FAKTOR RISIKO INFEKSI LUKA OPERASI PASIEN PASCA SEKSIO SESAREA DI RSUD BENDAN PEKALONGAN

REMILDA ARMIKA VIANTI, dr. Jarir At Thobari, Ph.D

2015 | Tesis | S2 Keperawatan

Latar Belakang: ILO(ILO) merupakan salah satu infeksi nosokomial yang paling sering terjadi di Indonesia dan sulit untuk diketahui penyebab pastinya. Di Indonesia sendiri prevelensi kejadian ILOsekitar 2-18%. Kasus ILOpasca seksio sesarea sekitar 15%. Dampak dari ILOmeningkatkan angka morbiditas dan mortalitas serta bertambahnya lama hari rawat di rumah sakit sehingga biaya perawatan di rumah sakit meningkat. Salah satu cara untuk menekan angka kejadian ILOadalah dengan mengurangi faktor-faktor yang bisa meningkatkan risiko ILOpasca seksio sesarea. Tujuan Penelitian: Mengukur faktorrisiko dan faktor yang paling berisiko terhadap kejadian ILO(ILO) pada pasien pasca operasi seksio sesarea di RSUD Bendan Pekalongan. Metode: Penelitian inimerupakan penelitian analitik observasional dengan rancangan case controlretrospektif dengan pendekatan kuantitatif. Penelitian ini menggunakan rekam medis sebagai sumber data mulai dari bulan Januari tahun 2011-Desember 2013. Subjek penelitian ini adalah semua wanita dengan seksio sesarea di RSUD Bendan Pekalongan. ILOditegakkan melalui kriteria tanda dan gejala ILO berdasarkan kriteria Centers for Disease Control and Prevention (CDC). Hasil observasi didapatkan 311 pasien dengan ILOdan 311 pasien yang tidak terkena infeksi luka operasi. Analisis bivariat menggunakan independent t- Test dan uji Chi-squaredan analisis multivariat menggunakan regresi logistik. Hasil: Dari 1592 pasien dengan seksio sesarea terdapat 311 pasien yang mengalami ILO(19%). Hasil analisis multivariat regresi logistik, faktor risiko yang signifikan terhadap kejadian ILOyaitu lama hari rawat [OR=5,09 (1,04- 25,02)], antibiotik profilaksis [OR=3,03 (1,43-6,41)], diabetes [OR=2,42 (1,09- 5,39)], tipe operasi [OR=2,02 (1,33-3,08)], lama operasi [OR=1,85 (1,23-2,78)], anemia [OR=1,75 (1,05-2,79)], paritas [OR=1,69 (1,19-2,40)], jenis antibiotik profilaksis [OR=0,49 (0,33-0,76)] dan usia dengan kriteria <20 and >35 years [OR=0,39 (0,25-0,64)]. Faktor risiko yang tidak signifikan terhadap kejadian ILOyaitu lama rawat sebelum operasi dan KPD. Sedangkan nilai dari analisisCox & Snell R Square yaitu 0,125. Kesimpulan:Lama hari rawat merupakan faktor risiko dominan yang berhubungan dengan kejadian infeksi luka operasi. Faktor risiko lainnya yang berhubungan dengan kejadian ILOyaitu antibiotik profilaksis, diabetes, tipe operasi, lama operasi, anemia, paritas, jenis antibiotik profilaksis dan usia.

Background: The surgical site infection is one of the effect nosocomial infection in Indonesia. The prevalence of surgical site infection in Indonesia was 2-18%. The case of surgical site infection post cesarean section was 15%. Surgical site infection after cesarean section may increase mortality and morbidity, length of stay and cost of hospitalization. Surgical site infection may decrease risk factors especially risk factors for surgical site infection post cesarean. Objective: To determine the risk factors and the dominant factor related to surgical site infection after cesarean section in Bendan General Hospital in Pekalongan. Method: This study was an observational analytical study. Retrospektif case control design was used in this study with quantitative approach. The primary data of this study were the medical records from 2011-2013. The subject was all of the women having been through cesarean section in Bendan general Hospital in Pekalongan. The diagnosis of surgical site infection was defined according to the criteria of the Centers for Disease Control and Prevention (CDC). The observation resulted in 311 patients experiencing surgical site infection, which then resulted in 311 control patients. The bivariat analysis used independent T-test and Chi-square and then the multivariate analysis used logistic regression analysis. Results: Surgical site infection were identified in 311 (19%) of 1592 women having been through caesarean section. The result of multivariate logistic regression analysis showed that the factors significantly suppoting surgical site infection were the length of stay [OR=5,09 (1,04-25,02)], prophylactic antibiotics [OR=3,03 (1,43-6,41)], diabetes [OR=2,42 (1,09-5,39)], type of surgery [OR=2,02 (1,33-3,08)], duration of surgery [OR=1,85 (1,23-2,78)], anemia [OR=1,75 (1,05-2,79)], paritas [OR=1,69 (1,19-2,40)], kind of prophylactic antibiotics [OR=0,49 (0,33-0,76)] and age with criteria <20 and >35 years [OR=0,39 (0,25-0,64)].. Risk factors that did not have significant influence were rupture of membrane and length of stay before surgery. The value of Cox & Snell R Square is 0,125. Conclussion: Length of stay was the dominant risk factors related to the surgical site infection incidence, and the other risk factors related to the surgical site infection were prophylactic antibiotics, diabetes, type of surgery, duration of surgery, anemia, parity, kind of prophylactic antibiotics and age.

Kata Kunci : Infeksi luka operasi, seksio sesarea, faktor risiko