Criterion 5.5.3
Community health centers that reduce the risk of infection related to health services need to implement and implement PPI programs to reduce the risk of infection for patients, staff, patient families, the community and the environment.
1) Main Thoughts:
a) The infection prevention and control program at the Community Health Center is a program carried out to identify and reduce the risk of contracting and transmitting infections among patients, staff, families, communities and the environment through the implementation of isolation precautions consisting of standard precautions and transmission-based precautions, use of antimicrobials wisely, and bundles for healthcare-associated infections.
b) The implementation of the program needs to be monitored continuously to ensure consistent implementation.
c) Standard Precautions are implemented in accordance with the provisions of laws and regulations through the following:
(1) Hand hygiene
Hand hygiene is a very effective way to prevent infection that must be carried out by health workers, patients, visitors and the wider community. Implementation and education about hand hygiene needs to be carried out continuously so that it can be implemented consistently.
(2) Use personal protective equipment (PPE) correctly and according to indications
Personal protective equipment (PPE) is used correctly to prevent and control infections. The PPE in question includes headgear (hats), masks, goggles (face shields), gloves, protective gowns, protective shoes used appropriately and correctly by Puskesmas staff, and used according to indications in providing patient care.
(3) Coughing and sneezing etiquette
Coughing and sneezing etiquette is applied to everyone in cases of infection by droplet or airborne transmission. When coughing or sneezing, a person must cover their nose and mouth with a tissue or sleeve under their clothes, immediately throw the used tissue in the trash, then wash their hands using clean water and soap or alcohol-based hand sanitizer, and must wear a mask.
(4) Correct patient placement
Patients with infectious diseases should be placed separately from patients without infectious diseases. Patient placement must be adjusted to the infection transmission pattern and should be placed in a separate room. If a separate room is not available, cohorting can be done. The distance between one patient's bed and another is at least 1 meter.
(5) Safe injection
Safe injection procedures need to pay attention to the sterility of the equipment used and the injection procedure. The use of sterile syringes and needles must be single use and this also applies to the use of multidose vials to prevent microbial contamination when the drug is used on patients. Safe injections based on PPI principles include:
(a) apply aseptic techniques to prevent contamination of injection equipment;
(b) all syringes used must be single use for one patient and one procedure, even if the syringe is different;
(c) use a single dose for injection drugs and flushing fluids;
(d) mixing of drugs is carried out in accordance with statutory regulations; And
(e) management of used sharps waste needs to be managed properly in accordance with statutory regulations.
(6) Properly decontaminate patient care equipment.
Reducing the risk of infection is carried out by decontamination activities through pre-cleaning, cleaning, disinfection and/or sterilization with reference to the Spaulding category which includes:
a) critical, relating to medical devices used on sterile tissue or blood vessel systems using sterilization techniques, such as surgical instruments and parturition sets.
b) semicritical, relating to equipment used on mucous membranes and small areas of abrasion skin using high-level disinfection (DTT), such as oropharyngeal airway (OPA)/Guedel, tongue depressors, and dental mirrors.
c) non-critical, relating to equipment used on body surfaces in contact with intact skin to carry out low-level disinfection, such as blood pressure monitors or thermometers.
The decontamination process includes the following actions.
(a) Initial cleaning is carried out by officers at the workplace using PPE by cleaning themselves of all dirt, blood and body fluids with running water and then transporting them to the cleaning, disinfection and sterilization site.
(b) Cleaning is a physical process of removing all dirt, blood, or other body fluids from the surface of equipment manually or mechanically by washing the equipment clean with detergent (disinfectant and chlorine group with composition in accordance with applicable standards) or enzymatic solution, and drained before disinfection or sterilization.
(c) High level disinfection is carried out for semicritical equipment to remove all microorganisms, except for some endospore bacteria by boiling, evaporating, or using chemical disinfectants.
(d) Sterilization is the process of removing all microorganisms, including endospores, using high pressure steam (autoclave), dry heat (oven), chemical sterilization, or other sterilization methods. Environmental decontamination is the cleaning of environmental surfaces around the patient from possible contamination of blood, blood products, or body fluids. Cleaning is carried out using a disinfectant liquid such as 0.05% chlorine for environmental surfaces and 0.5% for environments contaminated with blood and blood products. Apart from chlorine, other disinfectants can be used according to the provisions.
(7) Proper management of linen
Good and correct management of linen is one effort to reduce the risk of infection. Linen is divided into non-infectious dirty linen and infectious dirty linen. Infectiously dirty linen is linen that has blood or other body fluids on it. Handling linen that has been used must be done carefully. This precaution includes the use of PPE by officers who manage linen and hand hygiene in accordance with IPC principles, especially for infectious linen. Health facilities must create management regulations. Linen management includes managing linen in the room, transporting linen to the washing/laundry room, and managing linen in the washing/laundry room. The principle that must be considered in managing linen is to always separate clean linen, dirty linen and sterile linen. In other words, each group of linen must be placed separately.
(8) Waste management properly and in accordance with statutory regulations
Puskesmas produce waste every day, especially infectious waste, sharp objects and needles which, if disposal is carried out incorrectly, can pose a risk of infection. Infectious waste management includes the management of infectious body fluid waste, blood, laboratory samples, sharp objects (such as needles) in special storage (safety boxes), and B3 waste. Education process for employees regarding safe management, availability of special storage areas, and reporting exposure to infectious waste or needle sticks and sharp objects. Waste management includes the following waste:
(a) Infectious waste is waste contaminated with blood and body fluids, laboratory samples, blood products, etc. which are placed in yellow plastic bags and processed in accordance with statutory provisions.
(b) Sharps waste is all waste that has sharp surfaces which is placed in a special puncture-resistant and waterproof storage (safety box). Storage should not exceed ¾ of the contents of the storage box.
(c) Infectious liquid waste is immediately disposed of at a liquid waste disposal site (spoel hoek).
(d) Waste management includes identification, storage, transportation, temporary storage and final processing of waste.
In carrying out their service duties, health workers need to be protected from exposure to infection.
Officer protection is carried out through regular checks, vaccination and protection, as well as follow-up if exposure occurs.
(9) Protect personnel against infection
Health workers in carrying out their service duties need to be protected against exposure to infection. Officer protection is carried out through regular inspections, vaccination, and protection and follow-up if exposure occurs.
d) The implementation of standard precautions needs to be monitored by the PPI team or officers who are given responsibility so that they are carried out periodically in the implementation of Puskesmas service activities.
Assessment Elements:
a) There is evidence of implementation and monitoring of Standard precautionary principles in accordance with the Main Ideas in numbers (1) to (9) in accordance with established procedures (R,D,O,W).
b) If there is management in Principles number (6) to number (8) which is carried out by a third party, the Puskesmas must ensure that quality standards are implemented by the third party in accordance with the provisions of statutory regulations (D,W).
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