2012 and PERMENPU 21 2019."