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"Hospital Acquired Pneumonia HAP merupakan pneumonia yang terjadi pada pasien yang dirawat dirumah sakit setelah 48 jam. Prevalesi kejadian HAP sangat tinggi khususnya pada pasien terpasang NGT. Peran perawat sangat dibutuhkan untuk menurunkan kejadaian HAP pada pasien terpasang NGT. Tujuan penelitian ini adalah menggambarkan hubungan antara tingkat pengetahuan perawat terhadap tingkat perilaku perawat tentang pencegahan HAP pada pasien terpasang NGT. Penelitian deskriptif dengan desain croos sectional ini menggunakan sampel 107 perawat. Hasil penelitian dianalisis dengan Chi-square menunjukkan adanya hubungan yang bermakna antara pengetahuan terhadap perilaku perawat p value= 0,001. Penelitian ini merekomendasikan, peningkatan pengetahuan perawat sangat diperlukan untuk meningkatkan perilaku perawat. Saran bagi peneliti selanjutnya adalah melakukan penelitian menggunakan metode observasi pada variabel perilaku.

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Hospital Acquired Pneumonia HAP is a pneumonia in patient with NGT is high, that occurs in hospitalized patients after 48 hours. The prevalence of HAP occurrence is high in patients with NGT. The role of the nurse is needed to reduce the HAP's mortality in patients with NGT. The purpose of this study is to identifi the relationship between the nurse's knowledge and the nurse's behavior on prevention of HAP in NGT attached patients. This study was conducted by cross sectional design with 107 respondents. The data was analyzed with Chi square. The result showed a significant correlation between knowledge to nurse behavior p value 0,001. This study recommends that the improvement of nurse knowledge is needed to improve nurse behavior."

"Perilaku perawat dalam pencegahan Hospital Acquired Pneumonia (HAP) mempengaruhi kejadian HAP di rumah sakit. Hasil observasi beberapa perawat belum menjalankan praktik pencegahan HAP dengan benar. Penelitian ini bertujuan mengidentifikasi determinan perilaku perawat dalam pencegahan HAP. Penelitian deskriptif dengan desain cross sectional ini menggunakan sampel 107 perawat. Hasil penelitian menunjukkan jenis kelamin (p꞊0.001; 95%CI꞊0.047;0.431), fasilitas (p꞊0.001; 95%CI꞊1.902;11.11), sikap (p꞊0.036; 95%CI꞊1.138;5.625), dan pengetahuan (p꞊0.001; 95%CI꞊2.105;11.66) mempengaruhi perilaku perawat dalam pencegahan HAP. Sementara usia (p꞊0.110; 95%CI꞊0.933;4.505), masa kerja (p꞊0.067; 95%CI꞊1.023;4.958), pelatihan (p꞊1.00; 95%CI꞊0.332;2.483), motivasi (p꞊0.118; 95%CI꞊0.916;5.975), dan supervisi kepala ruang (p꞊0.203; 95%CI꞊0.821;3.921) tidak mempengaruhi perilaku perawat dalam pencegahan HAP. Penelitian ini merekomendasikan peningkatan pengetahuan, sikap, dan fasilitas untuk meningkatkan perilaku perawat dalam pencegahan HAP.

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Nurses behaviors on the prevention of Hospital Acquired Pneumonia (HAP) may affect the incidence of HAP. Our observations showed that some nurses did not perform HAP prevention properly. This study aimed to identify determinants of nurses’ behaviors on the prevention of HAP. The study employed a descriptive cross- sectional design. A sample of 107 nurses took part in the study. Results revealed that nurses’ sex (p꞊0.001; 95%CI꞊0.047;0.431), attitude (p꞊0.036; 95%CI꞊1.138;5.625), knowledge (p꞊0.001; 95%CI꞊2.105;11.66) and hospital facilities (p꞊0.001; 95%CI꞊1.902;11.11), affected nurses’ behaviors on the prevention of HAP. On contrary, nurses’ age (p꞊0.110; 95%CI꞊0.933;4.505), motivation (p꞊0.118; 95%CI꞊0.916;5.975), job tenure (p꞊0.067; 95%CI꞊1.023;4.958), trainings (p꞊1.00; 95%CI꞊0.332;2.483), and head nurse oversight (p꞊0.203; 95%CI꞊0.821;3.921) did not affect nurses’ behaviors on the prevention of HAP. This study recommended the enhancement of nurses behavior and attitude as well as hospital facilites in order to improve nurses’ behaviors on the prevention of HAP."

"Community acquired pneumonia (CAP) oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang tinggi. CAP akibat PRO memerlukan terapi antibiotik spektrum luas, skor Drugs Resistance in Pneumonia (DRIP) mampu memprediksi kasus tersebut. Penggunaan skor DRIP dapat mencegah kegagalan terapi antibiotik empirik dan mempersingkat lama rawatan, untuk itu diperlukan validasi. Penelitian ini merupakan studi Cohort Retrospektif pada pasien CAP yang dirawat inap selama periode Januari 2019 hingga Juni 2020. Data diambil dari rekam medis, kegagalan antibiotik bila terdapat kematian, pindah rawat ICU dan eskalasi antibiotik. Performa skor DRIP dianalisis dengan menentukan nilai kalibrasi dan diskriminasi, uji Hosmer-Lemeshow dan Area Under Curve (AUC). Diperoleh 480 pasien yang telah memenuhi kriteria. Terdapat 331 pasien (69%) dengan skor DRIP <4 dan 149 pasien (31%) dengan skor DRIP ≥4, dengan jumlah kegagalan antibiotik sebesar 283 pasien (59%), 174 pasien (61,4%) skor DRIP <4 dan 109 pasien (38,5%) skor DRIP ≥4. Kalibrasi DRIP menggunakan uji Hosmer-Lemeshow diperoleh p-value = 0,667 (p>0,05), diskriminasi AUC pada kurva ROC diperoleh 0,651 (IK 95%; 0,601-0,700). Skor DRIP menunjukkan performa yang cukup baik dalam memprediksi kegagalan antibiotic empiric pada pasien CAP yang terinfeksi PRO. Skor DRIP tidak berhubungan dengan lama rawatan di Rumah Sakit.

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Community-acquired pneumonia (CAP) caused by drug resistant pathogens (DRP) has a high level of severity. The incidence of CAP due to DRP requires broad spectrum antibiotic therapy, the Drugs Resistance in Pneumonia (DRIP) score is able to predict these cases. The use of the DRIP score can prevent antibiotic failure and minimize length of hospitalization, but validation is needed . This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from patient medical records, and failure of empiric antibiotics occurs when one of this criteria are found: patient mortality, ICU transfer and escalation of antibiotics as well as length of stay. Furthermore, the performance of the DRIP score was analyzed by determining the calibration and discrimination, using the Hosmer-Lemeshow test and the Area Under Curve (AUC). There were 480 patients who met the criteria. There were 331 patients (69%) with a DRIP score <4 and 149 patients (31%) with a DRIP score ≥4, with a total of 283 patients (59%) of antibiotic failures which were detailed in 174 patients (61.4%) with a DRIP score <4 and 109 patients (38.5%) DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value=0.667 (p>0.05), AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). The DRIP score showed good performance in predicting failure of empiric antibiotics in infected CAP patients. PRO. The DRIP score is not related to the length of stay in the hospital."

"Latar Belakang: Infeksi HAP oleh bakteri multidrug-resistant (MDR) menyebabkan mortalitas yang tinggi, lama rawat yang memanjang dan biaya perawatan yang tinggi. Karena itu perlu diketahui gambaran faktor risiko terjadinya infeksi bakteri MDR pada pasien HAP. Tujuan: Mengetahui gambaran faktor risiko terjadinya infeksi bakteri MDR pada pasien HAP di RSUPN Cipto Mangunkusumo. Metode: Penelitian dengan desain Kohort retrospektif menggunakan rekam medik pasien HAP yang memiliki hasil kultur sputum di RSUPN Cipto Mangunkusumo tahun 2015-2016 dengan metode total sampling. Pasien HAP diklasifikasikan menjadi terinfeksi bakteri MDR dan terinfeksi bakteri bukan MDR berdasarkan kategori resistensi isolat yang paling resisten pada sputum yang pertama kali didiagnosis MDR. Evaluasi gambaran faktor risiko dilakukan kepada semua subjek. Seluruh analisis dilakukan menggunakan program Microsoft Excel. Hasil: Proporsi HAP selama tahun 2015 dan 2016 berturut-turut adalah 6,12 dan 6,15/1000 admisi. Proporsi pasien HAP yang terinfeksi bakteri MDR selama tahun 2015 dan 2016 berturut-turut adalah 95% dan 82,1%. Gambaran proporsi faktor risiko infeksi bakteri MDR pada pasien HAP RSUPN Cipto Mangunkusumo tahun 2015-2016 mulai dari yang paling tinggi ke yang paling rendah berturut-turut adalah riwayat pemakaian antibiotik 90 hari sebelum diagnosis (100%), albumin <2.5 g/dL (100%), Charlson Comorbidity index≥3 (95,9%), usia> 60 (95,2%), lama rawat> 5 hari (92,5%), riwayat pemasangan NGT (92,1%), riwayat perawatan ICU/HCU sebelumnya (81,8%) dan penggunaan steroid setara prednison>10 mg/hari atau ekivalen selama>14 hari (28,6%). Simpulan: Proporsi infeksi bakteri MDR pada pasien HAP RSUPN Cipto Mangunkusumo tahun 2015 dan 2016 berturut-turut adalah 95% dan 82,1% dengan proporsi faktor risiko infeksi bakteri MDR yang paling tinggi adalah pada pasien dengan riwayat pemakaian antibiotik 90 hari sebelum diagnosis dan albumin <2.5 g/dL.>

Background: Multi-drug Resistant (MDR) Hospital-acquired Pneumonia (HAP) is associated with high mortality, prolonged hospital stay and high cost. Therefore, it is important to have description risk factors distribution for MDR HAP.

Aim: To have description of risk factors proportion for infection with MDR bacteria in HAP patients hospitalized in Cipto Mangunkusumo General Hospital.

Methods: A Cohort retrospective study with total sampling methode was conducted to collect medical records of HAP patients hospitalized in 2015-2016. Patients were classified as infected with MDR bacteria and infected with non-MDR bacteria based on the most resistant category of the sputum firstly diagnosed infected with multidrug-resistant bacteria. Risk factors evaluation were conducted to all subjects. All analysis was done using Microsoft Excel.

Results: Proportion of HAP during 2015 and 2016 respectively were 6.12 per 1000 admission and 6.15 per 1000 admission. Proportion of HAP patients infected with MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively. MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively. Description of risk factors proportion for infection with MDR bacteria from the highest to lowest respectively were prior antibiotic use 90 days before diagnosis (100%), albumin level <2.5 g/dL (100%), Charlson Comorbidity index≥3 (95,9%), age >60 years (95,2%), hospitalization>5 days (92,5%), NGT insertion (92,1%), prior ICU/HCU hospitalization in the last 90 days (81,8%) and prior steroid use equivalent to prednisone >10 mg/day for >14 days (28,6%).

Conclusion: Proportion of HAP patients infected with MDR bacteria in 2015 and 2016 were 95% and 82,1% respectively with the highest risk factors proportion for infection with multidrug-resistant bacteria were prior antibiotic use in 90 days before diagnosis and albumin <2,5 g/dL."

"Caring merupakan bentuk perilaku dalam keperawatan. Caring merupakan aspek penting yang harus dimiliki oleh perawat dalam praktik keperawatan. Namun fakta di lapangan menunjukkan bahwa perilaku caring beberapa perawat disebagian besar rumah sakit masih belum sesuai harapan. Beberapa penelitian tentang perilaku caring perawat dibeberapa rumah sakit menunjukkan bahwa sebagian perawat memiliki perilaku caring rendah. Penelitian ini bertujuan untuk mengetahui gambaran perilaku caring perawat di ruang rawat inap lantai 4 gedung A RSUPN Dr. Cipto Mangunkusumo Jakarta menurut penilaian perawat sendiri. Penelitian ini merupakan penelitian kuantitatif dengan jenis penelitian deskriptif. Pengambilan data dilakukan selama kurang lebih 10 hari dengan jumlah responden sebanyak 60 orang perawat dengan menggunakan teknik total sampling. Pengambilan data menggunakan kuesioner CNPI (Caring Nurse Patient Interaction Scale) yang sudah diterjemahkan. Hasil analisis perilaku caring berdasarkan 10 faktor karatif didapatkan bahwa perawat sudah menerapkan perilaku caring pada faktor karatif 1 sampai dengan karatif 9 dengan persentase diatas 80%, kecuali karatif 10 baru mencapai 70%. Saran bagi penelitian selanjutnya agar dapat meneliti lebih dalam tentang perilaku caring perawat tidak hanya menurut penilaian perawat sendiri, tetapi berdasarkan penilaian pasien atau melalui observasi.

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Caring is a form of behavior in nursing. Caring is an important aspect that must be possessed by nurses in nursing practice. But the facts on the daily practice showed that some nurses caring behavior in most hospitals were still not as expected. Several studies of the behavior of caring nurses in several hospitals indicated that some nurses had low caring behavior.

This study aims to describe the behavior of caring nurses in the inpatient unit 4th floor of building A Cipto Mangunkusumo National Referal Hospital according to its own assessment nurse.

This study was a quantitative descriptive research. Data collection was performed for approximately 10 days with the number of respondents as many as 60 nurses using total sampling technique. Retrieving data using questionnaires CNPI (Caring Nurse Patient Interaction Scale) which had been translated.

The results of the analysis is based on 10 caratif factors of caring behavior found that nurses had applied caring behavior on caratif factors 1 through 9 with percentages above 80%, except karatif 10 had reached 70%.

Suggestions for further research is to study the nurse caring behavior not only based on the judgment of the nurses themselves, but also based on the assessment of the patients or through observation."

"Infeksi aliran darah banyak terjadi pada pasien yang terpasang kateter vena sentral. Infeksi sistemik mengakibatkan lama rawat karena memerlukan terapi pengobatan yang panjang dan berdampak pada mahalnya biaya perawatan. Perilaku perawat yang sesuai dengan standar prosedur operasional dapat mencegah terjadinya infeksi aliran darah mulai dari pemasangan, perawatan, dan pencabutan kateter vena sentral.Tujuan penelitian ini adalah mengetahui gambaran perilaku perawat dalam pencegahan infeksi aliran darah melalui kateter vena sentral di ruang perawatan intensif. Penelitian ini merupakan penelitian deskriptif dengan metode cross sectional terhadap 107 perawat di sebuah RS di Jakarta diambil dengan teknik simple random sampling.Hasil penelitian menunjukkan bahwa perawat yang berperilaku baik dalam pencegahan infeksi aliran darah melalui kateter vena sentral sebesar 54,2%. Hasil penelitian ini merekomendasikan penambahan informasi dan pelatihan mengenai CVC bundle pada perawat serta penyusunan dan sosialisasi standar prosedur operasional tentang perawatan dan pencabutan kateter vena sentral, termasuk desinfektan yang digunakan.

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The infections in bloodstream often occur in patient with Central Venous Catheter (CVC). Systemic infection can result in longer hospitalization due to requiring lengthy treatment therapy and has an impact on the higher cost of treatment expenses. Appropriate nurse behavior standards of operational procedures can prevent bloodstream infections starting from the CVC insertion preparation, CVC maintenance, and CVC removal.The purpose of this research was to describe the behavior of nurses in the prevention central line associated with bloodstream infections in intensive care. This research is a descriptive research using cross sectional method involving 107 nurses in the hospital in Jakarta. The respondents were taken by using simple random sampling.The result of this study, showed that the behavior of nurses in the prevention of bloodstream infections related to Central Venous Catheter is good behavior 54,2%. This research recommends the importance of the provision of information and training on CVC bundle in nurses, as well as the promotion of standards operational procedures about CVC maintenance and removal, including disinfectant used."

"Community-Acquired Pneumonia CAP adalah penyakit sistem pernapasan yang menyerang jaringan parenkim paru. Penyakit ini banyak mengancam individu dewasa dengan penurunan sistem imun. Penderita CAP mengalami peningkatan setiap tahunnya akibat peningkatan polusi udara yang berada di wilayah perkotaan, terutama pada kawasan industri. Penderita CAP akan mengalami peningkatan produksi sputum yang berujung pada kesulitan dalam mengeluarkan sputum. Pasien dengan CAP sering mengalami penurunan refleks batuk yang membuat sputum terakumulasi di jalan napas sehingga menyebabkan peningkatan usaha untuk bernapas. Fisioterapi dada merupakan salah satu teknik pembersihan jalan napas pada pasien dengan penurunan refleks batuk. Karya Ilmiah Akhir Ners ini bertujuan untuk menganalisis intervensi fisioterapi dada untuk mengurangi gejala serta mencegah perburukan pada pasien dengan CAP. Metodologi yang digunakan adalah metode studi kasus dan analisa penelitian yang telah ada. Hasil analisa yang didapatkan menunjukkan fisioterapi dada dapat menurunkan usaha napas pasien, pengurangan episode demam, perubahan karakteristik sputum, serta penuruan persentase mortalitas melalui skoring CURB-65.

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Community Acquired Pneumonia CAP is a respiratory disease that attacks the pulmonary parenchymal tissue. This disease threatens many adults with decreased immune system. CAP sufferers are increasing every year due to increasing air pollution in urban areas, especially in industrial areas. CAP sufferers will experience an increase in sputum production that leads to difficulties in removing sputum. Patients with CAP often have decreased cough reflexes that make sputum accumulate in the airway causing increased effort to breathe. Chest physiotherapy is one of the airway cleansing techniques in patients with decreased cough reflexes.

This Final Scientific Work of Ners aims to analyze the interventions of chest physiotherapy to reduce symptoms and prevent worsening of patients with CAP. The methodology used is the case study method and the existing research analysis. The results obtained showed chest physiotherapy can decrease the patient 39 s breathing effort, reduction of febrile episodes, changes in sputum characteristics, as well as the percentage of mortality by scoring CURB 65."

"Background: Community acquired pneumonia (CAP) in the elderly is still a major problem due to its high morbidity and mortality. There is considerable variability in ?the result of various studies on prognostic factors. The prognostic factors in Indonesia have not been identified.Methods: We performed a prospective cohort study on 147 elderly patients hospitalized with CAP in the internal medicine ward of Cipto Mangunkusumo National Central General Hospital, Jakarta from September 2002 to March 2003. We calculated the survival rate during hospitalize-tion. We used Cox proportional-hazard regression analysis to examine factors associated with mortality in the first 48 hours of hospitalization. .Results: There were 34 deaths (23.1) associated with CAP in 1471 person-days. The survival rate at day 5, 10 and 15 were 88.9%, 77.2 and 67.2% respectively. Severe. pneumonia, an serum albumin of d"3.5 g/dL, reducedconsciousness, temperature > 37.0"C, and a hemoglobin level of d" 9.0 g/dL demonstrated a tendency towards increased mortality rate. Other factors such as age, sex, immobilization, swollen disorders, co-morbidities, leukocyte count, and serum creatinine level demonstrated no significant relationship with mortality.Conclusion: Severe pneumonia, low serum albumin, decreased consciousness, high temperature and low hemoglobin level in the first 48 hours hospitalization were found to be worse prognostic factors. Early identification and modification of these factors are recommended."

"Latar Belakang: Dalam beberapa tahun terakhir, permasalahan yang sering muncul pada pneumonia komunitas adalah terkait timbulnya patogen penyebab yang bersifat resisten obat. Skor DRIP merupakan suatu model prediksi terhadap Patogen Resisten Obat (PRO) pada pneumonia komunitas. Skor DRIP memiliki akurasi prediksi patogen PRO yang lebih baik dibandingkan dengan beberapa alternatif skor lain termasuk kriteria HCAP. Belum adanya studi validasi terhadap penggunaan skor DRIP di Indonesia sehingga belum diketahui tingkat akurasi prediksi skor ini pada populasi, karakteristik pasien dan pola kuman di Indonesia terutama di RSUPN dr. Cipto Mangunkusumo Jakarta.Tujuan: Penelitian ini dilakukan untuk mengetahui performa skor DRIP sebagai instrumen dalam memprediksi infeksi akibat patogen PRO pada pneumonia komunitas di RSUPN dr. Cipto Mangunkusumo Jakarta.Metode: Suatu penelitian dengan menggunakan desain potong lintang. Subyek penelitian adalah pasien pneumonia komunitas yang dirawat di RS Cipto Mangunkusumo pada periode Januari 2019 hingga Juni 2020. Penelitian dilakukan dengan mengambil data rekam medis pasien pneumonia komunitas yang dirawat inap. Didefinisikan sebagai PRO apabila dari hasil kultur sputum didapatkan resisten terhadap antibiotik golongan β-laktam non pseudomonas (ceftriaxone, cefotaxime, ampicilin sulbaktam), Makrolid (azitromisin) dan fluorokuinolon respirasi (levofloxacin, moxifloxacin). Performa skor dianalisis dengan menentukan nilai kalibrasi dan diskriminasi menggunakan uji Hosmer-Lemeshow dan AUROC.Hasil: Sebanyak 254 subyek yang memenuhi kriteria pemilihan diikutkan dalam penelitian. Terbagi menjadi kelompok PRO 103 pasien (40,6%) dan non PRO 151 pasien (59,4%). Hasil analisis kalibrasi skor DRIP dengan uji Hosmer-Lemeshow didapatkan nilai p=0,001 (p<0,05). Sementara untuk analisis diskriminasi skor DRIP dari kurva ROC didapatkan nilai AUC 0,759 (IK95%;0,702-0,810). Pada skor ≥ 4, skor DRIP memiliki nilai sensitivitas 70,9%, spesifisitas 92,7%, nilai prediksi positif 86,9%, dan nilai prediksi negatif 82,3%.Simpulan: Skor DRIP memiliki performa yang baik untuk memprediksi infeksi akibat patogen PRO pada pneumonia komunitas.

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Background: In recent years, problems that often arise in community-acquired pneumonia are related to drug-resistant pathogens. The DRIP score is a predictive score model for Drug-Resistant Pathogens (DRP) in community-acquired pneumonia. It also has a better DRP pathogen prediction accuracy compared to other alternative scores including HCAP. There is no validation study on the use of the DRIP score in Indonesia, so the accuracy of this score prediction in the population, patient characteristics and germ patterns in Indonesia is not known, especially in RSUPN dr. Cipto Mangunkusumo Jakarta.

Objective: This study aims to determine the performance of the DRIP score as an instrument in predicting infection due to DRP pathogens in community-acquired pneumonia at Cipto Mangunkusumo Hospital Jakarta, Indonesia.

Methods: A study with cross-sectional design, on community-acquired pneumonia patients who were treated at Cipto Mangunkusumo Hospital in the period January 2019 to June 2020. Furthermore, this was conducted by reviewing medical records of inpatients. It is defined as DRP if the sputum culture results show resistance to non pseudomonas β-lactam antibiotics (ceftriaxone, cefotaxime, ampicillin-sulbactam), macrolides (azithromycin) and respiratory fluoroquinolones (levofloxacin, moxifloxacin). Score performance analyzed by determining the calibration and discrimination values using the Hosmer-Lemeshow and AUROC tests.

Results: 254 subjects who met the selection criteria were included in the study. It was divided into a PRO group of 103 patients (40.6%) and a non-PRO of 151 patients (59.4%). The results of the calibration analysis of the DRIP score with the Hosmer- Lemeshow test obtained a value of p=0.001 (p<0.05). Discrimination analysis from ROC curve got an AUC value of 0.759 (CI95%; 0.702-0.810). At a threshold ≥ 4 points, DRIP score demonstrated a sensitivity of 70,9%, a specificity of 92,7%, a positive predictive value of 86,9%, a negative predictive value of 82,3%.

Conclusions: The DRIP score have good performance to predict infections due to DRP pathogens in community-acquired pneumonia."