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http://stikesmadani.ac.id/modern-wound-care/ Hubungan anrtara indikasi, pemrakarsa dan prosedur ceasarean section dengan terjadinya infeksi luka operasi di RSUD Prof. DR. W Johannes Kupang Penulis Utami, Rasvitri Pembimbing: Prof. dr. Iwan Dwiprahasto, M.Med.Sc, PhD ABSTRACT : Background: Patient safety is a global issue that has become world wide attention. The impact of patient safety is significant; it increases morbidity; mortality and economic loss. One of the patient safety indicator is surgical site infection which is in the third rank with the incidence as much as 14% - 16% of nosocomial infection. All surgical interventions including caesarean section bring risk for the incidence of surgical site infection. Caesarean section is increasing over years either nationally or internationally. Caesarean section has to be undertaken according to standard operational procedure, based on indication. However, lots of caesarean section are carried out without indication initiated either by the doctor or the patient. Lots of factors can affect the incidence of surgical site infection. These factors may come from health staff, environment, device, and the patient. Some studies reveal the incidence, prevalence and risk factors of surgical site infection. In December 2008 there were (7) cases of surgical site infection at Prof. DR. W.Z. Johannes Hospital Kupang, 4 of them had another operation due to deheciency and the incidence rate of surgical site infection and factors affecting the incidence of surgical site infection are unknown. Objective: To find out the relationship between indication, initiator and procedure of caesarean section and the incidence of surgical site infection. Method: The study was prospective observational method. Subject of the study were all patients having caesarean section from June 9

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http://stikesmadani.ac.id/modern-wound-care/

Hubungan anrtara indikasi, pemrakarsa dan prosedur ceasarean section dengan terjadinya infeksi luka operasi di RSUD Prof. DR. W Johannes Kupang

Penulis

Utami, Rasvitri

Pembimbing: Prof. dr. Iwan Dwiprahasto, M.Med.Sc, PhD

ABSTRACT : Background: Patient safety is a global issue that has become world wide attention. The impact of patient safety is significant; it increases morbidity; mortality and economic loss. One of the patient safety indicator is surgical site infection which is in the third rank with the incidence as much as 14% - 16% of nosocomial infection. All surgical interventions including caesarean section bring risk for the incidence of surgical site infection. Caesarean section is increasing over years either nationally or internationally. Caesarean section has to be undertaken according to standard operational procedure, based on indication. However, lots of caesarean section are carried out without indication initiated either by the doctor or the patient. Lots of factors can affect the incidence of surgical site infection. These factors may come from health staff, environment, device, and the patient. Some studies reveal the incidence, prevalence and risk factors of surgical site infection. In December 2008 there were (7) cases of surgical site infection at Prof. DR. W.Z. Johannes Hospital Kupang, 4 of them had another operation due to deheciency and the incidence rate of surgical site infection and factors affecting the incidence of surgical site infection are unknown. Objective: To find out the relationship between indication, initiator and procedure of caesarean section and the incidence of surgical site infection. Method: The study was prospective observational method. Subject of the study were all patients having caesarean section from June 9 to July 10 2009 at Prof. DR. W.Z. Johannes Hospital Kupang. The dependent variable was surgical site infection (SSI) and the independent variable were indication, initiator and procedure of caesarean section. Data were analyzed using chi square and multivariate logistic regression. Result: There was no association between indication and the incidence of SSI. There was no association between initiator and the incidence of SSI. There was association between non standard procedure of caesarean section and the incidence of SSI (p<0.05). The incidence of SSI at Prof. DR. W.Z. Johannes Hospital was 16.7%; the location of the incidence of SSI was 7 (43.7%) at inpatient room and 8 (50.0%) at the Polyclinic during control and 1 (6.3%) came back for hospitalization. Types of SSI found were: superficial SSI in 12 patients (75.0%), deep incisional SSI in 4 patients (25.0%) and 4 patients (25.0%) had second operation due to deheciency. No antiseptic shower preoperative (OR=5.9: (95% CI=1.2-28.5), non standard surgical attire (OR=8,4; 95% CI=1.6-43,0) and no handwashing prior wound care (OR=54.6; 95% CI=8.9 – 334.6) were risk factors for the incidence of SSI. Conclusion: No standard procedure of caesarean section was associated with the incidence of SSI. Keywords: caesarean section, indication, initiator, procedure, surgical site infection

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INTISARI : Latar belakang: Patient Safety merupakan issue global yang menjadi perhatian seluruh dunia. Dampak dari masalah patient safety amat besar yaitu meningkatkan angka kesakitan, angka kematian juga kerugian ekonomi. Salah satu indikator patient safety adalah Infeksi Luka Operasi (ILO), dimana menempati urutan ke 3 dengan insiden 14%-16% dari angka infeksi nosokomial. Semua tindakan pembedahan termasuk caesarean section berisiko untuk terjadi Infeksi Luka Operasi. Caesarean section dari tahun ketahun semakin meningkat baik diluar maupun didalam negeri. Prosedur caesarean section selayaknya dilakukan sesuai standard operating procedure, berdasarkan Indikasi, namun demikian banyak caesarean section dilakukan tanpa indikasi baik pemrakarsa oleh dokter ataupun oleh pasien.Teori menyebutkan: banyak faktor yang dapat mempengaruhi terjadinya infeksi luka operasi. Faktor tersebut dapat bersumber dari petugas kesehatan, lingkungan, alat, serta dari pasien sendiri. Banyak penelitian yang mengungkap insiden, prevalensi serta faktor risiko infeksi luka operasi. Di RSUD Prof.DR.W.Z.Johannes pada bulan Desember 2008 ditemukan (7) kasus infeksi luka operasi, 4 diantaranya menjalani operasi ulang karena mengalami dehesiensi, dan belum diketahui angka kejadian infeksi luka operasi sebenarnya dan apa saja yang mempengaruhi terjadinya infeksi luka operasi tersebut. Tujuan Penelitian: Untuk menghubungkan antara Indikasi, Pemrakarsa dan Prosedur Caesarean Section dengan terjadinya infeksi luka operasi. Metode: Jenis penelitian prospective observational. Subyek penelitian adalah seluruh pasien yang menjalani caesarean section dari 9 Juni 2009 sampai 10 Juli tahun 2009 di RSUD Prof.DR.W.Z.Johannes Kupang. Variabel dependen adalah Infeksi Luka Operasi dan variabel independen adalah Indikasi, Pemrakarsa dan Prosedur Caesaerean Section, data dianalisa dengan chi square dan multivariate regressi logistic. Hasil Penelitian: Tidak ada hubungan antara Indikasi caesarean section dengan terjadinya Infeksi Luka Operasi. Tidak ada hubungan antara Pemrakarsa caesarean section dengan terjadinya Infeksi Luka Operasi. Ada hubungan antara Prosedur caesarean section yang tidak sesuai standard operating procedure dengan terjadinya Infeksi Luka Operasi (p<0,05). Kejadian Infeksi Luka Operasi di RSUD Prof.DR.W.Z.Johannes sebesar (16,7%) dari 96 sampel, tempat terjadinya Infeksi Luka Operasi: di Rawat Inap: sebesar 7(43,7%),di Poli Klinik waktu kontrol besarnya: 8(50,0%), dan yang kembali masuk rumah sakit untuk Rawat Inap: 1(6,3%). Bentuk Infeksi Luka Operasi: Superficial 12 (75,0%), Deep Incisional 4 (25,0%), dan yang mengalami operasi ulangan oleh karena dehesiensi 4 (25,0%). Tidak mandi sebelum operasi (OR=5,9; 95% CI:1,2-28,5), kelengkapan Alat Pelindung Diri tidak sesuai standar (OR=8,4; 95% CI:1,6-43,0) dan tidak cuci tangan sebelum merawat luka (OR=54.6; 95%CI:8,9-334,6), merupakan faktor risiko untuk terjadinya Infeksi Luka Operasi. Kesimpulan: Prosedur caesarean section yang tidak sesuai standard operating procedure dapat meningkatkan kejadian Infeksi Luka Operasi. Kata Kunci: Indikasi, Pemrakarsa, Prosedur Cesarean Section dan Infeksi Luka Operasi.

Kata kunci Indikasi,Pemrakarsa,Prosedur cesarean section,Infeksi luka operasiProgram Studi S2 IKM/MMR UGMNo Inventaris c.1 (4244-H-2009)

Deskripsi xiv, 72 p., bibl., ills., 29 cmBahasa IndonesiaJenis Tesis

Penerbit [Yogyakarta] : Universitas Gadjah Mada, 2009Lokasi Perpustakaan Pusat UGM

http://etd.repository.ugm.ac.id/index.php?mod=penelitian_detail&sub=PenelitianDetail&act=view&typ=html&buku_id=45110