Beruflich Dokumente
Kultur Dokumente
FKUB
Malang
2
HAI
1. Infection Control Programme
3
MENTERI KESEHATAN
REPUBLIK INDONESIA
4
5
A PRACTICAL GUIDE — PREVENTION OF HOSPITAL-ACQUIRED INFECTIONS
WHO/CDS/CSR/EPH/2002.12
Environment
8.1 Buildings
8.2 Air / udara
8.2.1 Airborne contamination and transmission
8.2.2 Ventilation
8.2.3 Operating theatres / OR / OK
8.3 Water
8.4 Food
8.5 Waste
6
Air / Udara
Indoor Air Quality / IAQ
7
Keys word
Sumber pollutant
Ventilation rate / ACH
Negative / Positive pressure
Indoor / out door air quality
Smbr poll
8
Sumber Pollutants
9
10
Guidelines for Air Quality, WHO, Geneve, 2000
BE CAREFUL WHEN USING THESE PRODUCTS !
sneezing
11
12
(B) flash photo of a human sneeze
( Airborne Respiratory Diseases and Mechanical Systems for CONTROL OF MICROBES. HPAC July 1998 )
18
Aerobiology and Its Role in the Transmission of Infectious Diseases
J Pathog. 2013; 2013: 493960
size
20
( Airborne Respiratory Diseases and Mechanical Systems for CONTROL OF MICROBES. HPAC July 1998 )
21
size
Common air contaminants and their relative sizes [Hinds 1982].
( Guidance for Protecting Building Environments from Airborne Chemical,Biological, and Radiological Attacks ;
NIOSH April 2003 )
23
24
SMK3
SMK3
Sistim Managemen Keselamatan
dan
Kesehatan Kerja
25
SMK3
Elimination
Substitution
Separation / Isolation
Engineering / Environ Control
Administrative Control
PPE
26
EC 27
RS UA
Kenapa ?
Ruangan perawatan pasien jarak antar titik tengah TT + 2,4 m
Atau jarak TT > 1 meter ( PMK RI 24 TAHUN 2016 )
Kenapa ?
31
( Airborne Respiratory Diseases and Mechanical Systems for CONTROL OF MICROBES. HPAC July 1998 )
32
Aerosol - generating procedure
Diagnostic sputum inducer
Nasopharyngeal aspiration / airway suction
Aerozoliced medication
ET intubation
Chest PT
Bronchoscopy
Positive pressure ventilation
High frequency ventilation
CPR
Postmortem excition of lung tissue
Chariya Sangsajja, MD.
Bamrasnaradura Infectious Disease Institute
Department of Disease Control, MOPH, Thailand May 2009
33
SMK3
Elimination
Substitution
Separation / Isolation
34
Engineering Control
( Environmental Controls )
- Air Cleaning
- Ventilation
35
Air Cleaning
Ultraviolet / UVGI
HEPA filter
( High Efficiency Particulate Air )
OAUGDP
BioBlower (TM)
36
Ultraviolet / UVGI
Ultraviolet
Germicidal
Irradiation
UV kuman
37
Viability of airborne microbes indoors in absence of sunlight.
Based on averages for each microbial group.
( Airborne Respiratory Diseases and Mechanical Systems for CONTROL OF MICROBES. HPAC July 1998 )
38
UV wave
Ultra Violet
UV-C light ranges in wavelength from 200–280 nanometers (nm) but operates most
effectively as a germicidal light at a frequency of 253.7 nm.
UVC-Germ Blaster's UV-C light penetrates the cell walls of the
microorganism, damaging its genetic structure by separating the bonds
in the DNA strand.
The damaged bonds in the DNA prohibit future reproduction and ultimately
destroys the microorganism. 39
UV damage to DNA
40
41
( TUBERCULOSIS INFECTION CONTROL : A PRACTICAL MANUAL FOR PREVENTING TB )
hepa 42
Air Cleaning
Ultraviolet C
HEPA filter
( High Efficiency Particulate Air )
OAUGDP
BioBlower
43
Four primary filter collection mechanisms
44
ventilasi
45
FILTER
Secondary filter
- Air Cleaning
- Ventilation
48
Ventilation
- Natural ventilation
( ada yg hybrid )
- Mechanical ventilation
Local exhaust ventilation
General ventilation
49
Natural Ventilation
If this dilution effect is combined with a way to replace room air with fresh air,
such as an open window or door, the result will be fewer particles overall in
the room.
52
Ventilation
Natural ventilation
Mechanical ventilation
Local exhaust ventilation
General ventilation
53
Local Exhaust Ventilation
- enclosing devices
- exterior devices
54
Enclosing devices for local exhaust ventilation include :
1. booths for sputum induction or administration of aerosol-ized
medications
2. tents or hoods for enclosing and isolating a patient, and
3. BSCs
exterior
devices
las 56
Exhaust fan
Ada perubahan fasa
dari padat , cair
dan gas
hobby 57
GV
( All About Power Tools, 2002, ISBN: 0-89721-478-1 ) 58
Ventilation
- Natural ventilation
- Mechanical ventilation
Local exhaust ventilation
General ventilation
59
General ventilation
- Dilution & Removal
- air pattern flow
- air direction
- directional airflow
- negative pressure
- positive pressure
60
AIR FLOW
PATTERNS
61
pressure
62
63
Monitoring Ventilation Systems
64
General ventilation
- Cooling tower
- AHU
- single pass
- recirculation
Cooling t
65
Diagram cooling tower
AHU
ahu
66
dilution
OA
RA
Schema ahu
Recirculation & single pass
( HCWH )
+
Humidifier
Terminal filter
68
69
70
71
72
2 room
73
74
Isolation Room
- Protective Environment Room / PE’r
( al : Kamar operasi )
75
Protective Environment Room / PE’r
Kamar Operasi
Kamar luka bakar
Kamar utk immunosuppressive
Tindakan invasive
OR
76
Kamar Operasi
Operating Room
( protective environment )
77
8.2.2 Ventilation
Fresh filtered air, appropriately circulated, will dilute and remove airborne bacterial contamination.
It also eliminates smells. Desirable ventilation rates, expressed in air changes per hour, vary with the
purpose of a particular area (5). High-risk hospital areas (operating rooms, nurseries, intensive care
units, oncology, and burn units) should have air with minimal bacterial contamination.
• Adequate ventilation systems require proper design and maintenance to minimize microbial contamination.
All outdoor air inlets must be located as high as possible above ground level; inlets must be remote from
ventilation discharge outlets, incinerators, or boiler stacks.
• Within rooms, the location of air inlets and exhaust outlets influences the movement of air.
High wall or ceiling inlets and low wall outlets allow clean air to move
downward through the area toward the contaminated floor where it is
removed through the low exhaust.
or 79
High wall or ceiling inlets and low wall outlets
80
82
83
Layout of a typical air curtain system Air motion Control (ASHRAE Journal March 2009)
84
CFD / computational fluid dynamics analysis of a typical air curtain
1. Type of surgery
2. Quality of air provided
3. Rate of air exchange / ACH
4. Number of persons present in operating theatre
5. Movement of operating room personnel
6. Level of compliance with infection control practices
7. Quality of staff clothing
8. Quality of cleaning process
ilo / ssi 87
88
Basic Guide to Particle Counters and Particle Counting
( Copyright © 2006 Particle Measuring Systems, Inc.)
89
Demonstration of how a walking person may entrain air into their wake
(Tang et al., 2006)
( Natural Ventilation for Infection Control in Health-Care settings )
90
Demonstration of how opening a door may transport air from inside an isolation room to the
outside, during the door-opening motion itself (Tang et al., 2005)
91
plane
ACH
92
ACH
Air Change per Hour
93
( ACH )
( Q : V ) X 60
Q = air flow rate ( cu ft/min )
----------------------------------- X 60 min
V = room volume (cu ft )
94
CONTOH
Ruangan dengan volume 100m³ sekurang-kurangnya
1 (satu) fan dengan diameter 50 cm dengan debit
udara 0,5 m³/detik, dan frekuensi pergantian udara
per-jam adalah 2 (dua) sampai dengan 12 kali.
( Airborne Respiratory Diseases and Mechanical Systems for CONTROL OF MICROBES. HPAC July 1998 )
101
2 138 207
4 69 104
6 46 69
12 23 35
15 18 28
20 14 21
50 6 8
400 <1 1
Tabel 8 : Standar Baku Mutu Suhu, Kelembaban, dan
Tekanan Udara menurut Jenis Ruang
( Basic concept of ventilation flow rate http://www.who.int/csr/bioriskreduction/en/ )
• the higher the outdoor concentration, the higher the indoor concentration
• the higher the ventilation rate, the lower the indoor concentration
• the higher the generation rate, the higher the indoor concentration.
IR 106
Isolation Room
Protective Environment Room / PE’r
107
Chariya Sangsajja, MD.
Bamrasnaradura Infectious Disease Institute
Department of Disease Control, MOPH, Thailand
May 2009
108
SARS
Avian Influenza
TB (MDR)
dan
Other Airborne infection
( Covid-19 )
109
Evidence of Airborne Transmission
of
the Severe Acute Respiratory Syndrome Virus
Ignatius T.S. Yu, M.B., B.S., M.P.H., Yuguo Li, Ph.D., Tze Wai Wong, M.B., B.S.,
Wilson Tam, M.Phil., Andy T. Chan, Ph.D., Joseph H.W. Lee, Ph.D.,
Dennis Y.C. Leung, Ph.D., and Tommy Ho, B.Sc.
115
Single pass 116
117
118
119
120
121
122
Exhaust Air Grille Silencer Flow rate controller Fan Filter
+ Heater
Humidifier
Prefilter Terminal filter
125
Chariya Sangsajja, MD.
Bamrasnaradura Infectious Disease Institute
Department of Disease Control, MOPH, Thailand
May 2009
126
127
128
Ruang pelayanan penyakit menular melalui udara
Airborne transmission diseases
129
Airborne Transmission of Communicable Infection —
The Elusive Pathway
Chad J. Roy, M.S.P.H., Ph.D., and Donald K. Milton, M.D., Dr.P.H.
131
( n engl j med 350;17 www.nejm.org april 22, 2004 , Ignatius T.S. Yu, M.B., B.S., M.P.H.,)
132
133
134
135
136
Sewage
water drain
137
139
Air Sampling
- Passive
- Active
140
141
142
143
FS 209
144
ISO 14644
145
bio indstr
UV
TB 146
Fin 3 148
Take Action to Improve
Air Quality
in
Every Room
Fin 1 149
The right to healthy air
is everyone’s right
( Healthy Building 2000 conference, in Espoo, Finland, on 6–10 August. 2005 )
150
Fin
Pahlawan Kita
Pertanyaan ?
152
Semoga bermanfaat
aliimam04@yahoo.com
081 334 663 808
153
INDONESIA akan sulit mencapai eliminasi tuberkolosis yang ditargetkan pada 2030 apabila
strategi yang dilakukan hanya penemuan kasus dan mengobatinya hingga sembuh. Diperlukan
kerja sama lintas sektor dan komitmen bersama untuk mengakhiri tuberkolosis di Indonesia yang
angkanya saat ini diperkirakan 842.000 kasus setiap tahunnya.
MI Rabu 14 November 2018