Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 12
9
~ 1
33
I
S
SN
: 225
2-8
8
0
6
1
29
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
The Impact of Surgical Site Infect
ion to the Health Care Cost
Tria
ni Ma
rwati
1
,
A. A. Subi
yanto
2
,
To
to
k
M
a
rdikanto
3
, Priyam
bodo
4
,
Mar
s
ian
a
Wibow
o
5
, Nurul
Qom
a
riyah
6
1,5,6
Faculty
of Pu
blic Health, Ahmad Dahl
an
University
, Yog
y
ak
arta, Indon
esia
2
F
acult
y
of M
e
d
i
cine
, Univ
ers
i
t
y
of
Se
be
la
s Ma
ret,
Sura
karta, Indo
nesia
3
Faculty
of
Community
Empowerment,
Univ
ersity
of Sebelas Mar
e
t,
Surakar
t
a, In
donesia
4
Clinical Patholo
g
y
Departmen
t
,
Moew
ardi Hospital, Surak
a
rta, In
donesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Dec 26, 2015
Rev
i
sed
Mar
25
, 20
16
Accepted
May 22, 2016
Surgic
a
l
Site
Infe
c
t
ion (SSI)
is the most common cause of nosocomial
infections. Th
e inciden
ce of SSI is ranging betw
een 14 - 16% o
f
the en
tir
e
incid
e
nt of nosocomial infection
s
in hos
pitaliz
ed
patien
t
s. The o
b
jec
tives of
this stud
y
wer
e
to determine th
e re
lationship between know
ledg
e, attitude,
infrastructure and behavior of
health
person
nel to preven
t SSI and to
determ
ine th
e am
ount of additio
nal costs for hospital
care
as a result of SSI.
This stud
y
used
a m
i
xed m
e
tho
d
re
sear
ch. Qu
antitative research conduct
e
d
with descriptiv
e
anal
yti
c
design
with
cros
s
s
ecti
onal approa
ch.
Quantit
ativ
e
data was
ana
l
yz
ed b
y
univ
a
ri
ate
and bivari
ate
a
n
al
y
s
is
. Quali
t
a
t
ive res
e
arch
was used to m
e
asure add
ition
a
l
cost
due to SSI. Health p
e
rsonnel showed
good knowledge about SSI prev
ention (89
.
6%),
good attitude to
wards SSI
prevention (57%
), assessed good for hospita
l inf
r
astructure (93
.
8%
), but on
ly
55.2% showed good behavior to prevent SSI. There wer
e
no relationship
between knowledge and attitudes of
health
personnel,
an
d hospital
infrastructure with health
person
nel b
e
havior
to
prevent SSI. Additional
cost
due to
SSI was I
D
R 18,375,000
f
o
r each p
a
tient.
Keyword:
Cost treatm
e
nt
Health ca
re
Ho
sp
ital
Infectio
n op
eratin
g
area
Su
rg
ical site infectio
n
Copyright ©
201
x Institute of Ad
vanced
Engineering and Scien
c
e.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Triani Marwati
,
Facu
lty of Public Health
,
Uni
v
ersity
o
f
Ahm
a
d Da
hlan
,
Jl
. Pr
of
S
o
e
p
o
m
o, Jant
ura
n
,
War
u
ng
b
o
t
o
,
Yo
gy
aka
r
t
a
– I
n
d
o
n
esi
a
Em
ail: triyanim
@yahoo.c
o
m
1.
INTRODUCTION
Su
rg
ical Site In
fection
(SSI) is an
in
fectio
n o
n
surg
ical site o
r
o
r
g
a
n
th
at o
ccu
rred
with
in
30
d
a
y
s
post
-
su
r
g
ery
o
r
wi
t
h
i
n
1 y
e
a
r
i
f
t
h
ere a
r
e i
m
pl
ant
s
. The
sou
r
ce
of
i
n
fe
ct
i
on ca
n
be
d
e
ri
ve
d f
r
o
m
pat
i
e
nt
,
doct
o
r
an
d t
e
a
m
, t
h
e envi
r
o
n
m
ent
,
an
d i
n
st
r
u
m
e
nt
at
i
on [
1
]. SSI in
creased m
o
rtalit
y an
d
m
o
rb
id
ity, ex
ten
d
th
e
peri
od
o
f
po
st
-
s
ur
gi
cal
t
r
eat
m
e
nt
t
o
t
w
o
t
i
m
es l
o
nge
r a
n
d
i
n
crease t
h
e
c
o
st
of
heal
t
h
care
[
2
]
.
Th
e in
cid
e
n
ce
o
f
SSI can
reach
20
%, d
e
p
e
n
d
o
n
th
e site o
f
su
rg
ery, th
e crit
eria u
s
ed
for su
rv
eillan
c
e,
an
d th
e qu
ality of
d
a
ta co
llectio
n
.
Th
e
reported
i
n
cid
e
n
ce
of SSI in
t
h
e
US is
2
-
5
%
, Indo
n
e
sia is
2
-
1
8
%, an
d
i
n
P
K
U
M
u
h
a
m
m
adi
y
ah Yogy
a
k
art
a
H
o
spi
t
a
l
i
s
6%
[3]
.
The
m
o
st
c
o
m
m
on m
i
croor
ga
ni
sm
s are
Staphyloc
o
cc
us aureus, c
o
a
g
ulase-ne
gative
Staphyloc
o
cci,
Enterococ
c
us
s
p
p. a
n
d Esc
h
erichia coli [2].
SSI
pre
v
e
n
tion re
quires a s
e
ries of effort
s that
are i
n
terconnected
with each
othe
r:
syste
m
atic
conce
r
n t
o
t
h
e
num
ber of ri
sk fact
o
r
s t
o
r
e
duce t
h
e
ri
sk
of bact
eri
a
l
cont
am
i
n
at
i
on and t
o
i
n
c
r
eas
e t
h
e
p
a
tien
t
's i
m
m
u
n
e
system
. Guid
elin
es issu
ed b
y
t
h
e
Ce
nters for Diseas
e
Control a
n
d Prevention em
phasize
d
t
h
e im
port
a
nc
e of g
o
o
d
pat
i
ent
pre
p
arat
i
o
n, asept
i
c
p
r
a
c
t
i
ces, at
t
e
nt
i
on t
o
t
h
e sur
g
i
cal
proce
d
ure;
and
an
ti
m
i
cro
b
i
al th
erap
y is ind
i
cated
in
so
m
e
co
nd
itio
ns [2
].
PK
U M
u
ham
m
a
di
y
a
h Yo
gy
akart
a
a
nd
PK
U M
u
ham
m
ad
i
y
ah B
a
nt
ul
H
o
spi
t
a
l
s
are t
w
o o
f
se
veral
charitable e
f
forts of M
uham
m
adiyah orga
nization in t
h
e
health sector. PKU Muhamm
a
d
iyah
Yogyaka
r
ta was
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
12
9 – 1
3
3
13
0
est
a
bl
i
s
hed
i
n
19
2
3
a
nd
ru
n as t
y
pe B
hos
pi
t
a
l
w
h
i
c
h
has
been ac
c
r
edi
t
e
d i
n
1
6
servi
ce a
r
eas.
PK
U
Mu
h
a
mm
ad
iya
h
H
o
sp
ital Ban
t
u
l
w
a
s
f
ound
ed in
19
66
an
d ru
n as type C ho
sp
ital w
ith
ISO 9001
: 200
8
cert
i
f
i
cat
i
on, a
ccredi
t
e
d
by
a
ccredi
t
a
t
i
on
ve
rsi
o
n 2
0
12
fr
o
m
Ind
o
n
esi
a
n
M
i
ni
st
ry
of
He
al
t
h
[4]
.
T
h
e t
e
am
of
Prev
en
tion
and Con
t
ro
l t
o
Infectio
n
(
PP
I R
S
) in th
e
ho
sp
ital h
a
s
b
e
en
con
d
u
c
ting
sev
e
ral effo
rts t
o
p
r
ev
en
t
SSI, bu
t th
e
data is n
o
t
well d
o
c
u
m
en
ted
.
Patien
t
s and
t
h
e hos
p
ital are
also affected
by the risi
ng c
o
st of
health care
due to SSI.
The
r
ef
ore, th
e au
tho
r
s
was in
terested
to
in
v
e
stigate th
is issu
e. Th
e obj
ectiv
es o
f
th
is
stu
d
y
were to
d
e
term
in
e th
e
relatio
n
s
h
i
p b
e
tween
kn
owled
g
e
and
attitu
d
e
o
f
h
ealth personn
el, an
d
h
o
s
p
ital
in
frastru
ct
u
r
e,
with
b
e
h
a
v
i
or
o
f
h
ealth p
e
rson
n
e
l t
o
p
r
ev
en
t SSI and
t
o
coun
t add
itio
nal co
st
d
u
e
to
SSI.
2.
R
E
SEARC
H M
ETHOD
This study was a
m
i
xed m
e
thod re
search.
Qua
n
tita
tive resea
r
ch
was condu
cted with
analytic
d
e
scri
p
tiv
e d
e
sig
n
with
cro
s
s sectio
n
a
l
appro
ach. Qu
a
litativ
e research
was con
d
u
c
ted to m
easu
r
e ad
d
i
t
i
o
n
a
l
cost
due
t
o
SSI
.
Th
e
su
bj
ects o
f
t
h
is
stud
y w
e
r
e
h
ealth
per
s
onn
el
who
are ass
o
ciated w
ith
SSI
p
r
ev
en
tion
.
Th
e
po
p
u
l
a
t
i
on
wa
s 65
3
peo
p
l
e
(
f
r
o
m
PKU M
u
ham
m
a
di
y
a
h Yo
gy
aka
r
t
a
an
d B
a
nt
ul
Ho
sp
i
t
a
l
s
). The n
u
m
ber of
sam
p
l
e
s cal
cul
a
t
e
d by
Sl
o
v
i
n
f
o
rm
ul
a was
96
pe
o
p
l
e
. T
h
i
s
resea
r
ch
wa
s
co
nd
uct
e
d
i
n
Au
g
u
st
-
Se
pt
em
ber
2
015
.
Qu
an
titativ
e data was
ob
tained
b
y
qu
estionn
aire. Valid
ity
an
d reliab
ility o
f
th
e i
n
stru
m
e
n
t
were
do
ne
i
n
t
y
pe C
h
o
s
p
i
t
a
l
wi
t
h
30
pe
opl
e as
res
p
o
n
d
ent
s
, nam
e
l
y
:
m
e
di
cal
doct
o
rs,
nu
rses
, st
af
fs o
f
s
u
r
g
e
r
y
r
oom
,
sani
t
a
ri
an, st
af
fs of m
e
di
cal
r
ecor
d
, st
af
fs of
i
n
frast
r
u
ct
u
r
e and
ho
use
hol
d.
Val
i
d
i
t
y
t
e
st
was d
one
by
test
i
n
g
the conte
n
t va
lidity, face val
i
dity,
construc
t validity, and criterion
va
lidity. Validity
measurem
ent of each
que
stion
was done by Pea
r
s
on c
o
rrela
tion technique, foll
owe
d
by
t-test.
Reliability tes
t
conducte
d for each
v
a
riab
le in
th
e q
u
e
stio
nn
aire. Data was an
alyzed
with
uni
variate analysi
s
to desc
ribe t
h
e cha
r
acterist
i
cs of
resp
o
nde
nt
s.
B
i
vari
at
e anal
y
s
i
s
was
d
o
n
e
by
C
h
i
S
qua
re t
e
s
t
. Thi
s
t
e
st
was
d
one
t
o
det
e
r
m
i
n
e t
h
e rel
a
t
i
ons
hi
p
b
e
tw
een
tw
o
v
a
riab
les (know
ledg
e, attitu
d
e
s, beh
a
v
i
or
o
f
health
p
e
rso
n
n
e
l; an
d
h
o
sp
ital in
frastructu
r
e).
Qu
alitativ
e
d
a
ta was ob
tain
ed fro
m
seco
nd
ary d
a
ta to
d
e
termin
e ad
d
ition
a
l co
st
d
u
e
SSI.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Qua
n
ti
t
a
ti
ve An
al
ysi
s
3.
1.
1.
Charac
teristic
s of responde
n
Characteristics
of the
res
p
ondent
can
be
see
n
i
n
Ta
bl
e
1 (
n
=
9
6
)
.
Tabl
e
1. C
h
ara
c
t
e
ri
st
i
c
s of t
h
e
res
p
o
n
d
ent
Responde
nt char
acter
i
stics
Fr
equency
%
Age
19-
38 y
ear
s old
69
36.
5
39-
38 y
ear
s old
27
35.
4
Sex
M
a
le 17
17.
7
Fem
a
le 79
82.
3
E
ducation level
Senior
High School
6
63
(Diplo
m
a
) D3/ D4
73
76.0
Under
g
r
a
duate 17
17.
7
Pr
ofession
Nur
s
e 87
90.
6
Health Analy
z
e
6
6.
3
M
i
dwive 3
3.
1
Wo
rk
experience
11-
20 y
ear
s
88
59.
4
21-
30 y
ear
s
8
13.
5
3.
1.
2.
Uni
v
ari
a
te an
al
ysi
s
Th
e
resu
lt of un
iv
ariate an
alysis of
k
n
o
w
le
d
g
e
an
d
attitu
d
e
o
f
h
ealth
p
e
rsonn
el, h
o
sp
ital
i
n
fra
st
ruct
ure
,
and
be
havi
or
o
f
heal
t
h
pers
o
n
n
el
t
o
wa
rd
SSI
pre
v
ent
i
o
n at
PK
U M
u
ham
m
a
di
y
a
h Yo
gy
akart
a
hos
pi
t
a
l
can
be
seen
i
n
Ta
bl
e
2.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Th
e
Impa
ct
o
f
S
u
r
g
i
ca
l S
ite
In
fectio
n
t
o
t
h
e
Hea
lth Ca
re C
o
st in Yo
g
y
a
k
arta
Ho
sp
ita
l (Triya
n
i
Ma
rw
a
ti)
13
1
Tab
l
e 2
.
Kn
owled
g
e
,
attitu
d
e
,
in
frastru
c
ture, an
d
b
e
h
a
v
i
or
of h
ealth
p
e
rsonn
el
toward
SSI
prev
en
tion
at PKU
M
uham
m
adi
y
ah Yo
gy
aka
r
t
a
hos
pi
t
a
l
Var
i
ables
Categor
ies
Fr
equency
%
Knowledge
Not good
10
10.
4
Good
86
89.
6
Attitude
Not good
41
42.
7
Good
55
57.
3
Infrastructure
W
e
ll equipped
6
6.
3
Fair
ly equipped
90
93.
8
Behavior
Not good
43
44.
8
Good
53
55.
2
3.
1.
3.
B
i
vari
a
te an
al
ysi
s
The
res
u
lt of bi
variate a
n
alysis bet
w
een va
riable
s
with
Ch
i
sq
uare can
b
e
seen
in Tab
l
e 3.
Tabl
e
3. C
h
i
S
qua
re t
e
st
resul
t
s
Var
i
ables
p
value
CI
PR
Lower
Upper
T
h
e r
e
lationship between knowledge
and behavior
to pr
event SSI
0.
042
1.
316
2.
937
1.
966
The relationship between attitude an
d behavior
to prevent SSI
0.
235 0.445
1.
161 0.719
T
h
e r
e
lationship between infr
astr
uc
tur
e
and behavior
to pr
event SSI
0.
124
1.
282
3.
040
1.
974
3.
1.
4.
The relati
o
ns
hip betwee
n k
n
owledge
and behavior
to pr
even
t
SS
I
The res
u
l
t
s
of
C
h
i
Squa
re t
e
st
sho
w
ed
p val
u
e
= 0
.
04
2 (
p
< 0
.
05
). I
t
sh
ow
ed
th
at
th
er
e w
a
s
a
si
gni
fi
ca
nce re
l
a
t
i
onshi
p bet
w
een
kn
o
w
l
e
d
g
e an
d be
havi
o
r
t
o
pre
v
e
n
t
SSI. A
n
d
r
e
w
FS st
at
ed t
h
at
t
h
e level
of
education is a long term
process with
sys
t
em
atic and organi
ze
d structure [3]. Mana
gerial staff
will learn
conce
p
t
u
al
i
z
e
d
kn
o
w
l
e
d
g
e an
d t
h
e
o
ry
f
o
r ge
neral
pu
rp
ose
.
M
a
jo
ri
t
y
of re
s
p
o
n
d
ent
i
n
t
h
i
s
st
udy
h
a
d
di
pl
om
a
ed
u
cation
b
a
ckg
r
ou
nd
as a nurse.
Dip
l
o
m
a
ed
u
cation
lev
e
l
is a stud
y th
at
e
m
p
h
a
sized on sk
ills.
In
provid
i
n
g
med
i
cal serv
ices to
th
e p
a
tien
t
, a w
e
ll sk
illed
nu
rse is n
e
ed
ed, in
clud
ing
po
st surg
ery
reh
a
b
ilitatio
n
.
G
ood
sk
ills
m
u
st
b
e
su
ppo
rted
with
g
ood
k
nowledg
e.
Ed
ucat
i
onal
p
r
og
ram
s
devel
o
ped
f
o
r s
u
r
g
e
o
ns s
h
owe
d
si
g
n
i
f
i
cant
i
m
pro
v
em
ent
t
o
p
r
e
v
ent
SS
I.
Pre
su
rg
ery du
rati
o
n
and
tim
e o
f
proph
ylactic an
tib
io
tics ad
m
i
n
i
stratio
n hav
e
a sign
ifican
t relatio
n
s
h
i
p
with
th
e
SSI incidence
[5]. The nurs
e
s
m
u
st have a good
k
nowledge a
b
out SOP and wh
at to achieve for each
p
r
o
c
ed
ure th
at
will b
e
d
o
n
e
. Th
ey will h
a
v
e
m
o
re self
con
f
i
d
en
t
b
y
ap
p
l
yin
g
th
e
SO
P pro
p
e
rly. SOP serv
es as
gui
del
i
n
es,
co
m
m
uni
cat
i
ons
t
ool
s a
n
d c
ont
r
o
l
l
i
ng,
an
d t
h
e
wo
rk
ca
n
be c
o
m
p
l
e
t
e
d co
nsi
s
t
e
nt
l
y
[6]
.
3.
1.
5.
The relati
o
ns
hip betwee
n
attitude
and
be
ha
vi
or
t
o
pre
v
ent S
S
I
Th
e r
e
su
lts of Ch
i Squ
a
r
e
sh
ow
ed
p
v
a
l
u
e = 0.235
(p
> 0.05
). I
t
sh
ow
ed
th
at ther
e w
a
s
no
sig
n
i
fican
ce relatio
n
s
h
i
p
b
e
t
w
een
attitud
e
an
d
b
e
h
a
v
i
o
r
t
o
prev
en
t SSI. Th
e resu
lts of th
is stu
d
y
also
show
di
ffe
re
nt
resul
t
wi
t
h
pre
v
i
o
us
st
udy
co
nd
uct
e
d by
He
rpa
n
&
W
a
r
d
a
n
i
[7]
.
Her
p
a
n
st
udy
sho
w
e
d
si
gni
f
i
cant
relatio
n
s
h
i
p b
e
tween
attitud
e
an
d b
e
h
a
v
i
or t
o
co
n
t
ro
l
no
soco
m
i
a
l
in
fection
in th
e
ho
sp
ital.
The p
r
i
n
ci
pl
e
of en
ha
nce
d
re
cove
ry
aft
e
r su
rge
r
y
(ER
A
S
)
coul
d be i
m
pl
em
ent
e
d effect
i
v
el
y
i
f
t
h
ere
are g
o
o
d
c
o
l
l
a
bo
rat
i
o
n bet
w
e
e
n pat
i
e
nt
a
nd
heal
t
h
care
pr
o
v
i
d
e
r
. T
h
ere
f
o
r
e post
ope
rat
i
v
e
reco
very
i
s
n
o
t
t
h
e
respon
sib
ility o
f
h
ealth
care
p
r
ov
id
ers en
tirely, b
u
t
th
e
p
a
tien
t
s also
can p
a
rticip
ate activ
ely b
y
in
creasin
g
nut
ri
ent
s
t
o
i
m
pr
o
v
e t
h
e
rec
o
very
of
s
u
r
g
i
cal
wo
u
n
d
[
5
]
.
3.
1.
6.
The relati
o
ns
hip betwee
n i
n
fr
astru
c
ture
and
beh
a
vior
to pre
v
ent SSI
Th
e r
e
su
lts of Ch
i Squ
a
r
e
sh
ow
ed
p
v
a
l
u
e = 0.124
(p
> 0.05
). I
t
sh
ow
ed
th
at ther
e w
a
s
no
si
gni
fi
ca
nce rel
a
t
i
ons
hi
p bet
w
een i
n
f
r
ast
r
uct
u
re an
d be
ha
vi
or t
o
p
r
e
v
ent
S
S
I. T
h
e st
udy
s
h
o
w
e
d
t
h
at
93
.
8
% o
f
h
ealth
p
e
rsonnel assessed inf
r
astr
u
c
tur
e
s
av
ailab
l
e to
p
r
ev
en
t SSI
ar
e
w
e
ll equ
i
pp
ed.
A
per
s
on
's b
e
h
a
v
i
o
r
m
a
y
appea
r
base
d o
n
t
h
e st
im
ul
us prese
n
t
e
d t
o
t
h
e pers
on
. Se
ve
ral
fact
ors t
h
at
sup
p
o
r
t
t
h
e re
al
i
zat
i
on of be
havi
o
r
are: kno
wled
ge and
attitu
d
e
o
f
h
ealth p
e
rson
n
e
l, and
i
n
frastru
c
ture av
ailab
ility. WHO i
n
2
011
su
gg
est
e
d
th
at
th
e av
ailab
ility
o
f
resou
r
ces i
s
o
n
e
o
f
th
e facto
r
s th
at suppo
rt a p
e
rson
b
e
h
a
v
i
o
r
. Infrastru
cture is o
n
e
of th
e
so
urces th
at can
in
fl
u
e
n
ce
b
e
h
a
v
i
o
r
p
o
s
itiv
ely o
r
n
e
g
a
ti
v
e
ly [8
].
Majority o
f
h
ealt
h
p
e
rso
n
n
e
l in
th
is stu
d
y
(9
3.
8%
) st
at
ed t
h
at
PKU M
u
ham
m
a
di
y
a
h Yo
gy
aka
r
t
a
an
d B
a
nt
ul
h
o
s
p
i
t
a
l
s
were wel
l
equi
p
p
e
d
t
o
p
r
eve
n
t
SSI.
SOR (Sti
m
u
lu
s Org
a
n
i
sm
Re
sp
on
se) th
eo
ry
ex
p
l
ain
e
d
th
at
a p
e
rson
will b
e
h
a
v
e
b
a
sed
o
n
t
h
e stim
u
l
u
s
he/she
receive
d.
A pe
rson
will react based on t
h
e stim
ul
us a
nd t
h
e stim
ulus in this study
was the
hospital
i
n
fra
st
ruct
ures
.
Ho
weve
r, t
h
i
s
st
udy
sh
o
w
ed
t
h
at
go
od sc
o
r
e f
o
r i
n
frast
ru
ct
ure s
h
o
w
e
d
no
rel
a
t
i
ons
hi
p
wi
t
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
12
9 – 1
3
3
13
2
t
h
e be
ha
vi
or
t
o
p
r
e
v
ent
S
S
I
.
B
e
havi
or i
s
a defe
nce m
echani
s
m
,
and
i
n
t
h
i
s
c
ont
e
x
t
i
t
m
eans a d
e
fense
mechanism
to
respond e
n
vironm
ent threats (nosc
o
m
i
a
l
in
fectio
n
)
, esp
eci
ally SSI [9
].
Green
&
Kreuter in
2
008
stated
that th
e i
m
p
l
e
m
en
ted
p
o
licy is o
n
e
of th
e fa
ctors that s
u
pport the
em
erge
nce of the
be
havior.
Asserti
v
en
ess o
n
t
h
e po
licy i
m
p
l
e
m
en
tatio
n
to
prev
en
t SSI is n
e
ed
ed.
Asserti
v
e reg
u
latio
n
is an
extern
al
facto
r
fro
m
b
e
h
a
v
i
o
r
. Ev
en
th
oug
h
th
e
h
eal
th
p
e
rson
n
e
l sho
w
ed
attitu
d
e
th
at d
o
e
s no
t sup
port SSI preven
tio
n,
th
e assertiv
e reg
u
l
ation
will su
ppo
rt t
h
e
h
ealth
p
e
rso
n
n
e
l to i
m
p
l
e
m
en
t th
e reg
u
l
ation
[10].
3.
2.
Qual
i
t
ati
v
e A
n
al
ysi
s
Based on the
health care cost
calculati
on, a
pat
i
e
nt
m
u
st
pay
IDR
1
8
,
3
75
,0
00 as
add
itio
n
a
l co
st due
to SSI. C
o
st ca
lculation
on se
ctio caesarea
(SC)
without c
o
m
p
lication can be
seen in Ta
ble 4.
Tabl
e
4.
C
o
st
cal
cul
a
t
i
on
di
f
f
e
rence
bet
w
ee
n SC
wi
t
h
o
u
t
S
S
I a
n
d SC
wi
t
h
SSI
Descr
i
ption
SC without SSI
(
I
DR)
SC with SSI (I
DR)
M
e
dical ser
v
ices fro
m
obstetr
ics and
gy
necologist
1,
000,
00
0
8,
500,
00
0
M
e
dical ser
v
ices fro
m
anesthesiologis
t
400,
00
0
3,
400,
00
0
Equip
m
ent st
erilliz
a
tion 180,00
0
1,530,00
0
Dir
ect r
e
sour
ce
ov
er
head
870,
00
0
7,
395,
00
0
T
o
tal 2,
450,
00
0
20,
825,
0
0
0
D
i
ffe
r
e
nc
e
18,
375,
0
0
0
The i
n
ci
de
nce
of SS
I was r
a
nge
d 1
4
-
1
6
%
of n
o
s
o
com
i
al
i
n
fect
i
on i
n
hos
pi
t
a
l
i
zed p
a
t
i
e
nt
. SS
I
occurre
d e
v
ery year and is
associat
ed
w
i
th
lo
ng
er
du
r
a
tio
n
of
po
st
s
u
rgery
health care for
7-10 days
(m
ean=8.5
da
y
s
). Pat
i
e
nt
s wi
t
h
SSI
have
2-1
1
t
i
m
e
s hi
ghe
r fo
r deat
h com
p
are t
o
pat
i
e
nt
s wi
t
h
o
u
t
SSI.
Ad
di
t
i
onal
cos
t
rel
a
t
e
d t
o
S
S
I
i
s
va
ri
ed
,
dep
e
nd
o
n
t
h
e
ki
n
d
of
s
u
r
g
ery
p
r
oced
u
r
e a
n
d
i
n
fect
ed
pat
h
o
g
e
n
. B
u
t
the estim
a
t
ed cost
due
to
SSI
r
eache
d
t
o
$10
billion a yea
r
[11].
The i
n
ci
de
nce
of
SS
I i
n
I
n
do
nesi
a f
r
o
m
pre
v
i
o
us st
udy
i
s
vari
e
d
bet
w
ee
n
2
-
1
8
%
f
r
om
al
l
t
h
e s
u
r
g
ery
pr
oce
d
u
r
e an
d
2% f
r
om
appe
ndect
om
y
.
M
e
anw
h
i
l
e
t
h
e SS
I i
n
ci
de
nce i
n
PK
U M
u
ham
m
a
di
y
a
h Yo
gy
akart
a
i
n
20
1
2
was
6%
fr
om
al
l
nos
ocom
i
a
l
i
n
fect
i
on t
h
at
was
occu
rre
d i
n
P
KU M
u
ham
m
adi
y
ah
Yo
gy
a
k
art
a
hos
pi
t
a
l
[
12]
.
4.
C
O
N
C
L
U
S
ION
A
N
D
R
E
COMM
ENDATION
4.
1.
Co
nclusion
There
w
a
s
a si
gni
fi
cance rel
a
t
i
ons
hi
p bet
w
e
e
n kn
o
w
l
e
d
g
e and
be
ha
vi
o
r
t
o
pre
v
e
n
t
SS
I.
The
r
e wa
s
n
o
si
g
n
i
fican
c
e relatio
n
s
h
i
p b
e
tween
attit
u
d
e
and
b
e
h
a
v
i
or, infrastructu
r
e and
b
e
hav
i
or to
prev
en
t SSI.
Add
itio
n
a
l
co
st
du
e to SSI is
IDR 18
,375
,0
00 fo
r each
p
a
tien
t
.
4.
2.
Recommendation
Hos
p
i
t
a
l
m
a
nagem
e
nt
shoul
d
pro
v
i
d
e ap
pr
o
p
ri
at
e m
e
t
hods
t
o
i
n
crease k
n
o
w
l
e
d
g
e (
b
y
t
r
ai
ni
n
g
) o
f
h
ealth
p
e
rson
nel to
ch
an
g
e
t
h
eir attitu
d
e
s an
d
b
e
h
a
v
i
o
r
t
o
ward
SSI
p
r
even
tio
n. So
cializatio
n
is n
e
eded
for
infra
struct
ure
com
p
liance by appropri
ate s
o
cialization how to use the ne
w e
qui
pm
ent
,
i
n
or
der t
o
chan
ge
heal
t
h
pers
o
n
n
e
l
beha
vi
o
r
i
n
usi
n
g t
h
e e
qui
p
m
ent
.
Hos
p
i
t
a
l
m
a
nagem
e
nt
sho
u
l
d
consi
d
er a
b
o
u
t
pat
i
e
nt
saf
e
t
y
and ri
s
k
m
a
nagem
e
nt
i
n
every
ef
f
o
rt
esp
ecially th
e i
m
p
act o
f
i
n
fection
.
Op
timizin
g
th
e
ro
les of
Infectio
n
C
o
n
t
ro
l
Co
mmit
t
ee (
Ko
mite
Peng
enda
lia
n In
feksi
) to su
p
e
rv
ise an
d m
o
n
ito
r th
e
po
ten
tial in
cid
e
n
ce
o
f
in
fection
i
n
th
e
h
o
s
p
ital.
REFERE
NC
ES
[1]
Hiday
a
t, “Nursing Research
Methods a
nd
Data Analy
s
is Techn
i
ques
(Metode
P
e
nelitian Keper
a
watan dan
Tekn
ik
Analisa Data)
,
”
Jakarta,
Salemba Medika, 2009
.
[2]
C. D. Owen & K. Stoessel, “
S
urgica
l site inf
e
c
tions: ep
idemio
log
y
, microbio
l
og
y
and pr
even
tion,”
Journal of
Hospital Inf
ect
io
n
, vol/issue: 70(
S2), pp. 3–10, 2
008.
[3]
Mangkunegara,
& A. A. A. Prab
u, “C
ompan
y
Human Resource Management
(M
anajemen Sumb
er Day
a
Manusia
P
e
rus
a
haan)
,
Bandung, PT. Rem
a
ja Rosdakar
y
a
,
2003.
[4]
Rumah Sakit PKU Muha
mmadiy
a
h Bantul, “Gener
al data (Data Umu
m
),
” 2015. Available at
http://www.rspkubantul.com/h
al-
d
ata-umum.html diakses p
a
da 9
Oktober 2015
.
[5]
F. Rivai,
et al.
,
“
D
eterm
i
nant of S
u
rgical S
ite
Infect
ion P
o
s
t
-s
ect
ion Caes
ar
ea,
”
Jurnal Keseh
a
tan Masyarakat
Nasional
, vol/issue: 8(5), pp. 235–240, 2005. Retriev
e
d from
http://jurnalkes
m
as.ui.ac.id
/index.
php/kesmas/article/
download
/
3
90/389.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Th
e
Impa
ct
o
f
S
u
r
g
i
ca
l S
ite
In
fectio
n
t
o
t
h
e
Hea
lth Ca
re C
o
st in Yo
g
y
a
k
arta
Ho
sp
ita
l (Triya
n
i
Ma
rw
a
ti)
13
3
[6]
S. M. McHugh,
et al.
, “Preventing infection
in
general surger
y
:
improvements through educatio
n of surgeons
b
y
surgeons,”
Journal of
Hospital
I
n
fec
tion
, vol/issue: 78(4)
, pp
. 31
2–316, 2011
.
[7]
Herpan & Y.
Wardhani, “Analy
sis of
the nur
se’s performance in nosocomia
l infection
comtrol at B
a
ntul PK
U
Muhammadiy
a
h
hospital Yog
y
akarta (A
nalisis kinerja perawat
dalam penge
nd
alian inf
e
ksi nosokomial di RSU
P
KU M
uhamm
adi
y
ah B
a
ntul
Yog
y
ak
art
a
),
”
Jurnal Kesmas
, vol/issue: 6(3), 2012.
[8]
World Helath Organization, “
C
lean
Car
e
is Safer Care Team. Report on
theburden of en
demic health care-
associated inf
e
ction worldwide,”
Geneva
, World
HealthOrgan
i
zation Press, 2011
.
[9]
Maulana & D. J. Heri, “Health pr
omo
tion (Promosi Kesehatan),” J
a
karta,
Penerbit
Buku Kedokter
an EGC, 2009.
[10]
L. W
.
Green
&
M
.
W
.
Kreut
e
r,
“
H
ea
lth Promotion Planning: An
Education
a
l and
Enviromental A
pproach. Second
Edition
,
” May
f
i
e
ld Publishing
Com
p
an
y
,
USA, pp
. 30
, 2008
.
[11]
D. J. Anderson,
et al
.,
“
S
trateg
ie
s to preven
t sur
g
ica
l
sit
e
inf
ect
i
ons in acu
te
car
e hospita
ls,”
Infe
c
t
Control Hosp
Epidemiol
,
vo
l.
1, pp
. S51-61, 2
008.
[12]
N. Supiana, “I
mplementati
on
and Assessment of the use of PPE by
do
ctors
and midwives in maternity
an
d
postpartum room PKU Muha
mmadiy
a
h Yogy
ak
arta hospital Unit I,” (
Pela
ksanaan Kebija
kan dan Penila
ian
Penggunaan
APD oleh Dokter d
an Bidan
di
Rua
ng Bersalin
dan
Nifas RSU PKU
Muhammadiyah
Yogyakarta
Unit
I)
, 2015.
Evaluation Warning : The document was created with Spire.PDF for Python.