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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
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.**