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CEK LIST DOKUMEN

PENCEGAHAN DAN PENGENDALIAN INFEKSI

CHEKLIST OF PREVENTION AND INFECTION CONTROL

DOCUMEN TY/NREKOMENDATION

PPI 1Decree of IPCN & IPCLN

Job description

The schedule/Work program of IPCN

PPI 2SK Komite/Panitia/Tim PPI Committe Decre / PPI team

Job description

Notulen rapat

Minutes of the meeting

Bukti dokumentasi lainnya, misalnya surat menyurat Evidence of documentation ex: correspondence

PPI 3Program of PPI

PPI 4Adanya SIRS untuk program PPI ( bisa secara manual atau elektronik)

SIRS for PPI (manually or electronic)

SK penetapan IPCLN dan uraian tugasnya

Anggaran PPI ( APD, diklat, desinfektan

Decree of determination of IPCLN and job description.Budget of PPI. Personel protective equipment.

PPI 5Program PPI komprehensif (untuk pasien, pengunjung dan staf) yg antara lain meliputi

Comphrehensive program of PPI (for patient,visitor,staff) that include:

Melaksanakan Surveilans ( PPI 6

Do surveillance----- PPI 6

Melakukan Investigasi outbreak ( PPI 6

Investigate the outbreak--------PPI 6

Membuat Infection Control Risk Assessment (ICRA) (PPI 6 EP 4, PPI 7, PPI 7.1 sd PPI 7.5

Make Infection Control Risk AssessmentMonitoring Sterilization in hospital ( PPI 7.1

Monitoring laundry dan linen management ( PPI 7.1

Monitoring expired equipment &single-use become re-use

Monitoring Pembuangan sampah infectious & cairan tubuh

Monitoring Disposal of infectious waste &and body fluidsMonitoring Penanganan pembuangan darah dan komponen darah

Monitoring blood handling and disposal of blood componentsMonitoring Area kamar mayat dan post mortem

Monitoring mortuary area and post-mortemMonitoring Pembuangan benda tajam dan jarum

Monitoring disposal of sharps and needlesPencatatan dan pelaporan tertusuk jarum

Recording and reporting of needle stickMonitoring penggunaan ruang Isolasi

Monitoring the use of space InsulationMonitoring kepatuhan Hand hygiene

Hand hygiene compliance monitoring

PPI 5.1Sasaran Program PPI

The target of PPI

PPI 6Pedoman dan petunjuk teknis surveilance RS

Guidelines and clinical instruction of surveillance

Profil/kamus data/indikator PPI

Profile/ dictionary/ PPI indicator

Laporan Komite/panitia PPI

Report of the committee

Data surveilance, hasil analisis dan rekomendasi

Suveillance data, analysis, and recomendation

Tindak lanjut hasil analisis dan rekomendasi

Follow up from the result of analysis and recomendation

Hasil asesmen risiko infeksi pada setiap unit kerja pelayanan (ICRA)

Assessment result of ICRA

Kebijakan tentang penggunaan antibiotik yg rasional Policy of the rational used of antibiotic

Kebijakan pelaksanaan surveilans

Policy Implementation of surveillance

Kebijakan & SPO penanganan KLB

Policy & SPO management of outbreak

Kebijakan & SPO upaya pencegahan infeksi ILO, IADP, ISK, Pneumoni

Policy & SPO the prevention of infection, Surgical wound, Pheriperal arteri Infection, Urinary track Infection, Pneumoni

PPI 7Bukti telah dilakukan assessemen risiko (ICRA) pada pemberian terapi cairan

Evidence has been done assessemen risk (ICRA) in fluid therapy

Strategi penurunan risiko

The strategy of reducing risk

Identifikasi dan strategi penurunan risiko untuk PPI 7.1, 7.2, 7.3, 7.4, 7.5

Identification and the strategy reducing risk for PPI 7.1,7.2,7.3,7.4,7.5

SPO praktik menyuntik yg aman

SPO Giving injection safely

SPO praktik untuk lumbal punksi

SPO lumbal punction practice

PPI 7.1Pedoman dan SPO pelayananan Sterillisasi central & diluar CSSD

Guidelines and SPO Central sterilization service and outside CSSD

Pedoman dan SPO pelayananan Linen dan Laundry

Guidelines &SPO linen and laundry

Hasil monitoring dan evaluasi, pembersihan dan sterilisasi

Monitoring and evaluation result, cleanning & Sterilization

PPI 7.1.1Kebijakan dan SPO tentang pengawasan peralatan kadaluwarsa

Policy &SPO of monitoring the expired equipment

Kebijakan dan SPO tentang pemakaian ulang (re-use) peralatan dan material

Policy &SPO use of equipment re-use &material

Document monitoring dan evaluation

Document of examination of germ

PPI 7.2Kebijakan dan prosedur pengelolaan sampah infeksius dan cairan tubuh

Policy & procedure of infectious waste &and body fluids

Kebijakan dan prosedur pengelolaan darah dan komponen darah

Policy & procedure of blood & blood products management

Kebijakan dan prosedur pelayanan kamar jenazah

Policy &procedur of mortuary area service

PPI 7.3Kebijakan dan prosedur pengelolaan limbah RS khususnya untuk benda tajam dan jarum

Policy &procedure of waste management esspecially sharp disposal and nedlie

PPI 7.4Kebijakan dan prosedur n persiapan makanan, pemasakan dan penyajian dan pengambilan sample makanan secara rutin

Policies and procedures n food preparation, cooking and presentation of food and regular sampling

Kebijakan dan prosedur engontrolan peralatan ( periksa kumanPolicies and procedures germ control equipment check

PPI 7.5ICRA Kontruksi bangunan

Building Constuction of ICRA

Kebijakan ICRA kontruksi bangunan

Policy Building constraction

Penetapan pemantauan kualitas udara

Determination of air quality monitoring

Hasil pelaksanaan pemantauan kualitas udara.akibat dampak renovasi.

The results of the implementation of quality air because of the impact of renovation.

PPI 8Kebijakan prosedur kewaspadaan isolasi yg antara lain meliputi : Policy of isolation precautions procedures which include the following:Kebersihan tangan Hand hygienePenggunaan APD

Use of Self Protective equipmentPeralatan perawatan pasien

Patient tools

Pengendalian lingkungan, termasuk ambulance setelah mengantar pasien/jenazah infectious

Environment contoll, including ambulance after dropping off a patient / corpse infectiousPemrosesan peralatan pasien dan penatalaksanaan linen

Processing patients equipment and management of linensKesehatan karyawan/perlindungan petugas kesehatan

employee health / health protection officerPenempatan pasien.

Placement of the patient

Hygiene respirasi/etika batuk

Respiratory hygiene / cough etiquettePraktik menyuntik yang aman

Safe injecting practicesIsolasi dengan dugaan emerging disease

Isolation with allegations emerging disease

Bukti edukasi staf

Evidence of staff education

PPI 9 Area yang menggunakan APD

Area that used Self protecting tools

Prosedur pemakaian APD

Procedure of using self protective tools

Area yang harus cuci tangan, disinfeksi tangan atau disinfeksi permukaan

Areas that should wash their hands, disinfect hands or disinfect surfaces

Prosedur cuci tangan dan disinfeksi

Procedure of hand hygiene and desinfection

Hasil pemantauan cuci tangan Hand hygiene compliance

PPI 10 PMKP Program

PPI program

Kebijakan dan prosedur monitoring/pengawasan dari Komite/Panitia/Tim PMKP

Policy and procedure ,monitoring

Minutes of the meeting of PMKP dan PPI

PPI 10.1 Data pemantauan angka infeksi

Data monitoring infection ratesindikator angka infeksi

Indicator of infection rate

Notulen rapat pembahasan

The record of the meeting

Laporan Komite/panitia PPIsee PPI 6 EP 2 dan 3 dan PMKP 3.1, PMKP 4.

Committee report

PPI 10.2Hasil monitoring dan evaluasi pelaksanaan kegiatan PPI

The results of the monitoring and evaluation of implementation of the PPIHasil analisis epidemiologi

Analysis of epidemiology

Lihat Kamus indikator PPI (PPI 6) dan hasil analisis data surveilance (PPI 6, PMKP 3.1, PMKP 4)

Look at dictionary PPI indicator

PPI 10.3Follow up based on result of analysis

( see analysa data and follow up ( PPI 6, PMKP 3.1, PMKP 4

PPI 10.4Bukti data RS lain

Evidence of data other hospitalsBukti data acuan

Evidence reference dataAnalysis result see PMKP.4.2, EP 2 dan MKI.20.2, EP 3)

PPI 10.5Bukti komunikasi, misalnya dalam forum rapat

Evidence of communication, for example in a meeting forumDokumen laporan Komite/panitia PPI kepada manajemen RS

lihat PMKP 1.4 (publikasi data)

Documents Committee report / PPI to the hospital management committee see pmkp 1.4 (publication data)

PPI 10.6Dokumen laporan kepada Kemkes atau Dinas Kesehatan -> RL 6

Documents or reports to the MoH Public Health Service -> RL 6Bukti tindak lanjut atas laporan

Evidence of follow up on reports

PP1 11Program kerja PPI/Program diklat tentang PPI

PPIs work program /training program on PPIProgram pendidikan pasien dan keluarga

Patient and family education programsBukti implementasi pelatihan dan edukasi

Evidence of implementation of training and education