Mikrobiologi Dasar Terkait Pelayanan CSSD [PDF]

Citation preview

MIKROBIOLOGI DASAR TERKAIT PELAYANAN CSSD dr. ELITA DEVINA, Sp.MK LAB.MIKROBIOLOGI KLINIK RSUD SIDOARJO INHOUSE TRAINING CSSD 2018



SARS CoV-2003



Avian Influenza 2005



H1N1 Swine Flu-2009



MERS-CoV 2012-2014



Talaro and Chess, 2015



Evolutionary Timeline



Talaro and Chess, 2015



Fransisco Redi’s Experiment



Abiogenesis Theory



Pasteur and Theory of Germ



“Generatio Spontanea Theory” Talaro and Chess, 2015



Size comparison of viruses with a yeast cell and Bacteria



Talaro and Chess, 2015



VIRUS



VIRUS STRUCTURE: Consist of nucleic acid/ genome, surrounded by a protein coat



 Virion: the intact virus particle



 Capsid: the protein coat  Capsomeres: the protein structural units of capsid  Nucleic acid genome: either DNA or RNA  Envelope: some virus particles are surrounded by a lipoprotein envelope; containing viral antigens



Talaro and Chess, 2015



Virus Replication



Talaro and Chess, 2015



Viruses enter the body through 4 main ways: Inhalation: via respiratory tract.  Ingestion: via gastrointestinal tract.  Inoculation: through skin abrasions, mucous membranes (e.g. sexual); transfusion; injections; transplants; via the bite of an arthropod.  Congenital: i.e. from mother to fetus.



EFFECTS OF VIRUSES ON CELLS 1. Death: the infection is lethal; causes a cytopathic effect (CPE) which kills the cell; e.g. multinucleated giant cells/ syncitia, inclusion bodies. 2. Transformation: the cell is not killed, but is changed from a normal cell to a malignant or cancerous cell.



3. Latent infection: virus remains within the cell in a potentially active state, but produces no obvious effects on the cell’s functions. 4. Haemadsorption: some viruses have haemaglutinin in their outer coats adheres to erythrocytes agglutination



Cytopathic changes in cells and cell cultures infected by viruses



Talaro and Chess, 2015



Effect of Physical and Chemical Agents on Viruses  Heat: most are



inactivated at 56oC for 30 min or 100oC for a



few seconds.  Cold: stable at low temperatures, can be stored at -70oC for years.  Drying: variable  Ultraviolet: inactivates viruses



 Chloroform, ether and other organic solvents: enveloped viruses are inactivated; those without envelopes are resistant  Oxidizing & reducing agents: viruses are inactivated by formaldehyde, chlorine, iodine & hydrogen peroxide



(Effect of



Physical and Chemical Agents on Viruses)



 Phenols:



most viruses are relatively resistant.



 Virus desinfectants: the best are hypochlorite solution & glutaraldehyde. corrosive Sensitization & irritation to users



Virus HAI’s – Adenoviral pharyngitis – Influenza virus – Parainfluenza virus – Hepatitis A virus – Hepatitis B virus – Hepatitis C virus – HIV



BACTERIA



Morphology of Bacteria



Talaro and Chess, 2015



Bacterial Structures



Bacteria Cell Wall



Madigan, et al, 2015



Endospore Formation



Plasmid (mobile genetic material)



Mechanism of Bacterial Transfer Gene



Reproduction of Bacteria



DEFINISI



FLORA NORMAL KOLONISASI PATHOGEN PATHOGEN POTENSIAL OPPORTUNISTIC PATHOGEN INFEKSI PENYAKIT INFEKSI PATHOGENITAS



DEFINISI



FLORA NORMAL PADA TUBUH MANUSIA FLORA NORMAL : mikroba yang hidup pada kulit dan selaput lendir manusia dalam keadaan normal / sehat Ada 2 kelompok mikroba : 1. RESIDENT FLORA (FLORA TETAP) : mikroba yang secara normal menetap pada bagian tubuh tertentu



2. TRANSIENT FLORA (FLORA SEMENTARA) : mikroba non pathogen atau potensial pathogen yg tinggal di kulit atau selaput lendir selama kurun waktu tertentu yg berasal dari lingkungan Bila resident flora berubah, maka transient flora dapat membentuk kolonisasi, berkembang biak dan menimbulkan penyakit



The origins of microbiota in newborns



Talaro and Chess, 2015



DEFINISI



KOLONISASI: - MIKROBA



(+) → MINGGU → BULAN → TAHUN - Tidak ada luka, tidak invasi jaringan



Bacterial interactions with mucous membranes



BIOFILM FORMATION



Talaro and Chess, 2015



Biofilms Formation



Talaro and Chess, 2015



DEFINISI



PATHOGEN: ORGANISME YG MENYEBABKAN SAKIT PADA SUSCEPTIBLE HOST



PATHOGEN POTENSIAL: FLORA NORMAL, tapi pada keadaan tertentu dapat mengalahkan pertahanan tubuh host dan menyebabkan sakit



OPPORTUNISTIC PATHOGEN: - NORMAL HOST



TAK SAKIT - HOST DENGAN SISTEM IMUN ↓ → SAKIT



DEFINISI



INFEKSI: Proses masuknya organisme ke dalam host, invasi dan multiplikasi - LUKA / INVASI → JARINGAN RUSAK OLEH MIKROBA



PENYAKIT INFEKSI : Manifestasi klinis dari kerusakan atau gangguan struktur dan fungsi sel dan jaringan akibat proses infeksi. (+ symptoms, + signs, + syndromes)



Ten most common pathogens that account for 84% of all HAIs (n=33.848) • • • • • • • • •



Coagulase-negative staphylococci (15%) Staphylococcus aureus (15%) Enterococcus species (12%) Escherichia coli (10%) Pseudomonas aeruginosa (8%) Klebsiella pneumoniae (6%) Enterobacter species (5%) Acinetobacter baumannii (3%) Klebsiella oxytoca (2%) Infect Control Hosp Epidemiol 2008; 29:996-1011



Talaro and Chess, 2015



KAITAN CSSD dengan KUALITAS PELAYANAN terhadap KESELAMATAN PASIEN dan PENGENDALIAN INFEKSI



KESELAMATAN PASIEN



PENGENDALIAN



INFEKSI CSSD



KUALITAS PELAYANAN RS



FIVE FOR LIVE – LIVE IS FIVE 1



2



3



4



5



• Keselamatan pasien dari injury / cedera, infeksi akibat paparan darah/cairan tubuh, keparahan penyakit. • Keselamatan petugas dari cedera



• Keselamatan institusi, mencegah tuntutan hukum



• Keselamatan lingkungan , lingkungan bebas polutan



• Keselamatan bisnis RS memenuhi harapan semua fihak



SASARAN KESELAMATAN PASIEN



• Sasaran 1 • Sasaran 2 • Sasaran 3 • Sasaran 4 • Sasaran 5



• Sasaran 6



: Ketepatan identifikasi pasien : Komunikasi yang efektif : Keamanan obat yang perlu diwaspadai (high-alert) : Kepastian tepat-lokasi, tepatprosedur, tepat-pasien operasi : Pengurangan risiko infeksi terkait pelayanan kesehatan : Pengurangan risiko pasien jatuh



Prinsip Pencegahan & Pengendalian Infeksi



Benda Asing Tertinggal • Kasus di AS  28,4 juta pasien ranap operasi  1.550 kasus tertinggal benda asing  Hanya 0,005458% • Tidak luar biasa, tapi sangat berbahaya dan merugikan RS



Karakteristik Kasus Tertinggal Benda Asing (Massachusetts, 2001) Karakteristik



Kasus (%)



Jenis Benda Asing yang Tertinggal:  Kasa  Clamp  Lainnya (Mis: Retraktor, Elektrod)



69 7 24



Rongga Tempat Benda Asing Tertinggal:  Abdomen atau pelvis  Vagina  Toraks  Lainnya



54 22 7 17



Outcome: Meninggal Rawat ulang, LOS yang panjang, Sepsis atau infeksi  Operasi ulang  Fistula atau obstruksi usus halus  Perforasi viscera



2 59 43 69 5 7



INFEKSI PEMBEDAHAN  Sebagian besar infeksi tempat pembedahan disebabkan oleh masuknya mikroorganisme ke dalam luka operasi pada saat di kamar bedah (Nichols RL dlm Bennet JV & Brachman PS, 1992:463)



Lingkungan 5% Alkes/Linen



Petugas



10%



35% Pasien 50%