Alur Kerja

Unit Sterilisasi
Ammar Widitaputra
Tujuan
Tujuan Umum: Menjelaskan Alur Kerja Layanan Sterilisasi

Tujuan Khusus:
▪ Alur Layanan sterilisasi
▪ Sarana
▪ Prasarana
Fasilitas CSSD
Harus tersedia

Sterilisasi hanya dapat dilakukan dengan fasilitas yang tepat

Membangun fasilitas bersama dengan membangun budaya

Sir Cecil Clothier, 1980
Insiden Kematian 5 Pasien di Inggris Raya karena Sterilisator yang Tidak
Berjalan Baik
“The fundamental cause of this disaster is to be Sebab fundamental
found in human failings ranging from simple ◦ Ketidakpeduliaan pada SDM dan Mesin
carelessness to poor management of men and
plant.
The Committee heard of no imminent Komite PPI
technological advance in the field of production of ◦ Sterilisasi membutuhkan SDM yang berkualitas
intravenous fluids which will eliminate the need
for skilful men devoted to their work . . .
Fakta di Lapangan
Too many people believe that sterilization of fluids ◦ Sarana yang kecil (tidak memadai)
is easily achieved with simple plant operated by ◦ Supervisi yang rendah (SDM tidak memenuhi
men of little skill under a minimum of supervision syarat)
. . . Public safety in this, as in many other
technological fields, depends ultimately on
untiring vigilance . . . ”
NHS melakukan perbaikan dan tidak ditemukan
lagi kematian karena sterilisator . Health
Technical Memorandum 10.
CSSD, Autoclave
Medical Device Class II
Class II devices are those for which general controls alone
cannot assure safety and effectiveness, and existing methods
are available that provide such assurances.

In addition to complying with general controls, Class II devices

are also subject to special controls

Special controls may include special labeling requirements,

mandatory performance standards.

Devices in Class II are held to a higher level of assurance than

Class I devices, and are designed to perform as indicated
without causing injury or harm to patient or user.

AUTOCLAVE BUKAN MESIN PEMANAS AIR ATAU MESIN

PRESTO
AUTOCLAVE BUTUH VALIDASI YANG TEPAT
Lokasi CSSD
Kemudahan Akses

User CSSD; Kamar Operasi, IGD

Utilitas; Air, Listrik, Steam

Dasar One Way Flow
Pemisahan daerah kotor, bersih dan steril
Alur barang masuk dan keluar melalui pintu yang berbeda
Pemisahan antara barang bersih dengan barang steril
Menghindari kontaminasi silang
Pengendalian jumlah mikroba
Sesuai kaidah Dalin
Alur Perpindahan Barang Satu Arah
(One Way Flow)
Unit Pengguna
Reproses barang atau alat yang
dipakai :
Instrumen, kontainer,
Daerah Dekontaminasi
perlengkapan
•Penerimaan barang
•Penyortiran
•Perendaman
•Pembersihan
•Pembilasan
Daerah Steril
•Pemeriksaan
•Penyususnan alat
•Pengemasan
•Pelabelan
Proses•Sterilisasi
Penyimpanan
•Penyimpanan
steril
•Penyiapan
•Distribusi
•Pengiriman
Unit Pemakai
Denah CSSD
dengan
Mesin 2
Pintu
Denah CSSD
dengan
Mesin 1
Pintu
Denah GBPT Lantai I
 WHO - Lingkungan CSSD
Surfaces
All surfaces in the reprocessing space must be smooth, straight and
easy-to-clean without cracks and pores and be able to withstand
chemical disinfection. They must be made from waterproof
materials that are compatible with cleaning agents used. Wood and
laminates are not recommended because they absorb water and
chemical solutions. Stainless steel is recommended for work
surfaces, sinks and equipment coating as these are easiest to clean.
Ceilings
All ceilings must be smooth, straight, without cracks and should be
moisture-proof. Panel ceilings are not recommended directly over
the clean and sterile working areas as these release dust and debris
when disturbed.
Walls
Walls should be continuous as far as is practical, smooth (no peeling
of paint), straight and coated with washable paint or material. The
corners should be protected with metal ridging or similar to prevent
damage from carts and trolleys.
Floors
All floors should be straight, smooth, without cracks and able to
withstand the load of heavy carts transported across them. The
floor should be continuous with a non-slip finish, especially in the
decontamination and cart washing areas. The corners should be
covered and the flooring should rise up along the wall to ensure
easy and complete cleaning. There should be no sharp corners that
allow the collection of moisture, dirt and dust.
Ventilation
Mechanical or controlled ventilation is recommended for SSD areas
as they are demarcated into dirty and clean areas and have different
ventilation requirements in each of these sections. Turbulent air
flow and the use of portable fans are not allowed in any area of the
SSD because rapid, uncontrolled air circulation can spread
contamination. Ventilation systems must be cleaned, tested and
maintained according to the manufacturer’s instructions. There
must be a clear maintenance plan in each SSD to ensure that the
ventilation air-handling unit functions optimally.
 Ventilasi

RH.
Rekomendasi 40-50%. Negara tropis 70%
Bangunan CSSD
Unrestricted Zone
Semi restricted Zone

Traffic pattern, lalu lintas

petugas/ barang
Signage, penandaan
One Way Flow
▪ Alur proses kerja berhubungan erat dengan alur one way flow
▪ Mencegah kontaminasi

▪ Membedakan area kotor dan bersih

▪ Barrier fisik atau dinding untuk memisahkan area fungsional; area kotor, area bersih, area
penyimpanan steril
The Unrestricted Area
Locker rooms
◦ street clothes are allowed in this area
◦ traffic is not limited

Entrance to the sterile processing area is restricted to authorized personnel only

The Semirestricted Area
Includes all work areas for processing surgical instruments and storage areas for clean and
sterile supplies
◦ traffic is only allowed for authorized team members
◦ team members wear hospital laundered scrub attire, no outside clothes
◦ head and facial hair is covered
◦ masks are not required on the clean side
Penandaan
Garis Merah – Red Line
Menggunakan APD lengkap
Hand Hygiene Facilities
The Red Line
Fasilitas Minimum
Kesimpulan
Terima Kasih
Diskusi, Pertanyaan?