Df- Amrin 7 Nov 2008 Program Pengendalian Resistensi Antimikroba Di Rs

Peran Komite Medik dalam Pelaksanaan Program Pengendalian Resistensi Antimikroba

Dr. Dody Firmanda, Sp.A, MA Ketua Komite Medik RSUP Fatmawati, Jakarta http://www.esnips.com/web/komitemedik Disampaikan pada pertemuan Amrin (Antimicrobial Resistance of Indonesia) Diselenggarakan oleh Direktorat Bina Medik Spesialistik Depkes RI di Hotel Horison Bekasi 6 – 8 November 2008.

Clinical Leadership

Gambar 1. Konsep dan Filosofi Komite Medik RS: Etika, Mutu dan Evidence-based Medicine (EBM)

(untuk RS pendidikan)

KOMITE MEDIK: SISTEM CLINICAL GOVERNANCE, PATIENT SAFETY & CP

/ Adverse Events

Surveilans Infeksi Nosokomial

High Impact Interventions

Process: Implementation of Patient Safety

1

2

5

3 4

Peran Komite Medik: Menegakkan Etik dan Mutu Profesi Program Pengendalian Resistensi Antimikroba 1. Daftar Formularium RS 1. Audit Medis 2. SPM/SPO 2. Clinical Risks 3. CP: Penyakit Management Infeksi & Tropis 3. Safety 4. Surveilans Infeksi Nosokomial 5. High Impact Interventions

1. Seleksi Antibiotik 2. Penggunaan Antibiotik 3. Penyebaran Mikroba

Surveilans Infeksi Nosokomial

High Impact Interventions

Program Pengendalian Resistensi Antimikroba 1. Daftar Formularium 2. SPM/SPO

1. Audit Medis 2. Clinical Risks Management 3. Patient Safety

1. Seleksi 2. Penggunaaan 3. Penyebaran

1. Surveilans 2. High Impact Interventions Clinical Pathways: Penyakit Infeksi dan Tropis

Terintegrasi secara ko-ordinasi dan ko-operasi

“span& spin ofcontrol ”

“Patched-in” “Patched-in”

2005 -2008

MILIK KOMITE MEDIK RSUP FATMAWATI

Pola Kuman 2005

Jenis Kuman Menurut Bahan RSUP Fatmawati Jakarta Januari - Desember 2005

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2005

Pola Kuman 2006

Gram negatif 80.8%

Gram positif 19.2%

0.8% S.typhi A S.rubidiae .hinshawii S.enteritidis 1.3% 1.0% 1.0% 1.1% K.ozaenae E.gregov iae 1.8% P.aeruginosa 2.1% 2.4%

S.aureus 17.0%

P .stuart ii 0.2%

S.liquifaciens 2.9%

S.saprophyticus 3.4%

C.amalunat ycus 0.2%

P .mirabilis 3.6%

E.co li 21.4%

S.marces ens 9.2% K.pneumo niae 9.5%

β-haemolyt icus 23.4% S.epidermidis 55.1%

Pseudo mo nas sp. 21.2% E.aerogenes 19.9%

Jenis Kuman Menurut Bahan RSUP Fatmawati Jakarta Januari - Desember 2006

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2006

Pola Kuman 2007 Gram negatif 74.37%

Gram pos itif 25.63%

GRAM NEGATIF

GRAM POSITIF

S.mar cesens

K . pneumoni ae

4. 1%

11. 3%

S. l i qui f ac i ens K .ozaenae

7. 3% P.mi r abi l i s

Pseudomonas sp.

S.sapro phyticu s 22%

S.aureus 9%

Staphylo co ccu s sp 0%

3.6%

4. 6%

17.4%

P. aer ugi nos a 2. 6%

S.βhaemo lyticus 40%

E . cl oac ae 1. 5% S.typhi 1. 2% E . gr egov i ae 0.9% C.f r eundi i 0.7% M . mor gani i 0. 3%

E .aer ogenes 19. 5%

P.vul gar i s 0. 3%

S.epidermidis 29%

K.oxytoca 0. 2% E.col i 23.5%

S. r ubi di ae

E. sakazaki i

0. 2%

0.2%

S.ent er i t i di s

C.di ver sus

0. 2%

0.2% P.stuar ti i

P .r ettger i

0. 2%

0. 2%

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2007

Pola Kuman Januari – Juni 2008 Gram ne gatif 77%

Gram pos itif 23% P. mirabilis

GRAM NEGATIF

GRAM POSITIF

4.0% S. liquef aciens 3.8% E. ger goviae 2.8%

S. marcescens Pseudomonassp. 8.7%

S. bet a-haemol yti c 28%

E. cloacae

7.5%

2.6% S. rubidaea

P. aer uginosa 10.9%

2.6%

S. epi der mi di s

K. ozaenae

43%

1.3% P. Al calif aciens 0.6%

K. pneumoniae 13.3%

C. f reundii 1.0% C. diver sus

S. bet a-haem. Gr oup A

0.6%

0%

P. f luor escens

S. sapr ophyti cus

0.4%

20% S. aur eus S. non-haemol yti c (gamma)

6%

E. aggl omer ans 0.4%

E.aer ogenes 16.6%

S. Typhi 0.4%

3%

E.coli 21.4%

E.coli, ent er opat hogenic 0.3%

Al caligenes sp. 0.1% E. sakazakii 0.3%

Pr ot eusvulgar is 0.3%

Jenis Kuman Menurut Bahan RSUP Fatmawati Jakarta Januari - Desember 2008

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2008

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001) IADP : 6%

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001) Phlebitis : 5%

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001) ISK : 25%

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001) ILO : 12 %

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001) VAP : 50%

Golongan

Lantai 4

Lantai 5

Lantai 6

Jumlah

Certriaxone

Sefalosporin

87

64

73

224

Cefotaxim

Sefalosporin

0

44

0

44

Ciprofloxacin

Kuinolon

66

40

28

134

Meiact

Sefalusponin

28

0

0

28

Ceftazidin

Sefalosporin

18

0

4

22

Lacedim

Sefalosporin

1

0

0

1

Ceftum

Sefalosporin

3

0

0

3

6 Guns

Sistem satu pintu obat, Penggunaan seleksi obat antibiotika dan biaya obat

Form: Clinical Pathwaysof Pneumonia

Variances ANTIBIOTIC DRUGS 70 %

Cephalosporin 16% Amoxycillin 14%

Peningkatan SDM Sub Komite Pengendalian Infeksi Komite Medik RSUP Fatmawati 6 orang Certificate of Achievement dari Asia Pacific Society of Infection Control 1. 2. 3. 4. 5. 6.

Dr. Pratiwi Andayani, Sp.A Dr. Sjafruddin, Sp.THT Dra. DebbieDaniel, Apt, M.Epid. Zr. Salfitriawati Arwan, SKep Zr. Minarni, AMK Zr. Ni Nyoman Sriadi

Langkah Berikutnya Komite Medik RSUP Fatmawati

PENGEMBANGAN

WORLD CLASS HOSPITALS

Dr. Dody Firmanda, Sp.A, MA Ketua Komite Medik RSUP Fatmawati Jakarta

WORLD CLASS HOSPITALS DEFINITION(S) world-class adj. (of a person, thing, or activity) of or among the best in the world.

hos·pi·tal

n. 1. an institution providing medical and surgical treatment and nursing care for sick or injured people. 2. hist. a hospice, esp. one run by the Knights Hospitallers. © The Oxford Pocket Dictionary of Current English 2008, originally published by Oxford University Press 2008

WHO Europe : Performance Assessment Tools for Hospitals

(PATH)

Model Komite Medik RSUP Fatmawati

PATH

dengan

ClinicalPathways

Semoga Bermanfaat Jakarta, 7 November 2008 dodyfirmanda