TUBERCULOSIS

INFECTION PREVENTION
AND CONTROL

ARIEF BAKHTIAR
PELATIHAN TB DOTS
2019
 Dr. Robert Koch

• Myc tb, was

identified and
described on
March 24, 1882
• Nobel Prize in
physiology or
medicine in 1905
IT’S NOT
HOAX !!!

Undiagnosed TB Facts about TB:

Undiagnosed TB
• 10.4 million cases per year
• Most common cause of death
among HIV
Untreated TB • > 4 million never get
MDR diagnosed and treated
(WHO Global TB report 2017)
All cases of TB
 WHAT IS INFECTION CONTROL?

Patient to Worker to
Worker Worker
Visitor Visitor
Patient Patient
Visitor to
Worker
Visitor
Patient
 WHY HEALTHWORKER???
Rate of TB among HCW in a Romanian Hospital, 1971-
2500
1996

2000

1500

year

1000

500

0
1971 1973 1976 1980 1984 1986 1987 1988 1989 1990 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Incidence rate (per 100,000)

8
Sotgiu G, Migliori GB et al, IJTLD 2008;12(6):606
 Penderita TB
Penderita TB- MDR

Penderita TB

10
SIGN AND SYMPTOM of TB
 TUBERCULOSIS TRANSMISSION
• Sebagian besar kuman TB menyerang paru
tetapi dapat juga mengenai organ tubuh
lainnya.
• Penyakit ini menyebar dan ditularkan melalui
udara ketika orang yang terinfeksi TB paru
batuk, bersin, berbicara atau meludah

(WHO, 2015).
TRANSMISSION
Hashmi,,Infection Control Director ofNajran
Hospital,KSA
WHO  sejak 1999 sdh membuat panduan
2003  unsur screening dan perlindungan petugas
2009  memasukkan unsur manajerial , congegrat
setting, household
2019
RECOMMENDATION

ADMINISTRATIVE ENVIRONMENTAL
CONTROL CONTROL

RESPIRATORY
PROTECTION
 2.1. Administrative controls

Reducing exposure

Reducing transmission
of Mtb

WHO Guideline for Prevention and Control 2019

 Recommendasi
1. Triage
Triage pada orang dengan gejala TB
menurunkan transmisi M. Tuberculosis
transmission pada:
1. Petugas kesehatan
2. Orang yang datang ke Fasyankes
3. Orang yang tinggal di area risiko tinggi.

WHO Guideline for Prevention and Control 2019

 TB Screening
• Dilakukan di Poliklinik maupun di UGD sebelum
pemeriksaan lebih lanjut
• Pasien baru di Skrining:
Apakah mengalami batuk > 2
minggu

Apakah mempunyai faktor risiko TB (

DM, Imunocompromised, Penggunaan
Kortikosteroid, Sakit Ginjal Kronis)
 Triage
SCREENING TO THE PATIENTS WITH RESPIRATORY
SYMPTOMs
Minimalisasi waktu pelayanan pd
pasien suspek  FAST TRACK

• Screening dan pelabelan khusus untuk

mempermudah jalur pelayanan
 Recommendation 2. Respiratory
separation / isolation
• Respiratory separation / isolation of people
with presumed or demonstrated infectious TB
is recommended.

WHO Guideline for Prevention and Control 2019

GEDUNG TB TERPADU
RSUD Dr Soetomo
25
 JAUHKAN AEROSOL /
DROPLET INFEKSIUS
 Sputum Booth

UDARA LUAR
TERBUKA

26
 Recommendation 3. Prompt
initiation of effective treatment
• Prompt initiation of effective treatment of
people with TB disease is  to reduce M.
tuberculosis transmission

WHO Guideline for Prevention and Control 2019

 Recommendation 4. Respiratory
hygiene (including cough etiquette)
to reduce the dispersal of respiratory secretions
that may contain infectious particles

to prevent M. tuberculosis
transmission

WHO Guideline for Prevention and Control 2019

 ETIKA BATUK
(cough etiquette)
EDUKASI PASIEN POSTER

Promosi etika batuk pd

pasien bergejala

SATGAS BATUK

GUNAKAN TISSUE, MASKER, SAPUTANGAN, BAGIAN

DALAM LENGAN, TANGAN + HAND Hygiene
29
Educate patients on cough etiquette and
respiratory hygiene
 2.2 Environmental Control

DILUTION FILTRATION DISINFECTION

1. Upper-room germicidal ultraviolet systems

2. Ventilation systems
WHO Guideline for Prevention and Control 2019
Pada jaman dahulu….

32
33
WHO Guideline for Prevention and Control 2019
WHO Guideline for Prevention and Control 2019
 NATURAL VENTILATION
Cross ventilation and windows

Tilting windows (horizontal) Sliding windows (horizontal)

Almost 100% open area Maximum of 50% open area

ENGSEL TENGAH ENGSEL ATAS ENGSEL SAMPING
GOOD GOOD

SLIDING
 MECHANICAL VENTILATION

HARUS SEARAH
EXHAUST FAN
40
Mechanism of HEPA Filter
2.3 Respiratory Protection

WHO Guideline for Prevention and Control 2019

 Respiratory Protection
RESPIRATOR FACE MASK

1. Pori kecil untuk drop

nuklei ( menyaring 1. Pori lebar
95% partikel 0,3 2. no relies air tight seal
mikron) to face
2. air tight seal to face
47
 RESUME
• Worldwide, tuberculosis (TB) continues to be
the most important cause of death from a
single infectious microorganism
• TB is Airborne diseases
• There are 7 recomendation about IPC-TB:
1. Triage
2. Respiratory separation / isolation
3. Prompt initiation of effective treatment
4. Respiratory hygiene (including cough
etiquette )
5. Upper-room germicidal ultraviolet systems
6. Ventilation systems
7. Respiratory Protection
Journey of Dr. SOETOMO HOSPITAL
THANK YOU

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