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CV
• Name
• Positiom:
•
•
•
: Hindra Irawan Satari
Chief, Infection Control Committee RSCM
Chief, Infectious Diseases and Tropical Pediatrics , Child Health Dept FKUI-RSCM
Member, Antimicrobal Resistance Watch Unit, RSCM
• Education
– General practitioner, FK UNPAD, 1981
– General Pediatrician, FKUI, 1992
– Master of Tropical Pediatrics, School of Tropical Medicine, Liverpool
University, United Kingdom, 1995
– Infectious and Tropical Pediatrics Consultant, Kolegium IDAI, 2002
– PhD in Medical Science, FKUI, 2012
• Course
• Advance course in Hospital Infection, Hong Kong, 1994
Email: [email protected]
AGENDA
0 Introduction
0 Definition surveillance
0 Surveillance HAIs in RSCM
0 Results of surveillance in RSCM
0 Root cause analysis of CLABSI in RSCM
0 Summary
INTRODUCTION
0 Surveillance is generally recognized as essential to
the practice of hospital infection control
0 Collection, analysis and dissemination of
surveillance data to be the single most important
factor in the prevention of hospital-acquired
infections (HAIs)
DEFINITION
0 Ongoing, systematic, collection, analysis, interpret
ation of health data essential to the
planning, implementation, evaluation of infection
control practices, closely integrated with timely
dissemination of these data to whose who need to
know
0 Surveillance is careful monitoring and relevant
feedback
SURVEILLANCE IN CIPTOMANGUNKUSUMO
HOSPITAL (RSCM)
0 Goal
0 reducing infection rates
0 Objectives:
0 Identification of problem area and prioritising infection prevention and
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control (IPC) activities
Assisting the development of IPC policy and associated clinical practices
Detecting changes in the endemicity of an HAI (e.g., MRSA) or an adverse
event (e.g., needle stick injury in health-care works)
Detecting changes in compliance with IPC policies (e.g, hand hygiene, timely
removal of peripheral intravascular lines)
Detecting outbreaks of adverse events (eg., food-borne illness)
Establishing the effectiveness of an IPC interventions
Identifying whether current programme meets benchmarks for IPC
Establishing data for evidence-plan to improve care and, if required, to meet
accreditation or regularly requirements.
INFRASTRUCTURE FOR SURVEILLANCE
IN RSCM
0
Documented Plan
0 Definition of HAIs infection: Basic
concepts of infection control second
edition, 2011
0 Population under surveillance: Entire
facility
0 Identification of data source: The related
unit
0 Selection of method for surveillance:
Continuous
0 Distribution of reports and feedback:
0 Reports monthly
0 Feedback regular: Quarterly
0 Outbreak: as necessary
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0
0
People
0 Fulltime IPCN
0 IPCN link
Computers
0 Program: Excel
Money another non-personal resources
0 Budget Committee
SURVEILLANCE HAIs
RSCM
0 Primary Bloodstream Infections (IADP)
0 Ventilator-Associated Pneumonia (VAP)
0 Catheter-Associated Urinary Tract Infections (ISK)
0 Surgical Site Infection (IDO)
0 Hospital-Associated Pneumonia (HAP)
0 Peripheral IV catheters (Phlebitis)
0 Decubitus ulcer (Dekubitus)
0 Hand-hygiene compliance
0 Sharp devices injury
0 Organisms isolated that are know to cause outbreaks
HAIs INCIDENCE RATE
RSCM, 2012
5,00
4,50
4,00
3,50
3,00
2,50
2,00
1,50
1,00
0,50
-
4,87
1,17
0,58
0,74
0,70
0,87
SURGICAL SITE INFECTION (IDO)
RSCM, 2012
12,00
10,31
JUMLAH OPERASI/100
10,00
8,00
6,00
5,62
6,00
5,00
Bersih
5,00
Bersih Tercemar
Tercemar
4,00
Kotor
2,50
2,50
5,00
0,24
0,00
0,31
0,24
0,33
0,50
0,53
Target<2%
2,54
1,67
2,00
0,71
0,53
0,02
0,93
0,71
0,21
0,09
CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION
RSCM, 2012
Target<3.5‰
DEVICES DAYS / 1000
2,50
2,00
1,99
1,82
1,67
1,79
1,64
1,50
1,23
1,19
1,00
0,86
0,82
0,62
0,50
0,40
0,35
0,00
1
2
3
4
5
6
Month
7
8
9
10
11
12
CENTRAL LINE – ASSOCIATED BLOODSTREAM INFECTION
DEPT/UPT/UNIT RSCM 2012
25,00
21,80
JML HARI PEMASANGAN CVL/1000
20,41
1
20,00
2
15,15
3
15,00
4
5
10,00
8,13
8,73
7,75
5,66
5,00
3,45
6
7
8
9
10
0,00
11
12
PERIPHERAL IV CATHETER RATE
CIPTO MANGUNKUSUMO HOSPITAL, 2012
DEVICE DAYS / 1000
2,50
2,00
1,74
1,60
1,50
1,55
1,00
Target<1‰
0,96
0,84
0,70
0,50
0,42
0,35
0,21
0,13
0,07
0,00
1
2
3
4
5
MONTH
6
7
8
0,01
9
10
11
12
DECUBITUS ULCER RATE
RSCM, 2012
Jumlah hari pasien tirah baring/1000
Target<3‰
2,50
2,23
2,00
2,00
1,50
1,42
1,41
1,27
1,00
0,92
1,24
0,84
0,71
0,50
0,36
0,13
0,00
1
2
3
4
5
0,11
6
MONTH
7
8
9
10
11
12
90%
80%
HAND-HYGIENE COMPLIANCE
RSCM,2012
82%
76%
70%
66%
69% 70%
78%
82%
71% 71% 70%
73%
70%
60%
50%
40%
% Kepatuhan
30%
20%
10%
0%
Target(> 85%)
0,35%
SHARP DEVICES INJURIES RATE
RSCM, 2012
0,30% 0,30% 0,30%
0,30%
0,25%
0,21%
0,20%
0,18% 0,18% 0,18%
0,15%
0,15%
0,15%
0,12%
0,10%
0,05%
0,00%
0,09%
0,06%
BACTERIA AND SENSITIVITY PATTERN TO
ANTIBIOTIC
ANALYSIS
0 Total specimen increase
0 Shortage lab personel
0 Blood Culture results
0 Acinetobacter
0 K pneumonia
0 Pseudomonas
0 Panresisten significant increase
0 Signal
MRSA SURVEILLANCE
0 Organisms isolated that is know to cause outbreaks
0 MRSA
0 2007 – 2012 increase
0 Most source specimen:
0 Building A level 6 and 7
0 Environment:
0 culture MRSA (-)
0 Summary source:
0 endogen
0 Recommendation:
0 Screening
OUTBREAKS BSI - CLABSI
0March 2012 (NICU)
0 Enterobacter cloacae
0 Pseudomonas aeruginosa
0August 2012 (PICU)
0 Burkholderia cepacia
0November 2012 (ICU Cardiology Center Unit )
0 Burkholderia cepacia
ROOT CAUSE ANALYSIS
0 Step 1 AND 2
0 IDENTIFICATION INCIDEN AND TEAM BUILDING
0 STEP 3
0 DATA AND INFORMATION COLLECTING
0 STEP 4
0 MAPPING AND CHRONOLOGICAL FINDINGS
0 STEP 5
0 CARE MANAGEMENT PROBLEM IDENTIFICATION
0 STEP 6
0 INFORMATION ANALYSIS
0 RECOMMENDATION AND FOLLOW UP
STEP 1 and 2
IDENTIFICATION TEAM INCIDENCE
0 Incidence:
0 Outbreak pseudomonas
and enterobacter
0 Investigator Team
0 Hospital infection team
0 Sanitation unit
0 CSSD
0 Quality and control and
patient safety committee
0 Dept Microbiology
0 Head nurse
0 Incidence type
0 Sentinel
0 Impact
0 HAIs increase
0 Score risk
0 Impact X probability:
5x4=20
0 Band risk
0 Red
STEP 3
DATA AND INFORMATION COLLECTING
0 Written documentation
0 Medical record (Nurse notes, SOP, ward capacity)
0 Culture results
0 Nurse rotation schedule
0 Interview
0 MD
0 Head nurse
0 Nurses
0 Lab personal
0 Direct observation
0 Hand-hygiene compliance
STEP 4
MAPPING CHRONOLOGICAL INCIDENT
0 Identity patient
0 Culture results
0 Health Care problem
0 Nurse and bed ratio
STEP 5
CARE MANAGEMENT PROBLEM (CMP)IDENTIFICATION
0 Contamination source of water with Pseudomonas
0 Overload capacity
0 SCN 4 (12 babies with only 8 bed capacity)
0 Low nurse : bed ratio
0 Not met competency
0 Mixplacing patient elective surgery patient mixed
with infectious babies
0 Over load due to the Government Policy
0 Compliance Hand-hygiene
STEP 6
INFORMATION ANALYSIS
5 WHY
0 Water contamination :
0 source of water from EMG Dept
0 Overload:
0 government policy
0 Nurse capacity:
0 SCN level,
0 nurse bed ratio,
0 compliance Hand-Hygiene
STEP 6
INFORMATION ANALYSIS
5 WHY
0 Government policy
0 Compliance Hand-Hygiene Health-Care Worker
0 not met procedure
0 Nurse Competency:
0 not related competency
0 Compliance Hand-Hygiene
0 low
0 Compliance of aseptic and invasive technique in the
ward
0 low
0 New born management in delivery room
0 not met
RECOMMENDATION AND FOLLOW UP
0 Advocation to MOH regarding Government Policy
0 Optimalization referral system
0 Renovation water supply
0 In-service training
SUMMARY
0 Surveillance in RSCM detect changes patterns of
HAI
0 Useful data to improve the quality care
0 Use to assess the performance of healthcare
THANK YOU