Disertasi

Pencegahan dan pengendalian infeksi neonatal pada unit perinatal dengan pendekatan balanced scorecard. = Prevention and control of neonatal infection in the perinatal unit using balanced scorecard approach.

Latar belakang. Infeksi neonatal masih merupakan tiga penyebab utama kematian neonatus di negara berkembang baik di lingkungan masyarakat maupun rumah sakit. Di unit perinatal, infeksi aliran darah (IAD) merupakan jenis infeksi rumah sakit terbanyak. Pendekatan balanced scorecard (BSC) diperkirakan dapat digunakan dalam penyusunan, pemantauan, dan penilaian strategi pencegahan dan pengendalian infeksi neonatal di unit perinatal. Tujuan penelitian. Penelitian ini bertujuan memperoleh satu formulasi strategi penyelesaian masalah infeksi rumah sakit di unit perinatal yang efektif dan efisien. Metode penelitian. Penelitian ini menggunakan desain operational research, dengan pendekatan kualitatif dan kuantitatif. Penelitian dibagi menjadi dua tahap. Tahap I merupakan operational research dengan pendekatan pemecahan masalah menggunakan metode kualitatif dan kuantitatif. Fokus dalam tahap ini adalah identifikasi, perumusan, sampai pada penetapan langkah strategi pencegahan dan pengendalian infeksi. Tahap II dilakukan dengan metode kuantitatif, merupakan penelitian intervensional penerapan strategi yang sebelumnya telah disusun pada tahap I. Hasil penelitian. Strategi yang efektif dan efisien untuk pencegahan dan pengendalian infeksi di Unit Perinatal Rumah Sakit Cipto Mangunkusumo (RSCM) dilakukan dengan pendekatan BSC yang meliputi beberapa proses yang saling terkait. Proses tersebut dimulai dari edukasi-sosialisasi karyawan tentang infeksi rumah sakit, uji kompetensi, penempatan karyawan sesuai kompetensi, pelaksanaan jenjang karier karyawan, dan perhitungan remunerasi. Proses ini dilanjutkan dengan audit, surveilan berkala, serta evaluasi untuk menjamin praktik pencegahan dan pengendalian infeksi sesuai standar prosedur operasional (SPO). Strategi dengan pendekatan BSC ini terbukti secara bermakna menurunkan IAD dari 52,31 o/oo menjadi 1,36o/oo pada kelompok berat lahir 1000-1499 g (p=0,025) dan dari 29,96o/oo menjadi 1,66o/oo pada kelompok berat lahir 1500-1999 g (p=0,05). Pola kuman penyebab IAD masih didominasi oleh kuman gram negatif. Hasil simpulan sementara diduga asal kuman berasal dari lingkungan tempat perawatan (filter air keran dan cairan humidifier di inkubator). Ditemukan juga secara bermakna penurunan angka kematian neonatus dengan berat lahir 1000-1499 g, lama rawat, biaya rawat, dan peningkatan kepuasan pelanggan. Simpulan. Pencegahan dan pengendalian infeksi dengan pendekatan BSC secara efektif dan efisien dapat menurunkan secara bermakna angka IAD. Strategi yang dinilai sangat berperan adalah keterkaitan proses pembelajaran dan pertumbuhan karyawan dilanjutkan dengan audit, surveilan berkala, serta evaluasi untuk menjamin praktik pencegahan dan pengendalian infeksi sesuai SPO.
Kata kunc: Balanced scorecard, berat lahir 1000-1999 g, infeksi aliran darah, neonatus.



Background. Neonatal infection remains one of the three main causes of neonatal mortality in developing countries, either in community and in hospitals. In perinatal units, bloodstream infection (BSI) is the most common hospital infection. The balanced scorecard (BSC) approach is thought to be useful in establishing, monitoring, and evaluating neonatal infection prevention and control strategies in perinatal units. Study objectives. The objective of this study was to obtain formulation of an effective and efficient strategy to overcome hospital infection problem in perinatal units. Study methods. This study used operational research design with qualitative and quantitative approach. The study was divided into two stages. Stage I was an operational research with problem solving approach using qualitative and quantitative method. The focus in this stage was identification, formulation, up to the decision making for infection prevention and control strategy. Stage II was performed using quantitative method, a form of an interventional study on strategy implementation, which was previously established in stage I. Study results. The effective and efficient strategy for the prevention and control of infection in Cipto Mangunkusumo Hospital (CMH) Perinatal Unit was established using BSC approach, which involved several related processes. The process started from staff education and socialization about hospital infection, competence test, staff placement according to competence, practice of staff career stage/promotion, and remuneration calculation. Next step of this process was audit, regular surveillance, and evaluation in order to ensure that the infection prevention and control practices were performed according to the standard operational procedure (SOP). The BSC strategy was proved to be effective and efficient in substantially reducing BSI from 52.31 o/ oo to 1.36o/oo in neonates with birthweight 1000-1499 g (p=0.025), and from 29.96o/oo to 1.66o/oo in birthweight 1500-1999 g (p=0.05). Gram-negative bacteria still predominated as the main cause of BSI in CMH Perinatal Unit. So far, the sources of the microorganisms were thought to be from the environment of treatment unit (tap water filter and humidifying water in the incubator). Significant reduction was also found in neonatal mortality rate weighing 1000-1499 g at birth, length of stay, hospitalization costs, and improved customer satisfaction. Conclusions. Effective and efficient infection prevention and control using BSC approach could significantly reduce the rate of BSI. The major factors contributing to the success were the connection between staff learning process and growth, followed by audit, regular surveillance, and evaluation to ensure that the infection prevention and control practices are according to the SOP.
Keywords: Balanced scorecard, birthweight 1000-1999 g, bloodstream infection, neonates.