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Correlation of Nitrite Oxide with Severity and Survival Rate of Sepsis Patients Sotianingsih, Sotianingsih; Mulyono, Budi; Dahesihdewi, Andaru; Halim, Samsirun; Syauqi, Ahmad
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 1 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i1.1749

The objective of this research was to determine the correlation between Nitric Oxide (NO) levels with the severity ofsepsis, to describe the kinetics of NO levels, and to evaluate it in predicting mortality. This research was a longitudinal cohortobservational analytical study. The variables were serum NO levels and SOFA scores, which were serially evaluated. Thecorrelation test and difference test were used for statistical analysis. The survivor and the non-survivor group consisted of 14(41.18%) and 20 (58.82%) patients, respectively. There was a correlation between serum NO levels and the SOFA score at the24-hour observation (r=0.403; p=0.041). Non-parametric Mann-Whitney test showed that there was no kinetics of NOth levels at 0, 24, 72, and 144-hour observation (p-values =0.897 and 0.703, respectively). NO levels > 111,16 μmol/L at the 24hour could predict the risk of death with hazard ratio 4.7 compared to NO levels < 111,16 μmol/L. The survival rate ofpatients with serum NO levels <111,16 μmol/L and > 111,16 μmol/L was 83.3% and 37.5%, respectively. There was acorrelation between serum NO levels and SOFA scores at the 24-hour observation. However, there was no kinetics of NOlevels at serial evaluations. Nitric oxide levels with a cut-off of 111,16 μmol/L at 24 hours could predict the survival of septicth patients. Utilization of serum NO level at 24 hour can be used to evaluate the severity of septic patients and aggressivemanagement if there is an increase in serum NO levels > 111,16 μmol/L at 24 hours.

Screening of Extended-Spectrum β-Lactamases (ESBL)-producing Klebsiella pneumoniae with ChromID ESBL Media Emy Noerwidayati; Andaru Dahesihdewi; Osman Sianipar
The Indonesian Biomedical Journal Vol 10, No 3 (2018)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v10i3.430

BACKGROUND: Klepsiella pneumoniae, one of clinical isolates, is frequently found causative agent of hospital acquired infection. Currently, K. pneumoniae is found as extended-Spectrum β-lactamases (ESBL) producer, allowing it to become multidrugresistant. A clinical laboratory with limited facility needs a valid, reliable, inexpensive and simple laboratory test to control its infection and antimicrobial-resistancy. The aim of this study is to evaluate the diagnostic performance of a ESBL media to detect ESBL-producing K. pneumoniae.METHODS: An independent and blind comparative study of ChromID ESBL media and Double Disc Synergy Test (DDST) was conducted for detecting the clinical isolate of ESBL-producing K. pneumoniae. Clinical isolates of K. pneumoniae collected from the Clinical Laboratory of Dr. Sardjito Hospital were isolated.RESULTS: There were 103 clinical isolates of K. pneumoniae, which were isolated from urine, pus, blood, stool, cerebrospinal fluid, sputum, drain liquid, nasal sinus liquid, gastric wash, bronchi liquid, injury liquid and nasal swab. The number of true positive, true negative, false positive and false negative results were 74, 18, 9 and 2, respectively. Meanwhile, the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive result and likelihood ratio for negative result of the new ESBL media were 97.4%, 66.7%, 89.2%, 90%, 2.9 and 0.03, respectively.CONCLUSION: Since the new ESBL media and DDST results were similar, so the new ESBL media could be used for screening patients with clinical presentation that indicating a high suspicious of ESBL-producing bacteria.KEYWORDS: K. pneumoniae, ChromID ESBL, DDST, ESBL, sensitivity

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS COLONIZATION AND SCREENING METHOD EFFECTIVENESS FOR PATIENTS ADMITTED TO THE INTENSIVE CARE Andaru Dahesihdewi; Budi Mulyono; Iwan Dwiprahasto; Supra Wimbarti
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 1 (2017)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i1.1149

Methicillin-resistant S.aureus (MRSA) menyebabkan banyak infeksi nosokomial (inos) dan penyebarannya menunjukkan mutu cleancare. Kejadian inos MRSA meningkatkan angka kesakitan, kematian, lama rawat inap, kebutuhan antibiotika dan meluasnya resistensi,readmisi serta biaya kesehatan. Penapisan kolonisasi MRSA di pasien yang akan dirawat intensif diperlukan untuk mencegah penyebarandan mengendalikan peresepan antibiotika. Pemeriksaannya diharapkan tepat guna untuk mendukung Sistem Jaminan KesehatanNasional. Penelitian dilaksanakan di Ruang Rawat Intensif RSUP Dr Sardjito Yogyakarta di seluruh pasien pada tahun 2015 saat masuksesuai patokan kesertaan dan non-kesertaan. Spesimen dari nares anterior dan kulit (aksila-inguinal), diambil dalam 1x24 jam, dinilaikepositifan MRSA menggunakan beberapa media identifikasi di Instalasi Laboratorium Klinik. Perbandingan analitik dan praktikabilitasmetode identifikasi dianalisis efektivitasnya. Kejadian kolonisasi S.aureus dan MRSA di pasien saat masuk perawatan Ruang Intensif23,4% dan 9,7%. Faktor kebahayaan dominan kolonisasi MRSA adalah riwayat perawatan RS. Nares anterior dominan sebagai tempatkolonisasi S.aureus (74,2%) dan MRSA (33,7%). Terdapat 7,7% kolonisasi lolos deteksi bila sampling hanya dilakukan di nares.Kesepakatan hasil pemeriksaan antar metode baik (indeks Kappa >0,8) dengan metode yang disarankan adalah penggunaan mediaselektif MRSA langsung atau urutan metode deteksi menggunakan Blood Agar, pengecatan Gram, uji aglutinasi, media khromogenikselektif MRSA. Metode penapisan dengan tingkat deteksi dan praktikabilitas yang baik bermanfaat mendukung pengendalian infeksidi ruang berkebahayaan tinggi.

Diagnostic Performance of Molecular Rapid Test in Establishing Diagnosis of MDR-TB Nunung Dartini Wahyuningtyas; Osman Sianipar; Andaru Dahesihdewi
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 2 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i2.1843

Tuberculosis (TB) is a global health problem and is the leading cause of morbidity and mortality in many developing countries. Multi Drug Resistant Tuberculosis (MDR TB) becomes one burden of health problems considering the high morbidity and mortality rates. Establishment of MDR TB diagnosis is still a challenge, related to the tools and methods used, while cultural examination as gold standard is expensive and takes a long time. This study aims to evaluate diagnostic performance of Molecular Rapid Test or MRT (GeneXpert) in establishing diagnosis of MDR TB using Mycobacteria Growth Indicator Tube (MGIT) culture as gold standard. Using a cross sectional design, this study involved 51 subjects, a total of 26 (51%) male and 25 (49%) female, adult patients suspected TB, treated at dr. Ario Wirawan Lung Hospital (RSPAW) Salatiga. Mean age 48.2 + 16.35 years, (17-79 years). The MRT for TB and MDR TB detection showed 13 and 7 true positives, 32 and 43 true negatives; obtained 68.4% and 87.5% Sensitivity, 100% and 100% Specificity, 100% and 100% Positive Predictive Value (PPV), 84.2% and 97.7% Negative Predictive Value (NPV), respectively. A specific analysis to diagnose MDR TB by MRT on TB patient groups showed 7 true positives, 0 false positives, 11 true negatives and 1 false negative; obtained 87.5% Sensitivity, 100% Specificity, 100% PPV and 91.7% NPV. For establishing diagnosis of MDR TB, MRT provides perfect specificity. One false negative MDR TB in MRT results is likely resistant to other than rifampicin.

Efektivitas Kepemimpinan dan Komunikasi Tim Keselamatan Pasien di RSI Ibnu Sina Pekanbaru Riau Hetty Ismainar; Andaru Dahesihdewi; Iwan Dwiprahasto
Jurnal Kesehatan Komunitas Vol 2 No 1 (2012): Jurnal Kesehatan Komunitas
Publisher : STIKes Hang Tuah Pekanbaru

Patient safety is a priority in hospitals services. Implementation of patient safety are expected to minimize the risk of adverse event. Committee of Patient Safety in Hospitals invite all stakeholders to be more attention on patient safety issues. However, in the process, teamwork seems not effective. Leadership is one of the characteristics that an teamwork should have. Various patient safety studies have been done and the result is communication also affects the efficiency of teamwork. This study was aimed to evaluate leadership and communication effectiveness of patient safety teamwork in Ibnu Sina Islamic Hospital, Pekanbaru, Riau. This study used a mixed method exploratory sequential design. In-depth interview and observation were used to explore perception and behavior that describe leadership and communication effectiveness on patient safety teamwork. A Survey using questionnaires were used to categorize perception of both aspects into YAKKUM competency level. Data were analyzed qualitatively using open code 3.6 and quantitatively through frequency distribution. All member of patient safety team participated in the study. The results of study, Of the 42 cases reported incidents, there were 45.22% medication error cases, in which 2.38% result in death and 50% were not analyzed. There were no reports of internal and external work done by team. The effectiveness of leadership and communication still at level 2nd and 3rd. The Conclusion of the research was leadership and communication effectiveness on this team is not optimal and predominantly used passive leadership. Round of Patient Safety (RPS), The SBAR Tools, reward and punishment are recommended in this study.

Peran SNARS dalam Perubahan Perilaku Kebersihan Tangan pada Profesional Kesehatan Andaru Dahesih Dewi; Iwan Dwiprahasto; Supra Wimbarti; Budi Mulyono
The Journal of Hospital Accreditation Vol 1 No 02 (2019): Resistensi Antimikroba, Pencegahan Pasien Jatuh dan Waktu Tunggu
Publisher : Komisi Akreditasi Rumah Sakit (KARS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35727/jha.v1i2.39

Latar Belakang: Kebersihan tangan adalah kunci keselamatan pasien, menjadi standar akreditasi RS sejak tahun 2012, namunimplementasinya masih fluktuatif. Penelitian ini bertujuan mengeksplorasi faktor dan peran Standar Nasional Akreditasi RS (SNARS) dalam perubahan perilaku kebersihan tangan. Tujuan: (1) Mengeksplorasi komponen perubahan perilaku yang mempengaruhi kepatuhan petugas dalam praktik kebersihantangan; (2) Menyempurnakan metode edukasi, mentoring dan dukungan teknis lingkungan sesuai hasil eksplorasi; dan (3) Mengukur perubahan ketepatan praktik kebersihan tangan setelah intervensi. Metode: Penelitian dilakukan di RSUP Dr Sardjito Yogyakarta Juni 2014–April 2016. Dilakukan 22 wawancara mendalam dan 9diskusi kelompok terfokus dilakukan terhadap staf, dipilih judgemental sampai mencapai saturasi data. Kuesioner yangmengeksplorasi tingkat pengetahuan dan persepsi praktik kebersihan tangan diisi seluruh petugas di ruang rawat intensif dan bedah (n 186), dianalisis dengan chi-square. Hasil digunakan untuk menyesuaikan metode reedukasi. Ketepatan-konsistensi praktik sesuai kategori petugas di ruang observasi diukur dan dianalisis time series. Hasil: Persepsi positif praktik tidak dipengaruhi karakteristik demografik. Manajemen perubahan perilaku selanjutnya disesuaikankonsep mindfulness mengikuti ‘Pendekatan Lewin, unfreeze–change–refreeze’. Kampanye kreatif dan partisipasi aktif ditujukanmencairkan cara pikir lama. Reedukasi ditujukan membangun kesadaran dan motivasi bertindak individual/kelompok, melibatkanpimpinan sebagai role model. Perubahan dipertahankan dengan sistem audit yang ditautkan ke sistem pembinaan SDM dan evaluasi SNARS diposisikan sebagai tantangan eksternal untuk refreeze perubahan menjadi budaya. Analisis time series ketepatan dan konsistensi praktik menunjukkan trend sistematik meningkat (dari 60-70% menjadi 85-90%) dengan indikasi adanya periode postevent exhausted. Intensitas, lama paparan edukasi, mentoring, kreativitas promotif, kekerapan booster disesuaikan dengan pola setempat, mengedepankan bukti lokal. Kesimpulan: Pendekatan mindfulness berbasis data lokal bermanfaat membangun budaya kebersihan tangan. Instrumen SNARSberperan dalam refreeze proses perubahan perilaku profesional petugas. Indikator luaran yang peka mengidentifikasi ketidakpatuhan perlu dieksplorasi lebih lanjut.

Overview of The Incidence and Risk Factors for Nosocomial Infections Using a Geographic Information System Maps Setianto, Rochady; Lazuardi, Lutfan; Dahesihdewi, Andaru
Sains Medika : Jurnal Kedokteran dan Kesehatan Vol 5, No 2 (2013): July-December 2013
Publisher : Fakultas Kedokteran; Universitas Islam Sultan Agung (UNISSULA)

Hospitalized patients have a high risk of getting nosocomial infections due to various reasons. They tend to be more susceptible to infection because oftheir underlying disease condition, and they have higher when patients undergo invasive procedures. If the patientâ€™s immune system is impaired, thenon-pathogenic microorganism are capable of causing disease. Map is a method of illustrating an epidemiologic effectively . Maps can be used to showplace of incidence. Mapping the incidence of nosocomial infections in Sultan Agung Hospital is a method developed for the surveillance of nosocomialinfections. This type of research is a quantitative study with a cross sectional design. This study illustrates the risk factors of nosocomial infection withincidence of nosocomial infections that occur based on time point. Risk factors are extrinsic and intrinsic factors. Based on the spatial image on the map,in extrinsic incidence of nosocomial infections is Plebitis. Genesis Plebitis incidence correlates with the placement of hand washing points handrub. Whilethe intrinsic factor in the Plebitis image and ILO most inpatient distribution in patients aged 50 years with impaired skin integrity due to infusion andphysically due to decreased immunity associated with a variety of underlying diseases. Incidence of nosocomial infections in the inpatient unit is theprimary predisposing factors such as age and clinical issues related predisposing underlying disease can weaken the immune system of the patient, so thatthe procedures and even the most basic medical treatment could potentially cause nosocomial infection.

Correlation of Nitrite Oxide with Severity and Survival Rate of Sepsis Patients Sotianingsih Sotianingsih; Budi Mulyono; Andaru Dahesihdewi; Samsirun Halim; Ahmad Syauqi
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 1 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i1.1749

The objective of this research was to determine the correlation between Nitric Oxide (NO) levels with the severity of sepsis, to describe the kinetics of NO levels, and to evaluate it in predicting mortality. This research was a longitudinal cohort observational analytical study. The variables were serum NO levels and SOFA scores, which were serially evaluated. The correlation test and difference test were used for statistical analysis. The survivor and the non-survivor group consisted of 14 (41.18%) and 20 (58.82%) patients, respectively. There was a correlation between serum NO levels and the SOFA score at the 24-hour observation (r=0.403; p=0.041). Non-parametric Mann-Whitney test showed that there was no kinetics of NO th levels at 0, 24, 72, and 144-hour observation (p-values =0.897 and 0.703, respectively). NO levels > 111,16 Î¼mol/L at the 24 hour could predict the risk of death with hazard ratio 4.7 compared to NO levels < 111,16 Î¼mol/L. The survival rate of patients with serum NO levels <111,16 Î¼mol/L and > 111,16 Î¼mol/L was 83.3% and 37.5%, respectively. There was a correlation between serum NO levels and SOFA scores at the 24-hour observation. However, there was no kinetics of NO levels at serial evaluations. Nitric oxide levels with a cut-off of 111,16 Î¼mol/L at 24 hours could predict the survival of septic patients. Utilization of serum NO level at 24 hour can be used to evaluate the severity of septic patients and aggressive management if there is an increase in serum NO levels > 111,16 Î¼mol/L at 24 hours.

Diagnostic Performance of Molecular Rapid Test in Establishing Diagnosis of MDR-TB Nunung Dartini Wahyuningtyas; Osman Sianipar; Andaru Dahesihdewi
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 2 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i2.1843

Tuberculosis (TB) is a global health problem and is the leading cause of morbidity and mortality in many developing countries. Multi Drug Resistant Tuberculosis (MDR TB) becomes one burden of health problems considering the high morbidity and mortality rates. Establishment of MDR TB diagnosis is still a challenge, related to the tools and methods used, while cultural examination as gold standard is expensive and takes a long time. This study aims to evaluate diagnostic performance of Molecular Rapid Test or MRT (GeneXpert) in establishing diagnosis of MDR TB using Mycobacteria Growth Indicator Tube (MGIT) culture as gold standard. Using a cross sectional design, this study involved 51 subjects, a total of 26 (51%) male and 25 (49%) female, adult patients suspected TB, treated at dr. Ario Wirawan Lung Hospital (RSPAW) Salatiga. Mean age 48.2 + 16.35 years, (17-79 years). The MRT for TB and MDR TB detection showed 13 and 7 true positives, 32 and 43 true negatives; obtained 68.4% and 87.5% Sensitivity, 100% and 100% Specificity, 100% and 100% Positive Predictive Value (PPV), 84.2% and 97.7% Negative Predictive Value (NPV), respectively. A specific analysis to diagnose MDR TB by MRT on TB patient groups showed 7 true positives, 0 false positives, 11 true negatives and 1 false negative; obtained 87.5% Sensitivity, 100% Specificity, 100% PPV and 91.7% NPV. For establishing diagnosis of MDR TB, MRT provides perfect specificity. One false negative MDR TB in MRT results is likely resistant to other than rifampicin.

Blood Culture Positivity Rate: Antibiotical Therapy Impact Before Sample Collection in Sepsis Patients Sri Kartika Sari; Andaru Dahesihdewi; Osman Sianipar
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 29 No. 3 (2023)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v29i3.2016

Sepsis is one of the significant causes of global morbidity and mortality. One of the keystones of sepsis diagnosis and treatment is the Blood Culture (BC) test. BC performed after intravenous Antibiotic Administration (AA) appears to reduce the culture positivity rate. This study aimed to evaluate the influence of AA before obtaining blood culture samples on the positivity rate. This was a retrospective cohort study, conducted from January to February 2020 on patients with suspected sepsis at the Mataram General Hospital from January to December 2019. Patients with valid blood culture tests were included. Out of 178 suspected sepsis patients, 138 samples were culture-negative, and 40 samples were culture-positive. Out of 40 culture-positive patients, 23 (57.5%) samples were obtained before AA, whereas other 17 samples (42.5%) were obtained after AA. In addition, among 138 culture-negative patients, 101 (73.2%) subjects received antibiotics before sampling, and only 37 (26.8%) subjects received antibiotics after sampling. There was a significant difference in the blood culture positivity results between samples taken before and after AA (p=0.001). Samples were taken before AA had a 3.69 times greater possibility of positive culture results than samples taken after AA (OR 3.69; 95% CI 1.77-7.67; p= 0.0005). The percentage of positive culture results among subjects receiving antibiotics before sampling was highest (20%) in those whose samples were taken less than an hour before the next AA. Antibiotics administration of sepsis patients before blood culture sampling gives a lower positivity rate than AA after blood culture sampling.

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