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Abstrak :
[ABSTRAK
Staphylococcus spp. peragi manitol merupakan flora normal kulit terbanyak dan sering bersifat multiresisten, serta dapat menjadi salah satu penyebab healthcare associated infection (HAI). Di Indonesia, data mengenai Staphylococcus spp. peragi manitol yang resisten metisilin belum tersedia. Penelitian ini bersifat retrospektif untuk mengetahui pola kepekaan dan karakteristik genotipik (mecA dan tipe SCCmec I-V) flora normal Staphylococcus spp peragi manitol yang diisolasi dari pasien ICU Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM) tahun 2011, 2013 dan 2014. Dari 187 isolat, 15% di antaranya merupakan methicillin resistant Staphylococcus aureus (MRSA) yang sebagian besar resisten terhadap gentamisin (64,3%), klindamisin (50%), golongan fluorokuinolon (64,3-71,4%) dan tetrasiklin (57,1%). Sedangkan 55,6% merupakan Staphylococcus koagulase negatif resisten metisilin (MR-CoNS) yang sebagian besar resisten terhadap gentamisin (55%), fluorokuinolon (62,5-88,5%), eritromisin (91,3%), klindamisin (75%) dan rifampisin (82,7%). Resisten metisilin pada MRSA hampir semuanya disebabkan oleh gen mecA (96,4%), sedangkan pada MR-CoNS, gen mecA ditemukan pada 76,9% isolat. Tipe SCCmec yang paling banyak ditemukan pada kedua kelompok yaitu SCCmec tipe I. Dapat disimpulkan bahwa sebagian besar Staphylococcus spp. peragi manitol yang merupakan flora normal pasien yang dirawat di ICU RSUPNCM, merupakan pembawa gen mecA. Surveilens berkelanjutan dibutuhkan untuk mengetahui kecenderungan perubahan pola kepekaan dan pencegahan transmisi di fasilitas kesehatan.

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ABSTRACT
Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities.;Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities.;Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities., Staphylococcus spp. mannitol fermenters are the most abundant skin normal flora. It is frequently resistant to many drugs and could become one of the causes of the healthcare associated infection (HAI). There is no data about Methicillin Resistant Staphylococcus spp. mannitol fermenters in Indonesia yet. In this restrospective study we aim to identify the susceptibility patterns and genotypic characteristics (mecA gene and SCCmec type I-V) of normal flora Staphylococcus spp. mannitol fermenters isolated from Intensive Care Unit patients of Cipto Mangunkusumo Hospital during 2011, 2013 and 2014. This study found that 15% of 187 isolates were methicillin resistant Staphylococcus aureus (MRSA) and mostly resistant to gentamycin (64,3%), clindamycin (50%), fluoroquinolone (64,3-71,4%) and tetracycline (57,1%). While 55,6% of the isolates were methicillin resistant coagulase negative Staphylococcus (MR-CoNS) and mostly resistant to gentamycin (55%), fluoroquinolone (62,5-88,5%), erithromycin (91,3%), clindamycin (75%) and rifampicin (82,7%). Methicillin-resistant on almost MRSA, carried mecA gene (96.4%), while in the MR-CoNS, mecA gene was found in 76.9% of all isolates. The most common SCCmec type found was SCCmec type I. Thus, mecA gene carrier Staphylococcus spp. mannitol fermenters were found as normal flora in intensive care patients of Cipto Mangunkusumo Hospital. Continuous surveillance is however, necessary to determine the tendency of changing susceptibility patterns and transmission prevention in health facilities.]

Abstrak :
Berdasarkan konsep WHO (1994): The Four Pillars of Safe Motherhood Departemen Kesehatan menerapkan pelayanan kebidanan dasar melalui pertolongan persalinan aman dan bersih. Rumah sakit sebagai organisasi pelayanan kesehatan diharapkan dapat menjadi agen perubah perilaku hidup sehat dengan menjaga higienitas diri melalui praktek higienitas tangan. Membudayakan keselamatan pasien dengan melakukan praktek higienitas tangan yang baik dan benar diharapkan dapat menurunkan angka infeksi nosokomial. Di Indonesia angka kematian ibu masih merupakan masalah utama dalam bidang kesehatan. Angka kematian ibu mengacu pada jumlah kematian ibu pada kehamilan, persalinan dan masa nifas. Penelitian dilakukan dengan metode kuantitatif menggunakan uji t test dan chi square serta regresi logistik berganda dengan analisis bootstrapping. Sampel adalah bidan di ruang bersalin RSB Asih Panglima Polim Jakarta dengan cara pengambilan data melalui observasi serta pengisian kuesioner. Cuci tangan responden yang sesuai standar “5 Kesempatan Higienitas Tangan” lebih banyak yang angka kepatuhannya (61.1%) masih di bawah ratarata, sedangkan pada standar “11 Langkah Cuci Tangan” didapatkan lebih banyak (55.6%) yang angka kepatuhannya di atas rata-rata. Faktor predisposisi yang secara statistik terbukti signifikan berhubungan dengan angka kepatuhan cuci tangan bidan adalah usia, masa kerja, pengetahuan, dan sensitifitas kulit, faktor pemungkin yang secara statistik terbukti signifikan berhubungan dengan angka kepatuhan cuci tangan bidan adalah pelatihan. Hasil uji multivariat menyatakan sarana prasarana dan kepatuhan terhadap standar “5 Kesempatan Higienitas Tangan” adalah faktor yang paling dominan mempengaruhi kepatuhan terhadap standar “11 Langkah Cuci Tangan”. Dibutuhkan perhatian lebih dari pihak manajemen dan dukungan pimpinan RS terhadap higienitas tangan agar dapat meningkatkan angka kepatuhan cuci tangan para petugas kesehatan di RSB Asih. ......Based on the concept of the WHO (1994): The Four Pillars of Safe Motherhood Department of Health implements a basic obstetric care through safe and clean delivery assistance. Hospital as a health care organization is expected to be the agents of change of health behavior by maintaining hygiene of self through hand hygiene practices. Cultivating patient safety by implementing a correct hand hygiene practice is expected to reduce the number of healthcare associated infection. In Indonesia mother death rates remains a major problem in the health sector. Mother death rates refers to the number of maternal deaths in pregnancy, childbirth and the postpartum period. The study was conducted by quantitative methods using T-test, chi square test and multiple logistic regression with bootstrapping analyses. The sample was a midwife in the delivery room RSB Asih Panglima Polim Jakarta by collecting data through observation and questionnaires. Hand-wash respondents according to the standard "5 Hand Hygiene Opportunities" more of the compliance rate (61.1%) is still below average, while the standard "11 Steps of Hand Wash" earned more (55.6%) are above the compliance rate average. Predisposing factors that are statistically proven significantly associated with hand washing compliance rate of midwives are age, years of service, knowledge, and sensitivity of the skin, enabling factors that are statistically proven significantly associated with hand washing compliance rate of midwives is training. The results of the multivariate test state that the infrastructure and adherence to standards "5 Hand Hygiene Opportunities" is the most dominant factor affecting adherence to the standard "11 Steps Hand Wash". It takes more attention from management and leadership support of the hospital to hand hygiene in order to increase the compliance rate of hand washing among health workers in RSB Asih

Abstrak :
HAIs, masih menjadi penyebab signifikan peningkatan morbiditas dan mortalitas pada pasien rawat inap, penyebab pasien dirawat di rumah sakit berkepanjangan, ketidaknyamanan bagi pasien, dan menjadi beban ekonomi pada perawatan kesehatan. Untuk mengatasi hal tersebut Menteri Kesehatan telah mengeluarkan Permenkes nomor27 tahun 2017 tentang Pedoman Pencegahan dan Pengendalian Infeksi di Fasilitas Pelayanan Kesehatan. RS X Kota Sukabumi juga diketahui sudah memiliki SK mengenai pembentukan komite dan tim PPI untuk mengatasi infeksi terkait pelayanan kesehatan yakni SK Direktur RS X Nomor 85 Tahun 2014 dan SK Direktur RS XNomor 58 Tahun 2015. Namun, SK tersebut masih mengikuti peraturan sebelumnya yakni Keputusan Menteri Kesehatan Nomor 270 Tahun 2007 dan Keputusan Menteri Kesehatan Nomor 382 Tahun 2007, dan belum berdasarkan peraturan yang terbaru. Tujuan penelitian ini yakni untuk mengetahui kesiapan implementasi kebijakan surveilans infeksi terkait pelayanan kesehatan menurut Permenkes nomor 27 tahun2017 di Ruang GICU RS X Kota Sukabumi tahun 2018. Penelitian ini merupakan penelitian deskriptif - analitik dengan desain studi kasus dan menggunakan pendekatan kualitatif. Teknik pengumpulan data yakni dengan WM, telaah dokumen, dan observasi. Penelitian dilakukan di Dinas Kesehatan Kota Sukabumi dan di RS X Kota Sukabumidan. Penelitian ini dilakukan selama 3 bulan yakni bulan April sampai dengan Juni 2018. Dari penelitian ini ditemukan bahwa Tahapan perencanaan dan evaluasi surveilans yang dilakukan oleh Tim PPI RS X Kota Sukabumi masih belum sesuai dengan Permenkesnomor 27 tahun 2017, selain itu masih ada juga tahapan pengumpulan data, analisis,interpretasi, dan pelaporan surveilans yang belum sesuai dengan tahapan yang ada pada Permenkes nomor 27 tahun 2017. Komunikasi, sumber daya, disposisi, dan struktur birokrasi kesiapan implementasi kebijakan surveilans infeksi terkait pelayanan kesehatan menurut Permenkes nomor 27 tahun 2017 di Ruang GICU RS X Kota Sukabumi masih kurang baik. ...... HAIs is still being a significant cause of increased morbidity and mortality in hospitalized patients, prolonged hospitalization, discomfort for patients, and aneconomic burden on health care. Therefore, the Minister of Health has issued The Ministerial Regulation of Health number 27 of 2017. X Hospital in Sukabumi City isalso known for having a decree regarding the formation of committees and teams ofinfection prevention and control to overcome health care related infections, Director sdecree of X Hospital Number 85 of 2014 and Director s decree of X Hospital Number58 Year 2015. However, the decree still follows Ministerial Decree of Health Number 270 of 2007 and the Ministerial Decree of Health Number 382 of 2007 regulationsinstead of following the updated ones. The purpose of this research is to know ifimplementation analysis of health care related infection surveillance policy Ministerial Regulation of Health Number 27 of 2017 in GICU, X Hospital, Sukabumi City can beused properly. This study is a descriptive analytic case study and using qualitativeapproach such as in depth interview, document review, and observation. It was conducted at Public Health Office in Sukabumi City and X Hospital of Sukabumi Cityfor 3 months, from April until June 2018. Result shows that Stages of planning andevaluation of surveillance conducted by the Infection Prevention and Control Team, X Hospital, Sukabumi City, didn't match with The Ministerial Regulation of Healthnumber 27 of 2017. Furthermore, there are stages of data collection, analysis, interpretation and reporting of surveillance that didn 39 t correspond with the stages of The Ministerial Regulation of Health number 27 of 2017. Communications, resources, disposition, and bureaucracy structure of the readiness of implementation analysis of healthcare related infection surveillance policy Ministerial Regulation of Health Number 27 of 2017 in GICU, X Hospital, Sukabumi City is still inadequate.