Tesis

Efisiensi Pencucian Luka dengan Akuades Dibanding Perawatan Luka Standar pada Luka Laparotomi Mediana di Rumah Sakit Cipto Mangunkusumo = Efficiency of Aquadest Irrigation Compared with Standard Wound Care in Median Laparotomy Surgical Wound in Cipto Mangunkusumo General Hospital, Jakarta .

Latar Belakang: Surgical Site Infection (SSI) adalah infeksi sekitar luka operasi dalam kurun waktu 30 hari pascabedah. SSI merupakan 23,6% dari total infeksi nosokomial pascabedah abdomen di RSCM tahun 2009 – 2011. Tingginya angka morbiditas dan mortalitas dikarenakan SSI menyebabkan biaya penangganan SSI, sehingga pencegahan SSI akan mengurangi biaya pengobatan. Akuades diketahui cairan yang efektif untuk irigasi luka, mudah didapatkan, murah dan aman untuk irigasi luka. Tujuan: Mengetahui pencucian luka dengan akuades dibanding perawatan luka Standar. Metode: Penelitian ini merupakan penelitian eksperimental terandomisasi tersamar tunggal, yang dilakukan di departemen bedah, Fakultas kedokteran Universitas Indonesia, Rumah Sakit Cipto Mangunkusumo Mei – Juni 2018. Subyek berjumlah 80 orang setelah laparatomi mediana, dibagi menjadi grup kontrol (n=40) yang menerima perawatan standar dengan tulle setiap 2 hari dan grup eksperimental (n=40) yang menerima pencucian luka dengan akuades setiap hari, dimulai hari kedua pascabedah. Pada hari ketujuh, dilakukan kultur mikrobiologi yang diambil dari benang jahitan. Parameter yang dievaluasi adalah pertumbuhan kuman, tanda infeksi, dan biaya per subyek antara 2 grup untuk mengetahui efisiensi dan efektivitas keduanya. Hasil: Positif kultur mikrobiologi 57,5% (n=23) pada grup kontrol dan 55% (n=22) pada grup eksperimental. Tidak ada perbedaan bermakna antara kolonisasi kuman di grup kontrol dan grup eksperimental (p=0,820) maupun insiden SSI (p=1,00). Selisih biaya Rp 27.500,00 (Rp 19.400,00 – Rp 40.990,00) lebih rendah pada grup eksperimental (Rp 385.500,00 (Rp 379.500,00 – Rp 385.960,00)) dibanding grup kontrol (Rp 413.000,00 (Rp 398.900,00–Rp 426.950,00)) Simpulan: Pencucian luka dengan akuades lebih efisien dibandingkan perawatan luka dengan teknik standar.
Kata kunci: Efisiensi, SSI, perawatan standar, mediana, laparatomi, tulle, akuades.


Background: Surgical Site Infection (SSI) is infection at or around the incision site within 30 days postoperative. SSI accounts for 23.6% of total nosocomial infections after abdominal surgery in Cipto Mangunkusumo General Hospital during 2009 – 2011. The high morbidity and mortality due to SSI causes high cost burden for SSI management, hence prevention of SSI will reduced the cost of treatment. Aquadest has known as an effective substance for wound irrigation, easy to obtain, low-cost and safe for wound irrigation. Aim: The study objective was to know the efficiency of aquadest wound irrigation compared to standard wound care. Methods: This was a single-blinded randomized experimental study, conducted at the Department of Medical Surgery, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo General Hospital during May-June 2018. Subjects were eighty patients after median laparotomy, randomized into control group (n=40) which received standard wound care with tulle every other day and experimental group (n=40) which received aquadest wound irrigation every day, started on the second post operation day. On the seventh day, microbiological culture taken from surgical suture materials. Parameters evaluated were the bacterial growth, signs of infection and cost per subject between two groups to know the efficiency and efficacy of both treatment. Result: The positive microbiological culture were 57,5% (n=23) in control group and 55% (n=22) in experimental group. There was no significant difference of bacterial colonization in the control and experimental group (p = 0,820) neither in SSI incidence (p = 1,00). The cost difference was Rp 27.500,00 (Rp 19.400,00 – Rp 40.990,00) lower for subject in experimental group (Rp 385.500,00 (Rp 379.500,00 – Rp 385.960,00)) compared with control group (Rp 413.000,00 (Rp 398.900,00–Rp 426.950,00)). Conclusion: Surgical wound irrigation with aquadest was more efficient compared with standar surgical wound care.
Keywords: Efficiency, SSI, standard wound care, median, laparotomy, tulle, aquadest.