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  • DOK.GR 2013

  • PokokBahasanPendahuluanPengertian IAD PatogenesisKriteria IADP Sumber infeksiBundle CVLPencegahan IADP/Plebitis

    DOK.GR 2013

  • TUJUAN PEMBELAJARANPeserta diharapkan mampu :Memahami definisi & kriteria umum IADPMenjelaskan faktor risiko terjadinya IADPMemahami pencegahan dan pengendalian IADPMenerapkan tindakan PPI dalam mencegah IADP dalam melaksanakan asuhan keperawatan

    DOK.GR 2013

  • DOK.GR 2013

  • Dampak InfeksiPerawatan lebih lama Pasien CRBSI mengalami LOS 7 hari.Meningkatkan Biaya CDC 2002 Treatment Estimate per episode: $34,508Meningkatkan angka kesakitan dan kematian 4% untill 20% or 500-4000 patient dead / year because of CRBSI Tuntutan HukumKredibitas Rumah Sakit

    Maki DG. Infections due to infusion therapy. In: Hospital Infections, Third Edition, Bennett JV, Brachman PS (eds), Little, Brown, Boston 1992.(Soufir L et al. Infect Control Hosp Epidemiol 1999 Jun;20(6):396-401).

    DOK.GR 2013

  • Penggunaan alat IV tidak dapat dihindariPemasangan cateter intravaskuler tujuan utama untuk:Terapi cairanPemberian darahParenteral nutrisiPemantauan hemodinamik Komplikasi infeksi lokal maupun sistemik:endokarditis ,trombophlebitis,IADP

    Pendahuluan

    DOK.GR 2013

  • INSIDEN RATE INFEKSI ALIRAN DARAH (IAD) DI RSCM TAHUN 2011-2012

    Edukasi PPIKebersihan tanganRondeDukungan manajeman

    DOK.GR 2013

    Chart1

    2.822100511.670004473.5

    0.87007973981.64220129993.5

    18.60593213731.98539129613.5

    10.36435868870.85936023443.5

    25.23163121110.39556962033.5

    0.32801830650.82491038013.5

    6.54710809661.23487426733.5

    21.61540202691.8233189693.5

    3.3132479530.62150403983.5

    1.88141812741.1897899643.5

    0.46704588311.78845056783.5

    0.46569266310.35355122563.5

    Edukasi PPI

    Ronde

    2011

    2012

    Target 1

    The CPL index is the lower capability index for when you are only given a lower spec limit, LSL. You want a CPL > 1.

    The Cpk index is used when the process mean is shifted away from the target value, or the point half way between the spec limits. It is the minimum of the CPU and CPL. You want a Cpk>1.

    Percent Yield measures the proportion of the output that is within the spec limits, assuming a Normal population distribution.

    Probability of a Type I Error (a):If a sample value falls outside the control limits, we would conclude that the process is out of control. A Type I error is made when the process is concluded to be out of control when it is really in control. This probability is calculated assuming a normal distribution for the process.

    In-Control Average Run Length:If the process is in-control, the ARL is the number of samples, on average, you would observe before getting an out-of-control signal. In other words, you expect to get a false alarm (a point outside the control limits) every N samples, where N is the ARL.

    X-bar is the sample mean calculated as the sum of the observations divided by the number of observations in the sample (n).

    The range for each sample is calculated as the Max value minus the Min value.

    Instructions:

    This Control Chart template creates an X-bar Chart and R Chart with control limits calculated from values contained in the data table. All samples are assumed to be the same size.

    - Enter the label and the sample size for the quality characteristic that you are monitoring.- Choose a k-value (typically 3) for setting the control limits.- Replace the X-bar and Range values in the Data Table with your own data set (use Paste Special - Values).- You can delete unused rows in the data table.- If you need to insert additional rows in the data table, insert rows above the gray line below the table so that series in the chart expand accordingly. Copy the formulas for CL, UCL, and LCL to fill in the blank spaces.- The labels for CL, UCL, and LCL within the chart are created by selecting the last Data Point and formatting it so that the Data Labels include both the Series name and the Value.

    XbarR IAD

    X-bar

    CL

    UCL

    LCL

    Bulan

    Jumlah hari pemasangan ventilator/1000

    XbarR ISK

    Range

    CL

    UCL

    Sample #

    Range

    XbarR HAP

    Control Chart for Mean and Range

    [Title or Process] 2009 Vertex42 LLC

    [Date]HELP

    Quality CharacteristicAverage Thickness (mm), X-bar

    Sample Size, n16

    k1

    Statistics from Data TableProcess Capability

    R-bar8.011Upper Spec Limit, USL40

    Process Mean, m-hat0.750Lower Spec Limit, LSL30

    Process St.Dev., s-hat2.268Cp0.735

    sX-bar0.567CPU5.769

    CPL-4.299

    Cpk-4.299

    Percent Yield0.00%

    Control Limits for X-bar ChartControl Limits for R Chart

    CLX-bar0.750CLR8.011

    UCLX-bar1.317CL+ksX-barUCLR9.712

    LCLX-bar0.183CL-ksX-barLCLR6.310

    a0.3173

    ARL3.2samples

    Data TableX-bar ChartR Chart

    BulanX-barRangeCLUCLLCLCLUCLLCL

    10.869.710.7501.3170.1838.0119.7126.310

    22.0520.830.7501.3170.1838.0119.7126.310

    30.060.990.7501.3170.1838.0119.7126.310

    40.615.750.7501.3170.1838.0119.7126.310

    50.172.770.7501.3170.1838.0119.7126.310

    60.506.210.7501.3170.1838.0119.7126.310

    70.513.380.7501.3170.1838.0119.7126.310

    80.446.080.7501.3170.1838.0119.7126.310

    90.8613.700.7501.3170.1838.0119.7126.310

    100.232.750.7501.3170.1838.0119.7126.310

    110.636.900.7501.3170.1838.0119.7126.310

    121.0610.870.7501.3170.1838.0119.7126.310

    &L&8 2009 Vertex42 LLC&R&8Templates by Vertex42.com

    The number of measurements within each sample. For this chart, all samples are assumed to be the same size. In this spreadsheet, the sample size must be between 2 and 25.

    The k-value is number of standard deviations (typically 3) that the upper and lower control limits are placed away from the center line.

    R-bar is the mean of the Ranges in the data table and is used as the center line for the R-Chart.

    The estimated process mean is calculated as the mean of the X-bar values from the data table. It is used as the Center Line for the X-bar Chart.

    The estimated process standard deviation.

    The Cp index is calculated as (USL-LSL)/(6*sigma) where sigma is the process standard deviation. You want Cp to be greater than 1.

    This is the standard deviation of the sample mean, calculated as the process standard deviation divided by the square root of the sample size.

    The CPU index is the upper capability index for when you are only given an upper spec limit, USL. You want CPU > 1

    The CPL index is the lower capability index for when you are only given a lower spec limit, LSL. You want a CPL > 1.

    The Cpk index is used when the process mean is shifted away from the target value, or the point half way between the spec limits. It is the minimum of the CPU and CPL. You want a Cpk>1.

    Percent Yield measures the proportion of the output that is within the spec limits, assuming a Normal population distribution.

    Probability of a Type I Error (a):If a sample value falls outside the control limits, we would conclude that the process is out of control. A Type I error is made when the process is concluded to be out of control when it is really in control. This probability is calculated assuming a normal distribution for the process.

    In-Control Average Run Length:If the process is in-control, the ARL is the number of samples, on average, you would observe before getting an out-of-control signal. In other words, you expect to get a false alarm (a point outside the control limits) every N samples, where N is the ARL.

    X-bar is the sample mean calculated as the sum of the observations divided by the number of observations in the sample (n).

    The range for each sample is calculated as the Max value minus the Min value.

    Instructions:

    This Control Chart template creates an X-bar Chart and R Chart with control limits calculated from values contained in the data table. All samples are assumed to be the same size.

    - Enter the label and the sample size for the quality characteristic that you are monitoring.- Choose a k-value (typically 3) for setting the control limits.- Replace the X-bar and Range values in the Data Table with your own data set (use Paste Special - Values).- You can delete unused rows in the data table.- If you need to insert additional rows in the data table, insert rows above the gray line below the table so that series in the chart expand accordingly. Copy the formulas for CL, UCL, and LCL to fill in the blank spaces.- The labels for CL, UCL, and LCL within the chart are created by selecting the last Data Point and formatting it so that the Data Labels include both the Series name and the Value.

    XbarR HAP

    X-bar

    CL

    UCL

    LCL

    Bulan

    Jumlah hari pemasangan ventilator/1000

    XbarR PLEBITIS

    Range

    CL

    UCL

    Sample #

    Range

    XbarR DEKUBITUS

    Control Chart for Mean and Range

    [Title or Process] 2009 Vertex42 LLC

    [Date]HELP

    Quality CharacteristicAverage Thickness (mm), X-bar

    Sample Size, n16

    k1

    Statistics from Data TableProcess Capability

    R-bar8.973Upper Spec Limit, USL40

    Process Mean, m-hat1.103Lower Spec Limit, LSL30

    Process St.Dev., s-hat2.541Cp0.656

    sX-bar0.635CPU5.103

    CPL-3.791

    Cpk-3.791

    Percent Yield0.00%

    Control Limits for X-bar ChartControl Limits for R Chart

    CLX-bar1.103CLR8.973

    UCLX-bar1.738CL+ksX-barUCLR10.879

    LCLX-bar0.468CL-ksX-barLCLR7.068

    a0.3173

    ARL3.2samples

    Data TableX-bar ChartR Chart

    BulanX-barRangeCLUCLLCLCLUCLLCL

    11.5914.491.1031.7380.4688.97310.8797.068

    21.878.851.1031.7380.4688.97310.8797.068

    30.132.141.1031.7380.4688.97310.8797.068

    41.7417.241.1031.7380.4688.97310.8797.068

    50.182.141.1031.7380.4688.97310.8797.068

    60.354.911.1031.7380.4688.97310.8797.068

    71.4621.281.1031.7380.4688.97310.8797.068

    80.507.301.1031.7380.4688.97310.8797.068

    90.284.541.1031.7380.4688.97310.8797.068

    100.262.651.1031.7380.4688.97310.8797.068

    110.484.261.1031.7380.4688.97310.8797.068

    120.9810.001.1031.7380.4688.97310.8797.068

    &L&8 2009 Vertex42 LLC&R&8Templates by Vertex42.com

    The number of measurements within each sample. For this chart, all samples are assumed to be the same size. In this spreadsheet, the sample size must be between 2 and 25.

    The k-value is number of standard deviations (typically 3) that the upper and lower control limits are placed away from the center line.

    R-bar is the mean of the Ranges in the data table and is used as the center line for the R-Chart.

    The estimated process mean is calculated as the mean of the X-bar values from the data table. It is used as the Center Line for the X-bar Chart.

    The estimated process standard deviation.

    The Cp index is calculated as (USL-LSL)/(6*sigma) where sigma is the process standard deviation. You want Cp to be greater than 1.

    This is the standard deviation of the sample mean, calculated as the process standard deviation divided by the square root of the sample size.

    The CPU index is the upper capability index for when you are only given an upper spec limit, USL. You want CPU > 1

    The CPL index is the lower capability index for when you are only given a lower spec limit, LSL. You want a CPL > 1.

    The Cpk index is used when the process mean is shifted away from the target value, or the point half way between the spec limits. It is the minimum of the CPU and CPL. You want a Cpk>1.

    Percent Yield measures the proportion of the output that is within the spec limits, assuming a Normal population distribution.

    Probability of a Type I Error (a):If a sample value falls outside the control limits, we would conclude that the process is out of control. A Type I error is made when the process is concluded to be out of control when it is really in control. This probability is calculated assuming a normal distribution for the process.

    In-Control Average Run Length:If the process is in-control, the ARL is the number of samples, on average, you would observe before getting an out-of-control signal. In other words, you expect to get a false alarm (a point outside the control limits) every N samples, where N is the ARL.

    X-bar is the sample mean calculated as the sum of the observations divided by the number of observations in the sample (n).

    The range for each sample is calculated as the Max value minus the Min value.

    Instructions:

    This Control Chart template creates an X-bar Chart and R Chart with control limits calculated from values contained in the data table. All samples are assumed to be the same size.

    - Enter the label and the sample size for the quality characteristic that you are monitoring.- Choose a k-value (typically 3) for setting the control limits.- Replace the X-bar and Range values in the Data Table with your own data set (use Paste Special - Values).- You can delete unused rows in the data table.- If you need to insert additional rows in the data table, insert rows above the gray line below the table so that series in the chart expand accordingly. Copy the formulas for CL, UCL, and LCL to fill in the blank spaces.- The labels for CL, UCL, and LCL within the chart are created by selecting the last Data Point and formatting it so that the Data Labels include both the Series name and the Value.

    XbarR DEKUBITUS

    X-bar

    CL

    UCL

    LCL

    Bulan

    Jumlah hari pemasangan ventilator/1000

    XbarS

    Range

    CL

    UCL

    Sample #

    Range

    TermsOfUse

    Control Chart for Mean and Range

    [Title or Process] 2009 Vertex42 LLC

    [Date]HELP

    Quality CharacteristicAverage Thickness (mm), X-bar

    Sample Size, n16

    k1

    Statistics from Data TableProcess Capability

    R-bar11.692Upper Spec Limit, USL40

    Process Mean, m-hat1.286Lower Spec Limit, LSL30

    Process St.Dev., s-hat3.310Cp0.503

    sX-bar0.828CPU3.898

    CPL-2.891

    Cpk-2.891

    Percent Yield0.00%

    Control Limits for X-bar ChartControl Limits for R Chart

    CLX-bar1.286CLR11.692

    UCLX-bar2.114CL+ksX-barUCLR14.175

    LCLX-bar0.458CL-ksX-barLCLR9.210

    a0.3173

    ARL3.2samples

    Data TableX-bar ChartR Chart

    BulanX-barRangeCLUCLLCLCLUCLLCL

    11.6016.171.2862.1140.45811.69214.1759.210

    21.5510.531.2862.1140.45811.69214.1759.210

    30.707.161.2862.1140.45811.69214.1759.210

    40.848.471.2862.1140.45811.69214.1759.210

    51.7416.131.2862.1140.45811.69214.1759.210

    60.352.001.2862.1140.45811.69214.1759.210

    70.420.881.2862.1140.45811.69214.1759.210

    80.071.131.2862.1140.45811.69214.1759.210

    90.9610.101.2862.1140.45811.69214.1759.210

    100.212.391.2862.1140.45811.69214.1759.210

    110.010.231.2862.1140.45811.69214.1759.210

    120.132.111.2862.1140.45811.69214.1759.210

    &L&8 2009 Vertex42 LLC&R&8Templates by Vertex42.com

    The number of measurements within each sample. For this chart, all samples are assumed to be the same size. In this spreadsheet, the sample size must be between 2 and 25.

    The k-value is number of standard deviations (typically 3) that the upper and lower control limits are placed away from the center line.

    R-bar is the mean of the Ranges in the data table and is used as the center line for the R-Chart.

    The estimated process mean is calculated as the mean of the X-bar values from the data table. It is used as the Center Line for the X-bar Chart.

    The estimated process standard deviation.

    The Cp index is calculated as (USL-LSL)/(6*sigma) where sigma is the process standard deviation. You want Cp to be greater than 1.

    This is the standard deviation of the sample mean, calculated as the process standard deviation divided by the square root of the sample size.

    The CPU index is the upper capability index for when you are only given an upper spec limit, USL. You want CPU > 1

    The CPL index is the lower capability index for when you are only given a lower spec limit, LSL. You want a CPL > 1.

    The Cpk index is used when the process mean is shifted away from the target value, or the point half way between the spec limits. It is the minimum of the CPU and CPL. You want a Cpk>1.

    Percent Yield measures the proportion of the output that is within the spec limits, assuming a Normal population distribution.

    Probability of a Type I Error (a):If a sample value falls outside the control limits, we would conclude that the process is out of control. A Type I error is made when the process is concluded to be out of control when it is really in control. This probability is calculated assuming a normal distribution for the process.

    In-Control Average Run Length:If the process is in-control, the ARL is the number of samples, on average, you would observe before getting an out-of-control signal. In other words, you expect to get a false alarm (a point outside the control limits) every N samples, where N is the ARL.

    X-bar is the sample mean calculated as the sum of the observations divided by the number of observations in the sample (n).

    The range for each sample is calculated as the Max value minus the Min value.

    Instructions:

    This Control Chart template creates an X-bar Chart and R Chart with control limits calculated from values contained in the data table. All samples are assumed to be the same size.

    - Enter the label and the sample size for the quality characteristic that you are monitoring.- Choose a k-value (typically 3) for setting the control limits.- Replace the X-bar and Range values in the Data Table with your own data set (use Paste Special - Values).- You can delete unused rows in the data table.- If you need to insert additional rows in the data table, insert rows above the gray line below the table so that series in the chart expand accordingly. Copy the formulas for CL, UCL, and LCL to fill in the blank spaces.- The labels for CL, UCL, and LCL within the chart are created by selecting the last Data Point and formatting it so that the Data Labels include both the Series name and the Value.

    TermsOfUse

    X-bar

    CL

    UCL

    LCL

    Bulan

    Jumlah hari pemasangan ventilator/1000

    Range

    CL

    UCL

    Sample #

    Range

    IAD

    Control Chart for Mean and Range

    [Title or Process] 2009 Vertex42 LLC

    [Date]HELP

    Quality CharacteristicAverage Thickness (mm), X-bar

    Sample Size, n16

    k1

    Statistics from Data TableProcess Capability

    R-bar13.138Upper Spec Limit, USL40

    Process Mean, m-hat1.059Lower Spec Limit, LSL30

    Process St.Dev., s-hat3.720Cp0.448

    sX-bar0.930CPU3.490

    CPL-2.593

    Cpk-2.593

    Percent Yield0.00%

    Control Limits for X-bar ChartControl Limits for R Chart

    CLX-bar1.059CLR13.138

    UCLX-bar1.989CL+ksX-barUCLR15.928

    LCLX-bar0.129CL-ksX-barLCLR10.348

    a0.3173

    ARL3.2samples

    Data TableX-bar ChartR Chart

    BulanX-barRangeCLUCLLCLCLUCLLCL

    12.0027.031.0591.9890.12913.13815.92810.348

    20.9212.501.0591.9890.12913.13815.92810.348

    30.8410.421.0591.9890.12913.13815.92810.348

    41.4213.701.0591.9890.12913.13815.92810.348

    50.132.051.0591.9890.12913.13815.92810.348

    61.2712.501.0591.9890.12913.13815.92810.348

    71.2411.491.0591.9890.12913.13815.92810.348

    81.4112.051.0591.9890.12913.13815.92810.348

    90.111.771.0591.9890.12913.13815.92810.348

    100.362.651.0591.9890.12913.13815.92810.348

    110.715.991.0591.9890.12913.13815.92810.348

    122.2329.411.0591.9890.12913.13815.92810.348

    &L&8 2009 Vertex42 LLC&R&8Templates by Vertex42.com

    The number of measurements within each sample. For this chart, all samples are assumed to be the same size. In this spreadsheet, the sample size must be between 2 and 25.

    The k-value is number of standard deviations (typically 3) that the upper and lower control limits are placed away from the center line.

    R-bar is the mean of the Ranges in the data table and is used as the center line for the R-Chart.

    The estimated process mean is calculated as the mean of the X-bar values from the data table. It is used as the Center Line for the X-bar Chart.

    The estimated process standard deviation.

    The Cp index is calculated as (USL-LSL)/(6*sigma) where sigma is the process standard deviation. You want Cp to be greater than 1.

    This is the standard deviation of the sample mean, calculated as the process standard deviation divided by the square root of the sample size.

    The CPU index is the upper capability index for when you are only given an upper spec limit, USL. You want CPU > 1

    The CPL index is the lower capability index for when you are only given a lower spec limit, LSL. You want a CPL > 1.

    The Cpk index is used when the process mean is shifted away from the target value, or the point half way between the spec limits. It is the minimum of the CPU and CPL. You want a Cpk>1.

    Percent Yield measures the proportion of the output that is within the spec limits, assuming a Normal population distribution.

    Probability of a Type I Error (a):If a sample value falls outside the control limits, we would conclude that the process is out of control. A Type I error is made when the process is concluded to be out of control when it is really in control. This probability is calculated assuming a normal distribution for the process.

    In-Control Average Run Length:If the process is in-control, the ARL is the number of samples, on average, you would observe before getting an out-of-control signal. In other words, you expect to get a false alarm (a point outside the control limits) every N samples, where N is the ARL.

    X-bar is the sample mean calculated as the sum of the observations divided by the number of observations in the sample (n).

    The range for each sample is calculated as the Max value minus the Min value.

    Instructions:

    This Control Chart template creates an X-bar Chart and R Chart with control limits calculated from values contained in the data table. All samples are assumed to be the same size.

    - Enter the label and the sample size for the quality characteristic that you are monitoring.- Choose a k-value (typically 3) for setting the control limits.- Replace the X-bar and Range values in the Data Table with your own data set (use Paste Special - Values).- You can delete unused rows in the data table.- If you need to insert additional rows in the data table, insert rows above the gray line below the table so that series in the chart expand accordingly. Copy the formulas for CL, UCL, and LCL to fill in the blank spaces.- The labels for CL, UCL, and LCL within the chart are created by selecting the last Data Point and formatting it so that the Data Labels include both the Series name and the Value.

    IAD

    X-bar

    CL

    UCL

    LCL

    Bulan

    Jumlah hari pemasangan ventilator/1000

    ISK

    Range

    CL

    UCL

    Sample #

    Range

    HAP

    Control Chart for Mean and Standard Deviation

    [Title or Process] 2009 Vertex42 LLC

    [Date]HELP

    Quality CharacteristicAverage Thickness (mm), X-bar

    Sample Size, n4

    k3

    Statistics from Data TableProcess Capability

    s-bar4.500Upper Spec Limit, USL45

    c40.9213Lower Spec Limit, LSL25

    Process St.Dev., s-hat4.884Cp0.682

    Process Mean, m-hat44.167CPU0.057

    sX-bar2.442CPL1.308

    ss1.899Cpk0.057

    Percent Yield56.77%

    Control Limits for X-bar ChartControl Limits for S Chart

    CLX-bar44.167CLS4.500

    UCLX-bar51.493UCLS10.197

    LCLX-bar36.840LCLS0.000

    a0.0027

    ARL370.4samples

    Data TableX-bar ChartR Chart

    BulanX-barSt. Dev., sCLUCLLCLCLUCLLCL

    134444.16751.49336.8404.50010.1970.000

    225544.16751.49336.8404.50010.1970.000

    355644.16751.49336.8404.50010.1970.000

    435344.16751.49336.8404.50010.1970.000

    556644.16751.49336.8404.50010.1970.000

    666544.16751.49336.8404.50010.1970.000

    745344.16751.49336.8404.50010.1970.000

    832644.16751.49336.8404.50010.1970.000

    953544.16751.49336.8404.50010.1970.000

    1053344.16751.49336.8404.50010.1970.000

    1123444.16751.49336.8404.50010.1970.000

    1253444.16751.49336.8404.50010.1970.000

    &L&8 2009 Vertex42 LLC&R&8Templates by Vertex42.com

    Probability of a Type I Error (a):If a sample value falls outside the control limits, we would conclude that the process is out of control. A Type I error is made when the process is concluded to be out of control when it is really in control. This probability is calculated assuming a normal distribution for the process.

    The estimated process mean is calculated as the mean of the X-bar values from the data table. It is used as the Center Line for the X-bar Chart.

    The estimated population standard deviation. This is calculated by dividing s-bar by c4.

    The number of measurements within each sample. For this chart, all samples are assumed to be the same size. In this spreadsheet, the sample size must be between 2 and 25.

    The k-value is number of standard deviations (typically 3) that the upper and lower control limits are placed away from the center line.

    In-Control Average Run Length:If the process is in-control, the ARL is the number of samples, on average, you would observe before getting an out-of-control signal. In other words, you expect to get a false alarm (a point outside the control limits) every N samples, where N is the ARL.

    s-bar is the mean of the sample standard deviations from the data table. It is the center line for the S Chart.

    The sample standard deviation for each sample.

    X-bar is the sample mean calculated as the sum of the observations divided by the number of observations in the sample (n).

    This is the standard deviation of the sample mean, calculated as the process standard deviation divided by the square root of the sample size.

    This is the standard deviation of the sample mean, calculated from the estimated population standard deviation and c4.

    c4 is a factor that depends on the sample size and can be found tabulated in most control chart factor tables. Assuming the population distribution is Normal, c4 is used to find the mean and standard deviation of the sample standard deviation.

    The Cp index is calculated as (USL-LSL)/(6*sigma) where sigma is the process standard deviation. You want Cp to be greater than 1.

    The CPU index is the upper capability index for when you are only given an upper spec limit, USL. You want CPU > 1

    The CPL index is the lower capability index for when you are only given a lower spec limit, LSL. You want a CPL > 1.

    The Cpk index is used when the process mean is shifted away from the target value, or the point half way between the spec limits. It is the minimum of the CPU and CPL. You want a Cpk>1.

    Percent Yield measures the proportion of the output that is within the spec limits, assuming a Normal population distribution.

    Instructions:

    This Control Chart template creates an X-bar Chart and Standard Deviation Chart (s Chart) with control limits calculated from values contained in the data table. All samples are assumed to be the same size.

    - Enter the label and the sample size for the quality characteristic that you are monitoring.- Choose a k-value (typically 3) for setting the control limits.- Replace the X-bar and St.Dev. values in the Data Table with your own data set (use Paste Special - Values).- You can delete unused rows in the data table.- If you need to insert additional rows in the data table, insert rows above the gray line below the table so that series in the chart expand accordingly. Copy the formulas for CL, UCL, and LCL to fill in the blank spaces.- The labels for CL, UCL, and LCL within the chart are created by selecting the last Data Point and formatting it so that the Data Labels include both the Series name and the Value.

    HAP

    X-bar

    CL

    UCL

    LCL

    Bulan

    Average Thickness (mm), X-bar

    PLEBITIS

    St. Dev., s

    CL

    UCL

    LCL

    Sample #

    Standard Deviation

    DEKUBITUS

    Terms of Use

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    http://www.vertex42.com/ExcelTemplates/control-chart.html

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    http://www.vertex42.com/ExcelTemplates/control-chart.html

    INFEKSI RSCM

    Control Chart Template

    2009 Vertex42 LLC

    http://www.vertex42.com/ExcelTemplates/control-chart.html

    http://www.vertex42.com/ExcelTemplates/control-chart.html

    INFEKSI RSCM PER BLN

    IAD 2011

    BulanGEDUNG ABCHULBICU DEWASAPJTIGDIKAKEBIDANANRSCM KENCANAJUMLAH

    BulanGEDUNG Ax-barRangeBEDAHBEDAH SYARAFKELAS KHUSUSNEUROLOGIPENYAKIT DALAMHCUICU ANAKPICU

    BEDAHBEDAH SYARAFKELAS KHUSUSNEUROLOGIPENYAKIT DALAMHCUICU ANAKPICUBCHULBICU DEWASAPJTIGDIKAKEBIDANANRSCM KENCANADNDNDNDNDNDNDNDNDNDNDNDNDNDNDNDNDN

    10.000.000.000.00.000.0000000.000018.970.07.751.6718.9711570.0660.01940.060.02600.0930.01150.0660.00.00.0600.02390.02150.01670.01,318250.00.012913,08526

    20.000.000.000.00.000.0004.47000.000021.8000.001.6421.8021120.0720.01790.090.01530.0810.01090.089440.00.0270.02700.02580.01620.01,055230.00.01610.03,54227

    30.000.000.000.00.000.00015.15000.000016.610.00.001.9916.6131540.0730.02180.0310.01360.0750.01240.06610.00.0390.02990.02650.01500.09631640.0930.02,69017

    40.000.000.000.00.000.0000006.76006.990.00.000.866.9942410.0770.02060.050.02040.01230.01020.0680.00.00.0260.029622750.01780.0858660.01670.02,8328

    50.000.000.000.00.000.0000000.00006.330.00.000.406.335950.0400.01750.0480.02170.0890.01750.0680.00.00.0490.03300.02360.01650.01,106720.0870.02,8827

    60.000.000.000.00.000.0000004.59008.610.00.000.828.6161410.0770.02290.0220.02450.01290.02420.01100.00.00.0390.021812250.01850.092980.00.0850.02,8769

    70.000.000.000.00.000.0000008.130011.630.00.001.2311.6371630.0830.02000.0390.02710.01700.01620.01150.00.00.0680.024622940.01570.01,37616120.0830.03,43918

    80.000.000.000.00.000.0020.40816326530000.00008.760.00.001.8220.4181300.0670.02070.0340.02290.01820.019641110.00.00.0390.02830.02570.01530.01,2551170.0750.03,22515

    90.000.000.000.00.000.0000000.00009.940.00.000.629.9491080.0270.02590.070.02250.01360.01330.0900.00.00.0640.03190.02440.01820.01,6091670.01470.03,55716

    100.000.000.000.03.450.0000002.940012.650.00.001.1912.65102370.0550.02500.0340.029011530.01570.0920.00.00.0830.034012300.01020.02,2932940.01000.04,42031

    110.000.000.000.00.000.0000003.398.7336244541016.490.00.001.7916.49111600.0910.03010.0330.06950.01520.01690.01110.00.00.01140.029512292970.01,334220.00.01010.03,88225

    120.000.000.000.00.000.0000000.00005.660.00.000.355.66123060.0470.02820.040.02760.01400.0830.0790.00.00.0440.01720.03920.01600.01,59190.00.01550.03,7319

    JUMLAH2,0040.07750.02,7000.02720.03,20111,5230.01,76741,87050.00.06520.03,30773,12021,8580.015,687188420.01,383140,161208

    1.17

    1,49925

    2,0692,05827

    1,15317

    1,0286

    2,1541,3497

    1,2818

    1,65316

    1,56215

    1,83216

    2,54229

    1,61422

    1,7539

    19,324197

    0.00.0

    Insiden rateBenchmark 6.16)

    11.673.56.16

    21.643.56.16

    31.993.56.16

    40.863.56.16

    50.403.56.16

    60.823.56.16

    71.233.56.16

    81.823.56.16

    90.623.56.16

    101.193.56.16

    111.793.56.16

    120.353.56.16

    INFEKSI RSCM PER BLN

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    11

    12

    JML HARI PEMASANGAN CVL/1000

    INSIDEN RATE IAD DI DEPT/UPT/UNIT KERJA TAHUN 2012

    2011-2012

    Insiden rate

    Benchmark

  • Pengertian

    Adalah ditemukannya organisme dari hasil kultur darah semi- kuantitatif/kuantitatif disertai tanda klinis yang jelas serta tidak ada hubungannya dengan infeksi ditempat lain dan/atau dokter yang merawat menyatakan telah terjadi infeksi. Pada pasien yang terpasang kateter intra vaskuler setelah 48 jam

    DOK.GR 2013

  • Terdapat kuman pathogen yang diketahui hasil satu kali atau lebih dari biakan darah dengan salah satu gejala klinis seperti: * demam< 38C* menggigil* hipotensi Pada pasien berumur < 1 tahun paling sedikit satudari tanda-tanda : * demam > 38C* hipotermia < 37C* apneu * bradikardia

    Kriteria Klinis IADP

    DOK.GR 2013

  • Kriteria Klinis IADPIAD secara laboratorik dianggap positif bila ditemukan salah satu). a. Hasil kultur darah dari dua tempat yang berbeda dalam waktu yang bersamaan, mendapatkan kuman yang sama, b. Hasil kultur darah dua kali berturut-turut pada waktu yang berbeda ditemukan kuman yang sama, c. Hasil kultur pembuluh darah central dan perifer ditemukan kuman yang sama.d. Tidak ditemukan sumber infeksi selain pemasangan kateter vascular.e. Didapatkan bakteri pathogen dalam kultur darah.

    DOK.GR 2013

  • Gaynes R : UpToDate 2002; 10:1Patogenesis

    DOK.GR 2013

  • Sources of intravascular catheter infectionSkinVeinIntraluminal from tubes and hubsHaematogen from distant sitesExtraluminal from skin

    DOK.GR 2013

  • DOK.GR 2013

  • Faktor resikoSemua pasien yang menggunakan alat intravaskuler dalam waktu > 2 X 24 jam Faktor risiko adalah : Lamanya terpasang kateterLamanya hari perawatanKondisi penurunan daya tahan tubuh (immunocompromised)MalnutrisiLuka bakar Luka operasi tertentu

    DOK.GR 2013

  • Incidence density Events per 1000 device-daysCentral venous catheter (CVC)2.7/1000 catheter-days

    PICCs2.1/1000 catheter-days

    Tunneled CVCs1.6/1000 catheter-days

    Peripheral venous catheters0.5/1000 catheter-days

    Implantable port systems0.1/1000 catheter-daysINSIDEN IADPMaki. Mayo Clin Proc 2006;81:1159

    DOK.GR 2013

  • Central Line Bundle/IV BundleIHI (institute Healtcare Improvement) tahun 2006

    DOK.GR 2013

  • Hand HygieneKebersihan tangan harus dilakukan sebelum dan sesudah palpasi, pemasangan alat/set intra vena, penggantian alat/set intra vena, atau memasang perban

    DOK.GR 2013

  • Gunakan APD: steril : Gaun,sarung tangan, steril drapeTidak steril: Topi, makser, Maksimal Penggunaan APDPemasangan CVC dilakukan di Kamar Operasi

    DOK.GR 2013

  • Gunakan antiseptik alkhol 70 %, iodine,atau chlorhexidine 2 % sebelum insersi kateter lakukan insersi jika desinfektan sudah keringJika kontra indikasi gunakan chlorxedine >0,5 % atau alkohol 70 % atau alternatif lain

    Preparasi kulit

    DOK.GR 2013

  • Pemilihan Tempat Insersi yang OptimalPilih lokasi insersi kateter Vena sentral, pada pasien dewasa hindari vena FemoralPilih vena subclavia risiko infeksi lebih kecil daripada vena jugularis interna

    DOK.GR 2013

  • Observasi lokasi insersi setiap hariDOK.GR 2013Pertimbangkan melepaskan Kateter segera jika sudah tidak ada indikasiKaji tanda-tanda infeksiBila pemasangan cateter vena sentral dalam kondisi emergensi,kesterilan alat tidak dijamin,harus diganti dalam waktu 48 jamSemua perangkat/kateter set harus diganti jika diduga ada infeksi aliran darah

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHORekomendasi Umum dalam Pemakaian Alat IntraveskulerPendidikan dan Pelatihan Petugas MedisPendidikan dan pelatihan berkelanjutan bagi petugas medis terkait indikasi pemakaian alat intravaskuler,prosedur pemasangan,perawatan luka insersi dan peralatan intravaskuler.

    Metode audio visual dapat digunakan sebagai alat bantu yang baik dalam pendidikan ( Kategori I)

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHO

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHOPengganti perlengkapan dan cairan intravenaSecara umum ,set perlengkapan intravaskuler terdiri atas seluruh bagian mulai dari ujung selang yang masuk ke kontainer cairan infus sampai ke hubungan alatGanti selang penghubung tersebut bila alat vaskuler diganti.Ganti selang IV, termasuk selang piggyback dan stopcock, dengan interval yang tidak kurang dari 72 jam, kecuali bila ada indikasi klinis.Ganti selang yang dipakai untuk memasukkan darah, komponen darah atau emulsi lemak dalam 24 jam dari diawalinya infus.

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHOPenggantian alat administrasi setSet administrasi diganti tidak kurang dari 72 jamSet administrasi untuk transfusi darah, produk darah ,emulsi lemak dalam waktu 24 jamIntermiten infus dalam 24 jam

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHOBila hanya emulsi lemak yang diberikan, selesaikan infus dalam 12 jam setelah botol emulsi mulai digunakan .

    Infus harus diselesaikan dalam 24 jam untuk satu botol cairan parentral yang mengandung lemak.CAIRAN PARENTERAL

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHOPort Injeksi IntravenaBersihkan port injeksi dengan alkohol 70 % atau povidone -iodine sebelum mengakses sistem harus di desinfektan tunggu sampai kering.Campurkan seluruh cairan parentral di bagian farmasi dalam Laminar flow hood menggunakan tehnik aseptik

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHODOK.GR 2013Menggunakan vial multi dosisDinginkan dalam kulkas vial multi dosis yang dibuka, bila direkomendasikan oleh pabrik. Bersihkan karet penutup vial multi dosis dengan alkohol sebelum menusukkan alat ke vial Gunakan alat steril setiap kali akan mengambil cairan dari vial multi dosis, dan hindari kontaminasi alat sebelum menembus karet vial. Buang vial multi dosis bila sudah kosong, bila dicurigai atau terlihat adanya kontaminasi, atau bila telah mencapai tanggal kadaluarsa.

    DOK.GR 2013

  • Pencegahan IADP Rekomendasi WHOProfilaksis AntimikrobaJangan memberikan antimikroba sebagai prosedur rutin sebelum pemasangan atau selama pemakaian alat intravaskuler untuk mencegah kolonisasi kateter atau infeksi bakterimia .

    DOK.GR 2013

  • Dua jalur utama patogenesis Infeksi Aliran Darah Primer : pertama kolonisasi lokasi insersi kateter, kedua kolonisasi hub

    Lokasi insersi seringkali tidak menunjukkan gejala sehingga diagnosis Infeksi Aliran Darah Primer bergantung pada hasil mikrobiologis(kultur)

    Perlunya pemahaman dalam pelaksanaan pengendalian infeksi dengan tehnik aseptik yang benar.

    Pelatihan, pendidikan dan surveilans terhadap CA-BSI dan CR-BSI dapat menurunkan insidens

    Kateter dengan lapisan antibiotik hanya diperlukan bagi pasien berisiko tinggi atau jika metode lain telah gagal.

    Kesimpulan

    DOK.GR 2013

  • Cara Perhitungan Laju infeksi: Numerator x 1000=..... Denominator

    Jumlah kasus IADP x 1000 =..... Jumlah hari pemakaian alat

    DOK.GR 2013

  • DOK.GR 2013

    *[Title: View, Header and Footer, Notes and Handouts]**The central line bundle is a package of interventions that reduce the risk of the harm associated with having a central line placed and used.The risk of bloodstream infection is reduced by ensuring hand hygiene among staff, always using maximal barrier precautions at the time of placement, cleansing sites with chlorhexidine rather than other antiseptics, selecting the appropriate site, and reviewing daily.**