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"Latar Belakang: Catheter-related bloodstream infections (CRBSI) merupakan salah satu bentuk infeksi nasokomial (Healthcare Associated Infection / HCAI) yang sering terjadi dan memiliki gejala berat.Penanganan utama pada kasus CRBSI terdiri dari pemberian antibiotik yang tepat dan manajemen pelepasan atau pencegahan pelepasan kateter intravaskular. Beberapa faktor seperti kadar albumin dan komorbiditas diabetes melitus diketahui memengaruhi jumlah kejadian sekaligus berperan dalam pencegahan CRBSI. Namun, belum ada penelitian yang menghubungkan faktor tersebut dengan keberhasilan terapi empirisCRBSI.Tujuan: Menganalisis faktor-faktor yang berhubungan dengan keberhasilan terapi antibiotik empiris pada pasien CRBSI.Metode: Penelitian ini merupakan penelitian analitik observasional tidak berpasangan dengan metode kohort retrospektif yang dilakukan pada Maret 2022 hingga Juni 2022 di Rumah Sakit Umum Pusat Nasional Dr.Cipto Mangunkusumo Jakarta.Hasil: Terdapat total 64 subjekn pada penelitian ini, subjek dengan nilai albumin diatas 3,12 g/dL memiliki proporsi tingkat keberhasilan terapi antibiotik empiris yang lebih tinggi dibandingkan pada subjek dengan nilai albumin dibawah 3,12 g/dL. Pasien dengan komorbiditas diabetes melitus dan tanpa komorbiditasdiabetes melitus secara proporsi memiliki tingkat keberhasilan terapi antibiotik yang tidak signifikan.Simpulan: Kadar albumin diatas 3,12 g/dL memiliki tingkat keberhasilan terapi antibiotik empiris yang signifikan terhadap kasus penyakit ginjal tahap akhir dengan CRBSI.

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Background: Catheter-related blood infection (CRBSI) is a form of nosocomial infection (HealthcareAssociated Infection / HCAI) that often occurs and has severe symptoms. The mainstay of treatment in cases of CRBSI consists of appropriate antibiotic administration and management of removal or prevention ofintravascular catheter dislodgement. Several factors such as albumin levels and diabetes mellitus are known toinfluence the number of events as well as play a role in the prevention of CRBSI. However, there are no studies linking these factors to the success of empiric CRBSI therapy.

Objective: To analyze the factors associated with the success of empiric antibiotic therapy in CRBSI patients.

Methods: The study is an unpaired observational analytic with a retrospective cohort method, conducted at Cipto Mangunkusumo General Hospital from March 2022 to June 2022.

Results: There were a total of 64 subjects, in which subjects with albumin values of 3.12 g/dL had a higherproportion of antibiotic therapy success rates than subjects with albumin values below 3.12 g/dL. Patients with diabetes mellitus and without diabetes mellitus have a similar proportion of success rates of antibiotic therapy. Patients with quinolone group antibiotics have a higher therapeutic success rate than other antibiotic groups. The multivariate test showed that albumin and diabetes mellitus levels had no significant effect on the success of treatment.

Conclusion: There was a significant relationship between albumin levels and comorbid diabetes mellitus with the success of empiric antibiotic therapy in End Stage Renal Disease patients with CRBSI."

"Tujuan. Penelitian ini bertujuan untuk membuktikan hipotesis adanya hubungan faktor internal dan eksteruid responden dengan persepsi perawat pelaksana tentang upaya pencegahan infeksi nosokomial di ruang rawat inap Rumah Sakit Pusat Pertamina Jakarta.Metode yang digunakan adalah deskriptif analis yang bersifat cross sectional. Uji kai-kuadrat digunakan untuk menganalisis hubungan antara faktor internal dan eksternal responden dengan persepsi perawat pelaksama tentang upaya pencegahan infeksi nosokomial. Uji regresi logistik digunakan untuk melihat variabel independen mana yang paling berhubungan dengan upaya pencegahan infeksi nosokomial. Sampel penelitian berjumlah 204 orang dan 359 orang perawat pelaksana yang bertugas di 15 ruang rawat inap. Sampel diambil secara acak dan besarnya sampel tiap ruangan ditentukan secara proporsional.Instrumen. Instrumen dikembangkan dari teori manajemen keperawatan dan teori pencegahan infeksi nosokomial untuk mengukur pelaksanaan supervisi kepala ruangan, penggunaan sarana pencegahan infeksi nosokomial, dan pelaksanaan upaya pencegahan infeksi nosokomial oleh perawat pelaksana. Sedangkan untuk mengukur pengetahuan tentang SOP infeksi nosokomial digunakan pertanyaan dengan pilihan ganda. Instrumen telah diuji validitas dan reliabilitasnya.Hasil penelitian. Uji kai-kuadrat menghasilkan tiga variabel independen yang mempunyai hubungan bermnkna dengan upaya pencegahan infeksi nosokomial, yaitu supervise, sarana, dan SOP. Sedangkan variabel umur, pendidikan, masa kerja, dan pelatihan tidak mempunyai hubungan bermakna Uji regresi logistik yang dilakukan menentukan bahwa variabel saran merupakan variabel yang paling berhubungan dengan upaya pencegahan infeksi nosakamial.Pembahasan. Dengan ditemukannya sarana sebagai variabel yang paling berpengaruh, maka peluang bagi perawat pelaksana dalam melaksanakan pencegahan infeksi nosokomial adalah lima kali lebih baik dibanding yang tidak menggunakan.Rekomeadasi. Pihak manajemen pelayanan keperawatan rumah sakit agar meningkatkan kesadaran dan kepatuhan perawat dalam menggunakan saran yang ada, sehingga angka kejadian infeksi di rumah sakit dapat ditekan.

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The purpose of the research is to obtain information about the nurses' ward perceptions related to the prevention?s effort of nosocomial infection, in the Pertamina Hospital and how it relates to the nurse?s internal and external factors.

The hypothesis, which had been proved in this study, was the correlation between the internal and external factors of the nurses with the prevention's effort of nosocomial infection.

The methodology was descriptive correlation with cross sectional data collection. Chi Square was used to analysis the correlation between the independent with dependent variables and the logistic regression will select what was the strong independent variables relates to the nurse?s staff perceptions of the prevention?s effort of nosocomial infection. The population and sample were the nurses in 15 wards with 204 unit sample who were selected by random.

The instrument was developed into questioners based on management theories to measure the ward manager?s supervising activities, the utility of equipment and facilities, the nosocomial infection prevention activities of the nurses. The nosocomial infection theories to measure the standard operation procedure (SOP) knowledge of the nurses. It was developed into multiple-choice questioners. The instrument has been tested for the validity and reliability.

The Result of the research Chi square test result three variables which have had correlation with the efforts of the prevention of the nosocomial infection : supervision, equipment and facilities, and the standard operating procedure. The variables such as age, education experiences and training had no correlation with it. The logistic regression test determines the equipment and facility is the strong variable, which relate to the efforts of the prevention of the nosocomial infection.

Discussion. Based on result, equipment and facilities were the most significant variable it offers the opportunity of the nurses who work in the wards to prevent the nosocomial infection five times more than muses who did not use it.

Recommendation: The nursing care manager in hospital should promote the awareness and obeyness of nurses to use the available facilities to reduce the incident of nosocomial infection. So that the quality of nursing care can be increased."

"ABSTRAKInfeksi rumah sakit merupakan infeksi yang didapat di rumah sakit karena rumah sakit merupakan tempat berkumpulnya para penderita dengan berbagai macam masalah penyakit sehingga membuka peluang terjadinya penularan silang antar pasien. Di RS Awal Bros Bekasi, banyak ditemukan kasus infeksi rumah sakit sejak rumah sakit tersebut berdiri, salah satunya adalah phlebitis sebesar 58,3%. Tujuan penelitian adalah untuk mengetahui gambaran epidemiologi dan faktor-faktor yang mempengaruhi infeksi rumah sakit pasca tindakan invasif.Desain yang digunakan pada penelitian ini adalah case control dengan menggunakan data sekunder. Jumlah kasus yang diperoleh adalah 36 dengan perbandingan kontrol 1:2. Analisis dilakukan secara univariat dan bivariat.Dari penelitian ini didapat hasil, infeksi rumah sakit yang paling banyak ditemukan adalah phlebitis (58,3%) dan infeksi akibat tindakan invasif ganda (38,9%). Dari 9 variabel yang diteliti, terdapat 3 variabel yang secara statistik bermakna menyebabkan infeksi rumah sakit, yaitu umur ≥45 tahun (p value=0,032), tindakan invasif (OR=2,3), dan ruang perawatan (p value=0,008). Sedangkan faktor-faktor determinan lain (jenis kelamin, diagnosa masuk, diagnosa keluar, penyakit penyerta, lama rawat, dan lama sakit) tidak menunjukan hubungan yang signifikan.

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ABSTRACTHospital infection is an infecton that acquired in hospital, because it's the place where people gather with a wide range of disease problems so that opening up the possibility of cross infection between patients. In RS Awal Bros Bekasi, so many cases found, one of them is phlebitis (58,3%). The main purpose of this research is to get epidemiology description and to identify risk factors which affect oh hospital infection at RS Awal Bros Bekasi.The method of this research is case control study by using secondary data. The amount of obtained case at this research is 36 with control comparison 1:2. Data analysis obtained univariate analysis and bivariate analysis.According to the analysis, the result obtained infection that most commonly found is phlebitis (58,3%) and infection caused by the installation of multiple devices (38,9%). From 9 variabels studied, obtained 3 variabels that were statistically significant cause hospital infection, namely age (p value=0,032), invasive (OR=2,3; CI 1,027?5,285), and inpatient room (p value=0,008). Whereas the other determinant factors (gender, entry diagnostic, exit diagnostic, invasive, comorbidities, length of day care, and length of sick) showed no significant relationship to the hospital infection."

"Bedah ortopedi adalah suatu tindakan bedah untuk memulihkan kondisi disfungsi muskuloskeletal.Infeksi Luka Operasi (ILO) adalah infeksi pada luka operasi atau organ/ruang yang terjadi dalam 30 hari setelah operasi atau dalam kurun 1 tahun apabila terdapat implan. Salah satu cara pencegahan ILO adalah dengan menggunakan antibiotik profilaksis. Namun, penggunaan antibiotik yang tidak tepat dapat menimbulkan resistensi antibiotik yang sangat merugikan. Tujuan penelitian ini adalah untuk memperoleh data dan mengevaluasi kerasionalan penggunaan antibiotik profilaksis bedah ortopedi di RSAL Dr. Mintohardjo Jakarta Pusat periode tahun 2012. Penelitian dilakukan dengan desain potong lintang dan metode retrospektif dengan mengambil dan mengumpulkan data dari dokumen rekam medis pasien yang menjalani operasi ortopedi selama tahun 2012. Sebanyak 163 sampel yang diperoleh terdiri dari laki-laki 73% dan perempuan 27% dengan rentang usia dibawah 12 tahun 9,8%, 12-25 tahun 23,3%, 26-65 tahun 28,9% dan diatas 65 tahun 8,0%. Antibiotik profilaksis yang sering digunakan adalah seftriakson 87,8%, gentamisin 3,7%, sefotaksim 3,7%, sefoporakson 1,2%, siprofloksasin 1,2%, fosfomisin 0,6%, meropenem 0,6%, dan vankomisin 0,6%. Sebanyak 55,8% antibiotik yang diberikan sudah tepat waktu, sedangkan sebanyak 93,9% antibiotik tidak tepat obat. Terdapat 8 kasus ILO (4,9%) dari seluruh pasien bedah ortopedi yang mendapat antibiotik profilaksis. Jenis mikroorganisme yang paling sering ditemukan di RSAL Dr. Mintohardjo, Jakarta, adalah Eschericia coli (23,08%), Coliform (18,62%), Staphylococcus aureus sp. (18%). Pseudomonas Sp. (12,15%) dan Alkaligenes Sp (9,31%). Berdasarkan hasil penelitian ini dapat disimpulkan bahwa penggunaan antibiotik profilaksis bedah ortopedi di RSAL Dr. Mintohardjo tidak rasional. Hasil yang diperoleh dari uji kai kuadrat menunjukkan bahwa terdapat hubungan antara jenis antibiotik profilaksis yang digunakan dengan kondisi pasien pasca operasi.

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Orthopedic surgery is a surgery to recover muskuloskeletal dysfunction. The Surgical Site Infection (SSI) is an infection of the surgical wound or organ / space that occurs within 30 days after surgery or within 1 year if an implant there. One way to prevent SSI is by using prophylaxis antibiotics. However, improper use of antibiotics can lead to antibiotic resistance wich is very harmfull. The purpose of this study was to collect data and evaluate the rational use of prophylaxis antibiotic in orthopedic surgery at RSAL Dr. Mintohardjo Central Jakarta in 2012. The study was designed cross sectional and conducted retrospectively by taking and collecting data from the medical record document of patients who were undergoing orthopedic surgery during 2012. A total of 163 samples consisted of men 73% and women 27% with an age range under 12 years 9.8%, 12-25 years 23.3%, 26-65 years 58.9% and over 65 years 8.0%. Prophylaxis antibiotics which common used were ceftriaxone 87.8%, gentamycin 3.7%, cefotaxime 3.7%, cefoporaxone 1.2%, siprofloksasin 1.2%, fosfomycin 0.6%, meropenem 0.6%, and vancomycin 0.6%. A total of 55.8% of these prophylaxis antibiotics were given on time, and 93.9% of them were not appropriate drugs. There were 8 SSI cases or 4.9% of all orthopedic surgical patients who received prophylaxis antibiotics. The types of microorganisms which most frequently found at RSAL Dr. Mintohardjo Central Jakarta was Eschericia coli (23.08%), Coliform (18.62%), Staphylococcus aureus sp. (18%). Pseudomonas Sp. (12.15%) and Alkaligenes Sp (9.31%). From these results we could concluded that the use of prophylaxis antibiotics in orthopedic surgery RSAL Dr. Mintohardjo was irrational. Data were tested by chi square test and the results showed that there were a relationship between the types of antibiotic used with patient’s condition after surgery."

"Acinetobacter baumannii merupakan bakteri patogen gram negatif penyebab dominan infeksi nosokomial. World Health Organization (WHO) menerbitkan daftar prioritas pertama resistensi antibiotik terhadap Acinetobacter baumannii yang merupakan kategori kritis sebagai ancaman serius bagi kesehatan masyarakat global. Sefoperazon-sulbaktam merupakan salah satu antibiotik yang sensitif terhadap infeksi Acinetobacter baumannii. Berdasarkan penelitian di Rumah Sakit (RS) Dr. Soetomo Surabaya, telah terjadi resistensi terhadap antibiotik sefoperazon-sulbaktam sebanyak 27 %. Resistensi dapat terjadi karena konsentrasi di dalam darah tidak sesuai yang menyebabkan tidak efektifnya pengobatan. Metode bioanalisis dibutuhkan untuk penentuan konsentrasi obat di dalam darah. Penelitian ini dilakukan untuk memperoleh metode analisis sederhana, sensitif dan cepat yaitu analisis simultan sefoperazon sulbaktam dengan Kromatografi Cair Kinerja Tinggi (KCKT) detektor Photo Diodearray (PDA). Selain itu, untuk memperoleh metode preparasi biosampling untuk Dried Blood Spots (DBS) dan Volumetric Absorptive Microsampling (VAMS), serta melakukan perbandingan peak area ratio, selektivitas, recovery dan stabilitas dari DBS dan VAMS. Analisis kromatografi dilakukan dengan metode isokratik dengan fase gerak dapar fosfat 10 mM pH 3,2 – asetonitril (83 : 17), kolom C18 Xbridge (250 mm x 4,6 mm; 5 µm), laju alir 1,0 mL/menit, panjang gelombang 210 nm, suhu 35°C. Ekstraksi cair – cair dengan etil asetat sebagai metode preparasi untuk sampel dalam DBS dan VAMS. Hasil validasi metode bioanalisis memenuhi syarat LLOQ, linieritas, selektivitas, akurasi dan presisi, recovery, integritas pengenceran, carry over dan stabilitas yang mengacu pada Guideline on Bioanalytical Method Validation dari European Medicines Agency tahun 2011 dan FDA 2018, dengan nilai LLOQ untuk sulbaktam sebesar 1 µg/mL dan sefoperazon 5 µg/mL dan nilai r ³ 0,995. Hasil uji perbandingan menunjukkan bahwa metode biosampling VAMS memberikan hasil yang lebih baik, namun terdapat beberapa hasil yang tidak berbeda signifikan dari penggunaan dengan DBS.

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Acinetobacter baumannii is a gram-negative pathogenic bacteria that causes the majority of nosocomial infection. The World Health Organization (WHO) published the first priority list of antibiotic resistance against Acinetobacter baumannii which is a critical category as a serious threat to global public health. Cefoperazone-sulbactam is an antibiotic combination that is susceptible to Acinetobacter baumannii infection. According to studies conducted at the Dr. Soetomo Surabaya Hospital, up to 27% of patients exhibited resistance to cefoperazone-sulbactam medicines. When the drug in the blood is under the required concentration, the treatment is ineffective and resistance can develop. For this reason, a simple, sensitive, and fast analytical method is needed for the analysis of cefoperazone-sulbactam. This research was conducted to obtain a simple, sensitive and fast analytical method using the High Performance Liquid Chromatography (HPLC) Photo Diode Array (PDA) detector. In addition was obtained preparation method for the Dried Blood Spots (DBS) and Volumetric Absorptive Microsampling (VAMS), as well as to compare the peak area ratio, selectivity, recovery and stability of DBS and VAMS. Chromatographic analysis was carried out using the isocratic method with 10 mM phosphate buffer mobile phase pH 3.2 – acetonitrile (83:17), C18 Xbridge column (250 mm x 4.6 mm; 5 m), flow rate 1.0 mL/min, wavelength 210 nm, temperature 35ºC. Sample preparation method was performed by liquid-liquid extraction using ethyl acetate as a solvent. The results showed that the analytical method carried out meet the validation parameters requirements (LLOQ, linearity, selectivity, accuration and precision, recovery, dilution integrity, carry over and stabilitty) that refer to the Guideline on Bioanalytical Method Validation from the European Medicines Agency in 2011 and the FDA 2018, with an LLOQ value for sulbactam of 1 µg/mL and cefoperazone at 5 µg/mL and r ³ 0,995. The comparison test results demonstrated that the VAMS biosampling method provided better results, however certain results were not statistically different from those obtained using DBS in some cases"

"andida spp. merupakan patogen nosokomial yang paling umum diisolasi di antara spesies ragi dan menyebabkan mortalitas yang tinggi. Kontaminasi Candida yang resistan antifungal banyak ditemukan pada berbagai permukaan di lingkungan rumah sakit, sehingga meningkatkan kemungkinan transmisinya dari lingkungan. Penelitian ini bertujuan untuk mengetahui gambaran kontaminasi, efektivitas desinfeksi, serta karakteristik kepekaan Candida spp. terhadap antifungal. Penelitian dilakukan dengan pengambilan sampel permukaan di ruang perawatan intensif rumah sakit rujukan di Jakarta pada area high touch surfaces. Sampel dibiakkan pada medium CHROMagar Candida™, kemudian koloni ragi dihitung untuk mengetahui pengaruh disinfektan. Identifikasi spesies dilakukan menggunakan VITEK, kemudian dilanjutkan dengan PCR dan sekuensing dengan target regio ITS, serta dilakukan analisis filogenetik. Profil kepekaan Candida spp. dianalisis menggunakan VITEK. Berdasarkan hasil dijumpai 7 spesies Candida yang mengontaminasi permukaan yang didominasi oleh C. haemulonii. Hasil uji kepekaan antifungal menunjukkan bahwa seluruh isolat C. haemulonii resistan terhadap amphotericin B, dan satu isolat C. glabrata resistan terhadap caspofungin. Berdasarkan analisis efektivitas disinfektan, terdapat penurunan jumlah koloni Candida spp. sesudah prosedur desinfeksi yang menunjukkan bahwa prosedur desinfeksi sudah cukup efektif. Sebagai kesimpulan, C. haemulonii merupakan kontaminan utama pada permukaan yang resistan amphotericin B. Adapun tindakan desinfeksi sudah efektif namun cara melakukan desinfeksi perlu diperbaiki.

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Candida spp. is the most common nosocomial pathogen isolated among yeast species with a high mortality rate. Antifungal-resistant Candida contamination has been found on various surfaces in the hospital environment, thus increasing the possibility of transmission. This study was conducted to determine Candida’s contamination profile, disinfection efficacy, and antifungal susceptibility features. Surface samples were collected in the intensive care unit ofreferral hospital in Jakarta, at the high touch surfaces area. The samples were then cultured on CHROMagar™ Candida, then yeast colonies were counted to determine the disinfectant efficacy. Species were identified using VITEK, PCR and sequencing targeting the ITS region, followed by phylogenetic analysis. Susceptibility characteristic of Candida spp. were analyzed using VITEK. The surface was contaminated by seven species of Candida, with C. haemuloni predominating. All C. haemulonii isolates were resistant to amphotericin B, and one C. glabrata isolate was resistant to caspofungin. The disinfectant efficacy analysis showed that there was a decrease in the number of Candida spp. after disinfection treatment, indicating that the disinfectant is quite effective. In summary, C. haemulonii is the main contaminant on surfaces that are resistant to amphotericin B. Although the disinfection techniques have been effective, they still require improvement"

"Healthcare Associated Infections (HAIs) merupakan peristiwa buruk yang paling sering terjadi dalam pelayanan kesehatan di seluruh dunia. Setiap tahunnya terdapat ratusan juta pasien terkena HAIs yang mengarah pada kematian secara signifikan dan menyebabkan kerugian finansial untuk sistem kesehatan. Di negara-negara berpenghasilan menengah dan rendah, frekuensi infeksi di ICU setidaknya 2-3 kali lebih tinggi daripada negara-negara berpenghasilan tinggi. Tujuan dari penelitian ini adalah mendapatkan hasil analisis tata laksana pencegahan dan pengendalian Health care-associated infections (HAIs) di unit perawatan intensif RSUD Koja menggunakan metode bow tie. Penelitian ini merupakan jenis penelitian operasional yang bersifat kualitatif. Metode yang digunakan adalah wawancara mendalam, telaah dokumen, dan observasi. Hasil penelitian ini menunjukkan bahwa penyebab angka HAIs di RSUD Koja masih diatas standar yakni adanya latent failure dalam upaya pencegahan dan pengendalian HAIs. Maka dari itu diperlukan perbaikan dalam beberapa variabel laten untuk memaksimalkan upaya pencegahan dan pengendalian HAIs, serta dibutuhkan penelitian yang membahas kondisi pasien sebagai ancaman dalam upaya pencegahan dan pengendalian HAIs di rumah sakit.

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Healthcare Associated Infections (HAIs) are the most frequent adverse events in health services throughout the world. Every year there are hundreds of millions of patients affected by HAIs that lead to death significantly and cause financial losses to the health system. In middle and low-income countries, the frequency of infections in ICUs is at least 2-3 times higher than in high-income countries. The purpose of this study was to obtain the results of analysis of prevention and control of Health care-associated infections (HAIs) in the intensive care unit at Koja Disrict Hospital using the bow tie method. This research is a type of operational research that is used qualitative method. The methods used are in-depth interviews, document studies, and observations. The results of this study indicate that the cause of the number of HAIs in Koja District Hospital is still above the standard, namely the presence of latent failure in efforts to prevent and control HAIs. Therefore, improvements in some latent variables are needed to improve the effectiveness of HAIs prevention and control efforts, and research is needed to discuss the patients condition as a threat in preventing and controlling HAIs in the hospital."

"Thoroughly revised and updated for its Fourth Edition, a comprehensive reference on hospital epidemiology and infection control. Written by over 150 leading experts, this new edition examines every type of hospital-acquired (nosocomial) infection and addresses every issue relating to surveillance, prevention, and control of these infections in patients and in healthcare workers. This new edition features new or significantly increased coverage of emerging infectious diseases, avian influenza, governmental regulation of infection control and payment practices related to hospital-acquired infections, molecular epidemiology, the increasing prevalence of community-acquired MRSA in healthcare facilities, system-wide infection control provisions for healthcare systems, hospital infection control issues following natural disasters, and antimicrobial stewardship in reducing the development of antimicrobial-resistant organisms."