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A Descriptive Analysis of Patient Safety at Universitas Gadjah Mada Academic Hospital Yogyakarta : A Case Study Using IHI Global Trigger Tool for Measuring Adverse Events Novi Zain Alfajri; Domas Fitria Widyasari; Ratna Dewi Puspita
Academic Hospital Journal Vol 1, No 1 (2018): March
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v1i1.33622

Background: Management of medical treatment is a very complex multi-disciplinary process with many stages. During patient care at Universitas Gadjah Mada Academic Hospital (UGM Academic Hospital) incidents involving patient safety either go unreported or are accidentally found. According to some public health research only about 10-20% of incidents were reported. The purpose of this research aimed to provide data to the management about the level of patient safety and make recommendations to improve service quality, especially to reduce injury and increase patient safety.Methods: Our study was conducted by doing a review of patient medical records of hospitalized adults (n = 60) treated in September 2015 to detect trigger and adverse events using the IHI Global Trigger Tool for Measuring Adverse Events. Group Cares was designed to reflect the adverse events that occurred anywhere in UGM Academic Hopitaltal so that all samples should be reviewed by both modules. All three remaining modules were used if necessary depending on the unit where patients were treated. Technical analysis used in this research was descriptive statistics.Results: The study found 69 incidents / triggers that occurred in 27 patients (n = 60) consisting of 47 incidents in the treatment group, 16 incidents in the surgery group, one incident in intensive care, and 5 incidents at the Emergency Department. Based on the level of injury, the incidents which happened demanded extended day care, requiring more intervention and assistance of disability. No cases of death were reported due to the incidents.Conclusions: The incidence found in all categories according to the modules with the highest incidence was the incidence of treatment and the smallest was in intensive care. Most incidents resulted in extending the duration of treatment and require more intervention. No fatal cases were reported to have resulted in the studied sample.

Pulmonary Cryptococcosis due to Cryptococcus laurentii Co-infection with Miliary Tuberculosis in Adolescent Patient in Indonesia: Case Report Widyasari, Domas Fitria; Daniwijaya, M Edwin Widyanto; Siswanto, Siswanto; Wirastuti, Fita; Wibawa, Tri
Academic Hospital Journal Vol 7, No 2 (2025)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v7i2.110936

AbstractBackground: Non-neoformans cryptococci were previously considered to be saprophytes and nonpathogenic to humans. Cryptococcus laurentii is commonly found in the environment and pigeon feces and has been reported to be an emerging human fungal pathogen that causes infection in the immunocompromised host. Here, we report a unique case of pulmonary cryptococcosis coinfection with Miliary Tuberculosis.Case: A 14-years old adolescent underweight boy was admitted to the Emergency Unit with the chief complaint of fever, cough, chest pain, breathlessness, night sweats, malaise, and weight loss. He was referred from Public Health Center in Sleman Yogyakarta with Miliary Tuberculosis and consumed six weeks of fixed-dose combinations of the first-line anti-tuberculosis drug. Microbiology culture of good quality patient sputum revealed Cryptococcus laurentii along with Klebsiella oxytoca. The patient was diagnosed with Pulmonary Cryptococcosis. The patient's symptoms, especially fever and chest pain, were not improved by oral Fluconazole 200 mg treatment. However, he had an excellent response to Levofloxacin 500 mg during hospitalization and oral Fluconazole therapy at 400 mg/day for eight weeks. After eight weeks of Fluconazole treatment, the patient got well, and then Fluconazole was stopped. Anti-tuberculosis was treated for six months, and no recurrence was found.Conclusion: This article reports the rare pulmonary involvement of Cryptococcus laurentii in adolescent patients with Miliary Tuberculosis patient in Indonesia. A high degree of pulmonary mycosis suspicion and techniques improvement for respiratory specimen collection, culture, and identification contribute to early diagnosis and fungal infection treatment. In addition, interprofessional discussion can improve patient treatment and outcomes.

The hospital environment as an ecological driver of multidrug-resistant organisms: evidence from intensive isolation and operating rooms Widyasari, Domas Fitria; Daniwijaya, Edwin Widyanto; Purnomo, Galih Santo; Rahayu, Ayu; Nuryastuti, Titik
Berita Kedokteran Masyarakat Vol 42 No 01 (2026)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v42i01.24745

Purpose: Multidrug-resistant organisms (MDROs) present a significant challenge for hospital infection control, with environmental surfaces acting as key reservoirs. This study sought to identify MDRO species, evaluate their biofilm-forming capacity, and quantify microbial bioburden in intensive care isolation and operating rooms. Methods: Environmental sampling was conducted in 16 rooms. Air and surface samples, including floors, walls, and bedside monitors, were collected using a microbiological air sampler and sterile swabs. Samples were cultured to determine total bioburden and detect MDROs, with bacterial identification performed using VITEK 2. Antimicrobial resistance was assessed using the Kirby-Bauer disc diffusion test, and bioburden levels were compared to national standards. Results: Forty-nine MDRO isolates were identified: 3 methicillin-resistant Staphylococcus aureus (MRSA, 6.12%), 19 methicillin-resistant coagulase-negative staphylococci (MRCONS, 38.78%), 24 carbapenem-resistant Acinetobacter spp. (CRA, 48.98%), and 3 extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (6.12%). Mean microbial bioburden remained within acceptable limits for air (57.44 CFU/m³), walls (70.63 CFU/100 cm²), and bedside monitors (22.63 CFU/100 cm²), but exceeded thresholds on floors (753.75 CFU/100 cm²). Biofilm-forming capacity varied: MRCONS (26.32% strong biofilm), CRA (8.33% strong biofilm), and ESBL-producing Enterobacterales (66.67% weak biofilm). Conclusion: MDROs were detected in all sampled rooms, with CRA as the predominant species. Floors exhibited microbial loads above acceptable standards, highlighting the necessity for improved cleaning protocols. Enhanced environmental infection control strategies are essential to reduce MDRO transmission in healthcare settings.

The hospital environment as an ecological driver of multidrug-resistant organisms: evidence from intensive isolation and operating rooms Widyasari, Domas Fitria; Daniwijaya, Edwin Widyanto; Purnomo, Galih Santo; Rahayu, Ayu; Nuryastuti, Titik
Berita Kedokteran Masyarakat Vol 42 No 01 (2026)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v42i01.24745

Purpose: Multidrug-resistant organisms (MDROs) present a significant challenge for hospital infection control, with environmental surfaces acting as key reservoirs. This study sought to identify MDRO species, evaluate their biofilm-forming capacity, and quantify microbial bioburden in intensive care isolation and operating rooms. Methods: Environmental sampling was conducted in 16 rooms. Air and surface samples, including floors, walls, and bedside monitors, were collected using a microbiological air sampler and sterile swabs. Samples were cultured to determine total bioburden and detect MDROs, with bacterial identification performed using VITEK 2. Antimicrobial resistance was assessed using the Kirby-Bauer disc diffusion test, and bioburden levels were compared to national standards. Results: Forty-nine MDRO isolates were identified: 3 methicillin-resistant Staphylococcus aureus (MRSA, 6.12%), 19 methicillin-resistant coagulase-negative staphylococci (MRCONS, 38.78%), 24 carbapenem-resistant Acinetobacter spp. (CRA, 48.98%), and 3 extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (6.12%). Mean microbial bioburden remained within acceptable limits for air (57.44 CFU/m³), walls (70.63 CFU/100 cm²), and bedside monitors (22.63 CFU/100 cm²), but exceeded thresholds on floors (753.75 CFU/100 cm²). Biofilm-forming capacity varied: MRCONS (26.32% strong biofilm), CRA (8.33% strong biofilm), and ESBL-producing Enterobacterales (66.67% weak biofilm). Conclusion: MDROs were detected in all sampled rooms, with CRA as the predominant species. Floors exhibited microbial loads above acceptable standards, highlighting the necessity for improved cleaning protocols. Enhanced environmental infection control strategies are essential to reduce MDRO transmission in healthcare settings.

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