PENERAPAN PENCEGAHAN DAN PENGENDALIAN INFEKSI (PPI) COVID-19 PADA PELAYANAN GIGI DAN MULUT DI PUSKESMAS KABUPATEN TEMANGGUNG

Jatu Padmasari Evasi, Prof. dr. Adi Utarini, M.Sc., MPH, Ph.D ;dr. Citra Dewi Fitri Astuti, MPH

2023 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar Belakang: Covid-19 merupakan penyakit yang disebabkan oleh virus dan muncul di China tahun 2019. Penularan Covid-19 di pelayanan gigi dan mulut dapat terjadi karena kontak kurang dari satu meter, paparan aerosol selama prosedur gigi dan mulut, dan kontaminasi instrumen gigi dan mulut. Di Kabupaten Temanggung, proporsi dokter gigi sebesar 46 persen yang terjangkit Covid-19, sehingga Puskesmas menutup pelayanan tindakan gigi dan mulut. Hal ini mempengaruhi tingkat keparahan penyakit gigi dan mulut di kalangan masyarakat Temanggung. Oleh karena itu, tindakan Pencegahan dan Pengendalian Infeksi (PPI) Covid-19 diperlukan untuk meminimalkan penyebaran infeksi tersebut.

Tujuan: Penelitian ini bertujuan untuk mengevaluasi penatalaksanaan PPI terkait Covid-19 di Pelayanan Gigi dan Mulut di Puskesmas Kabupaten Temanggung sesuai hierarki pengendalian infeksi Pelayanan Gigi dan Mulut.

Metode: Studi kualitatif dilakukan dengan observasi nonpartisipatif dan wawancara mendalam di empat Puskesmas baik Rawat jalan dan rawat inap yang ditentukan dengan purposive sampling dan dilanjutkan dengan melakukan wawancara mendalam. Subyek penelitian adalah empat Puskesmas yang melibatkan Kepala Puskesmas dan enam staf yang terlibat dalam pelaksanaan PPI Puskesmas khususnya pelayanan gigi dan mulut.

Hasil: Hasil penelitian menunjukkan bahwa program PPI Covid-19 di pelayanan gigi dan mulut memiliki kelemahan pada proses perencanaan yang tidak berdasarkan penilaian resiko dan proses implementasi, dimana monitoring dan pelaporan program PPI tidak konsisten. Saat ini, sebagian besar Puskesmas Temanggung sudah tidak menerapkan tahap elimination namun beralih ke tahap administrative control. Kebijakan Dinas Kesehatan Kabupaten Temanggung telah melakukan relaksasi berdasarkan penurunan jumlah pasien terkonfirmasi dan peningkatan imunitas masyarakat Kabupaten Temanggung. Penerapan program PPI Covid-19 pada Puskesmas rawat inap tidak selalu lebih baik daripada Puskesmas rawat jalan. Selain itu status akreditasi Puskesmas yang lebih tinggi tidak selalu menerapkan program PPI Covid-19 dengan lebih baik.

Kesimpulan: Sebagian besar Puskesmas di Kabupaten Temanggung sudah tidak melaksanakan kegiatan elimination, namun masih melaksanakan administrative control dan pemakaian APD. Hal ini dapat menyebabkan efektivitas program PPI Covid-19 dalam mengurangi resiko penularan infeksi berkurang.

Background. Covid-19 transmission can occur through contact of less than one meter, aerosol exposure, and contamination in dental healthcare. In Temanggung, with a total percentage of dentists 46% confirmed with Covid-19, dental healthcare was closed. This has an impact on the severity of dental and oral cases suffered by the community. Therefore, Covid-19 Infection Prevention and Control (PPI) is needed to minimize the transmission of infection. Therefore, Covid-19 Infection Prevention and Control (PPI) is needed to minimize transmission.

Objectives. To evaluate the implementation of Covid-19 PPI in dental practice in healthcare within the district of Temanggung, according to the hierarchy of infection control for dentistry.

Methods. Qualitative research was conducted using non-participatory observation in four healthcare (2 providing outpatient care only, and the other 2 providing both outpatient and inpatient care), selected using purposive sampling, followed by in-depth interviews. The participants include the head of healthcare and six key staff members involved in the implementation of infection prevention and control.

Result. The results showed that the Covid-19 PPI program in dental healthcare has weaknesses in the planning process which is not based on risk assessment and the implementation process where there is inconsistent implementation of monitoring and reporting of the PPI program. Currently, most of healthcare does not seem to have implemented the elimination stage but has switched to the administrative control stage. This is because the policy of healthcare has been relaxed based on a decrease in the number of confirmed patients and an increase in community immunity in the Temanggung. The implementation of the Covid-19 PPI program at inpatient health centers is not always better than in outpatient health centers. However, the higher the number of visits and the number of confirmed Covid-19 cases, the better the implementation of the Covid-19 PPI program at the healthcare. In addition, the accreditation status of the healthcare does not affect the implementation of the Covid-19 PPI implementation.

Conclusion. Most of the health centers in Temanggung no longer carry out elimination activities, but still carry out administrative control and the use of PPE. This can cause the effectiveness of the Covid-19 PPI program in reducing the risk of transmission of infection to decrease.

Kata Kunci : Covid-19, Prevention and Control’s Infection, Dental healthcare