ABSTRAKInfeksi nosokomial adalah infeksi yang khas terjadi atau didapat di Rumah Sakit. Faktor risiko yang berhubungan dengan infeksi nosokomial di Ruang Perawatan RSUPN Dr.Cipto Mangunkusumo belum diketahui. Periode pengumpulan data dilakukan sejak tanggal 1 Juli 1996 sampai dengan 30 Juni 1997 dengan menggunakan desain kasus kontrol.Jumlah sampel kasus penelitian adalah 210 pasien dan jumlah kontrol 420 pasien.Dari hasil penelitian didapatkan bahwa rata-rata usia pasien yang terkena infeksi nosokomial lebih tua daripada rata-rata pasien yang tidak terkena infeksi dan perbedaan ini secara statistik bermakna (P = 0,0079).Rata-rata lama hari rawat pasien yang terinfeksi lebih lama daripada pasien yang tidak terinfeksi dan perbedaan ini secara statstik bermakna (P = 0,0122).Kelas III lebih berisiko terkena infeksi nosokomial dibanding kelas I dan II (OR = 1,12, P = 0,6968).Komplikasi dan penyakit penyerta lebih berisiko terkena infeksi nosokomial dibanding tanpa komplikasi dan penyakit penyerta (OR = 1,37, P = 0,0805).Lama tindakan infus yang menggunakan waktu lebih lama lebih berisiko terkena infeksi nosokomial (OR > 3 hari. = 1,85 P = 0,0038).Tindakan operasi yang lamanya lebih dari satu jam lebih berisiko terkena infeksi nosokomial dibanding yang iamanya kurang atau sama dengan satu jam (OR>1 jam = 1,20, p = 0,3897).Tindakan kateter yang membutuhkan waktu lebih lama (lebih 3 hari) berisiko terkena infeksi nosokomial dibanding yang waktunya lebih singkat (kurang atau sama 3 hari) (OR > 3 hari = 2,77, P = 0,0000).Janis tindakan kateter lebih berisiko terkena infeksi nosokomial dibanding tidak dilakukan tindakan kateter (OR = 1,74, P = 0,0020).Pasien yang mendapat banyak tindakan ( > 3 tindakan) lebih berisiko terkena infeksi nosokomial dibanding kurang dari 3 tindakan (OR 3 tindakan = 1,5, P = 0,0329).Pada pemakaian antibiotika yang tidak sesuai dengan hasil kultur (OR = 5,53, P = 0,5186), pemakaian antibiotika irrasional (OR = 3,07, P = 0,0000) dan pemakaian satu/dua jenis antibiotika (0R = 148,8 / 99,46, P = 0,0000) lebih berisiko terkena infeksi nosokomial dibanding antibiotika yang sesuai, antibiotika rasional dan tanpa antibiotika. Faktor-faktor lainnya yang berefek kepada kejadian infeksi nosokomial adalah tindakan infus yang lebih lama, jenis tindakan kateter dan pemakaian antibiotika tidak sesuai dengan hasil kultur.Secara multivariat efek positif tertinggi terdapat pada pemakaian antibiotika tidak sesuai dengan hasil kultur (OR = 6,1848, P - 0,0332) dan efek negatif tertinggi pada pemakaian satu jenis antibiotika (OR.= 0,0095, P = 0,0000).Terdapat interaksi antara lama tindakan lain-lain dengan jenis tindakan kateter (OR = 0,2226, P = 0,0538), interaksi, antara lama tindakan lain-lain dengan pemeriksaan kultur (OR = 0,0209, P = 0,0264), interaksi antara jenis tindakan kateter dengan pemeriksaan kultur (OR. = 0,1353, P = 0,0224).Prevalensi infeksi nosokomial 4,65% sedangkan prevalensi .jenis infeksi luka infus 4,63%, perlu mendapatkan perhatian khusus tentang faktor risiko infeksi nosokomial.
ABSTRACTNosocomial Infection is an infection that specifically occurs or is found in hospitals. The risk factors related to nosocomial infection in the wards of RSUPtk Dr. Cipto Mangunkusumo are not yet known. Data was collected from 1 July 1996 up to 30 June 1997 using the control case design. 210 patients were used as case samples for the research and 420 patients for control.The results of the research show that average age of patients who were nosocomially infected is older than the average age of patients who were not infected and this difference is statistically significant (P = 0,0079i.The average length of stay of infected patients is longer than patients not infected and this difference is statistically significant (P = 0,0122).Class III patients have a higher risk of being infected nosocomially than Class I and II (OR = 1,12, P = 0,6968).Patients with Complications and other side effect diseases have a higher risk of getting infected compared to those without complication or side -- effect (OR = 1,37.A longer use of infusion procedures increases the risk of nosocomially infection (OR ) 3 days = 1,65, P = 0,0038).Operation of longer than one hour cause a higher risk of nosocomial infection compared to operations of one hour or less OR > 1 hour = 1,20, P = 0,3897).The extended use of a catheter (longer than 3 days) increases the risk of nosocomial infection compared to cases in which a chateter is not used (less than or equal to 3 days) (OR > 3 days = 2,77, P = 0,0000).Treatment using a chateter increases the risk of nosocomial infection compared to treatment not using a chateter (OR = 1,74, P = 0,0020).Patients who are treated with several different treatment c> 3 treatments) run a higher risk of getting nosocomial infection compared to those receiving less than 3 treatments (OR 3 treatments = 1,5, F' = 0,0329).The use of unsuitable antibiotics for the culture result (OR = 5,53. F' = 0,5186). an irrational use of antibiotics (OR= 3,07, P = 0,0000) or the use of one or two different antibiotics (OR = 146,8 / 99,46, P = 0,0000) increase the risk of nosocomial infection compared to the use of suitable, rational or no use of infusion, use of catheter and the use of unsuitable antibiotics for culture results.Other factors that influence the occurrence of nosocomial infection are longer use of infusion, use of catheter and the use of unsuitable antibiotics for culture result.In terms of multi-variant the highest positive effect occurs in the use of antibiotics that are not suitable for the culture result (OR = 6.1848,?P = 0,0332) and the highest negative effect is the use of one kind of antibiotic OR = 0,0095, P = 0,0000).There is an interaction between the duration of other treatments and the use of catheter (OR = 0,2228, P = 0,0538), an interaction between the duration of other treatment and culture examinations (OR = 0,0209, P = 0,0264), the interaction between treatment using a catheter and culture examinations (OR = 0,1353, P = 0,0224).The prevalence of nosocomial infection of 4.65% compared to the prevalence of infection caused by wounds induced by infusion needles of 4.63%, shows that special attention should be paid to nosocomial infection risk factors. |
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