1. BAB 1
Intensive care unit (ICU) is a managed special care unit to care for patients and
critically ill, injured with life-threatening complications involving health
workers trained, and supported by the completeness of specialized equipment
(MOH, 2006). Judging from the criteria of ICU patients can be classified into
three priorities, namely patients with a first priority of critically ill patients,
unstable requiring intensive care with the help of ventilation equipment,
monitoring and continuous vasoactive drugs and others. Patients with advanced
second priority need of ICU care. This type of risk patients requiring intensive
therapy soon. And the latter is the third priority, is critically ill and patients with
unstable health status where previously, the underlying disease or acute disease,
either individually or in combination greatly reduces the possibility of healing
and or benefit from therapy in the ICU (MOH, 2006 ).
Oral Hygiene and dental oral care is applied to patients who are unable to
maintain oral hygiene and dental. This treatment is given by way of cleaning
and brushing the teeth and oral cavity on a regular basis. Mouth and dental care
aimed at maintaining oral hygiene and tooth, prevent infection due to damage to
the mouth or teeth (Saputra, 2012).
Clients who do not obey the Oral Hygiene sometimes have a bad gum tissue,
inflamed gums, coated tongue, tooth discoloration (especially at the boundaries
of the gums), dental caries, tooth loss, and halitosis (bad breath). And usually in
patients who are not adequately perform Oral Hygiene themselves usually on
the order of acute care clients who require a complete oral examination and
treatment (Perry Potter, 2010).
Dental hygiene and good oral is a state where the oral cavity free of an
accumulation of debris, plaque, materia alba, and stain (Carranza's, 2002). As
for the problems or disorders of the mouth and dental caries among other things,
halitosis, plaque, periodontal disease, stomatotitis (thrush), glossitis and kilosis.
In Indonesia, oral and dental care applied to patients who are unable to maintain
oral hygiene and dental. This treatment is given by way of cleaning and
brushing the teeth and oral cavity on a regular basis. Mouth and dental care
aimed at maintaining oral hygiene and tooth, prevent infection due to damage to
the
mouth
or
teeth
(Saputra,
2012).

2. As noted by the word of Allah in surah Al-Muddatsir paragraph 4 which means:
"and wipe your clothes". Similarly, Islam against individual attention as stated
in a hadith Rasullah Saw: Even if not incriminating my ummah, He enjoined
them I brush my teeth every want to perform ablution. (HR-Al-Baikhaqi, Malik,
Assyafii
and
Judge).
According to (Potter & Perry, 2010) clients in order acute care requires a
complete oral examination. Identification of the risk of infection will identify
the type and frequency of oral care. Proper oral care reduces pneumonia because
reduces the number of bacteria in the oral secretions aspirated and cause
bacterial infections (Research Update, 2002).
In ICU RSU PKU Muhammadiyah Bantul Oral Hygiene shall be done only 1
time in a day ie in the morning. However, patients with the aid of a ventilator
can be done more than one time because the patient has respiratory problems
and Oral Hygiene should be highly monitored by nurses. Patients with full
awareness Oral Hygiene can do yourself with a toothbrush, but if patients with
less
Oral
Hygiene
awareness
can
be
done
by
nurses.
According to (Abidia, 2007) oral care for patients in the ICU is essential, but it
must be done according to the procedures that have been implemented.
Therefore, patients in ICU oral care is important, to prevent dental problems and
the
likelihood
of
complications.
According to the head space in the ICU RSU PKU Muhammadiyah Bantul yet
legally endorsed RS Oral Hygiene related SOP. However, be assured that soon
passed. He told the investigators that the SOP Oral Hygiene in the ICU had only
lived there passed away. Oral Hygiene current SOP is in use as a guide in Oral
Hygiene care in the ICU.
The interview with the Head of ICU mother said in the Oral Hygiene doing has
not been done according to standard operating procedures for minimum nurse
who was in the ICU. Not all the pieces SOP checklist could be done. We know
the standard operating procedure is one of the guidelines in action.
Given the role of nurses in ICU is essential, and interact directly with patients
and play a role in the prevention of infection. Do with us as health workers or
nurses, should receive more attention in carrying out their duties, especially
knowledge about actions Oral Hygiene, as well as adherence to Oral Hygiene
procedure implementation in accordance with the provisions set each hospital.
Thus, researchers want to conduct research on the implementation of the

3. standard description of operating procedures (SOP) Oral Hygiene in ICU
patients by nurses in RSU PKU Muhammadiyah Bantul.
BAB 2
1.
Definition
of
Standard
Operating
Procedures
(SOP)
Standard Operating Procedure is a performance standard or as the affairs of the
desired values are able to be met in relation to the parameters that have been set
(Donabedian, 1960). Standards that had understanding as a guide to improve the
quality of being run effectively and efficiently and in the application of
standards of medical care considered several aspects related to information,
explanation
of
procedures,
health
care
and
medical
ethics.
2.
The
purpose
of
Standard
Operating
Procedures
(SOP)
The purpose of the application of medical standards by the Ministry of Health in
1993
are:
a. Protect the public from practices which are not in accordance with
professional
standards.
b. Protect the profession of it, and sometimes people who are not fair and as
guidance in the supervision and guidance as well as improving the quality of
medical
care.
c. As a guideline for running health services effectively and efficiently.
3.
Standard
Operating
Procedure
(SOP)
Oral
Hygiene
Standard Operating Procedure (SOP) Oral Hygiene in ICU RSU PKU
Muhammadiyah
Bantul:
a. Standard Operating Procedure (SOP) with a toothbrush Oral Hygiene:
1)
Checked
the
therapy
program
2)
Wash
hands
3)
Placing
the
device
near
the
patient
4)
Giving
greetings
and
greeting
the
patient's
name
5)
Explain
the
purpose
and
implementation
procedures
6)
Ask
the
patient's
consent
and
readiness
7)
Maintain
privacy
8) Install waterproof and base / towel under the patient's chin
9)
Wear
gloves
10)
Helping
patients
gargle
while
preparing
crooked
11)
Helping
prepare
toothbrush
and
pasta
12)
Helping
patients
brushing
the
front,
side
and
in
13) Helping patients to rinse the mouth while preparing crooked

4. 14) Repeating help patients brushing the front, side and in
15)
Helping
patients
gargle
16)
Dry
lips
with
a
tissue
17) Tidy patient as comfortable as possible and give the position
18)
Evaluate
the
results
of
the
action
19)
to
Leave
the
patient
20) Clearing and return the device to its original place
21)
Wash
your
hands
22) Record activities in the nursing record sheet
Standard Operating Procedure (SOP) Oral Hygiene in unconscious patients:
1) Explain the procedure to the patient even though the patient is unconscious
2)
Wash
hands
and
wear
gloves
3)
Adjust
the
position
of
the
client
4)
Bring
the
tool
kedekat
patients
5)
Open
the
patient's
mouth
with
the
tongue
spatula
6) Take the tweezers and gauze rolls (depper) that has been moistened with a
solution
of
chlorhexidin
or
Ekasari
7) Perform cleaning starts from the walls of the mouth, gums, teeth and tongue.
If necessary use suctin for cleaning fluids / secretions when accumulated
8)
Verify
the
condition
of
the
oral
cavity
is
clean
9) Clean equipment
and
return it
to its original
place
10)
Remove
the
glove
11)
Wash
your
hands
12) Documentation of procedures and evaluation of results
1. understanding Nurse
According to the International Council of Nursing (1965 in Ali, 2002)
nurse is someone who has completed a nursing education program,
country authorities concerned to provide services, and are responsible for
health promotion, disease prevention and patient services.
Nurse is a person who plays a role in caring for and helping someone to
protect them from pain, injury and aging process (Taylor in Ali, 2001).
According to the Act - Act No. 23 of 1992 nurses are those who have the
ability and authority to take action based on their knowledge of nursing,
nursing
education
obtained
through
(Ali,
2002).
Nurochmah (2002), states a nurse is one of the health professionals who

5. provide health services to people wherever they work. Form of service
provided has always been a service provided to the client system who
face health problems through the efforts of their basic needs. Nurse is a
professional assessment of the soul, a form of honor to do the work of
providing services to people in need and has the characteristics,
autonomy, academic preparation time, commitment, and responsibility.
2. role of Nurses
The role of nurses in CHS, 1989, is the behavior expected by others on a person
in accordance with the position in the system, which can be influenced by both
the social circumstances of the nursing profession and from outside the nursing
profession which is constant. Role as provider of nursing care, client advocate,
educator, coordinator, collaborator, consultant and innovator (Hidayat, 2008).
According Sumijatun 2011 said that nurses have a major role in determining the
standard of education and nursing services and apply nursing education
activities and services. Nurses play an active role in the professional
development of nursing activities. Then nurses actively participate in efforts to
build and maintain professional working conditions conducive for the
realization of high-quality nursing care.
According to the National Workshop (1983) in (Ali, 2002) the role of the nurse:
1.
As
implementing
nursing
services.
2.
Is
nursing
services
and
educational
institutions.
3.
Educators
in
nursing.
4.
Researchers
and
developers
of
nursing.
C.
ICU
1.
understanding
ICU
Intensive Care Unit (ICU) is a part of the independent hospitals, with
specialized staff and equipment specifically intended for observation, care and
treatment of patients suffering from an acute illness, injury or complicationsthreatening
complications
(MOH
2011).
2.
ICU
destination
ICU destination according to (MOH, 2011) consists of general and special
purpose.
a.
Main
objectives:
Improve the quality of care and patient safety in the ICU.

6. b.
Specific
Objectives:
1)
Provide,
improve
and
develop
human
resources.
2)
Improve
infrastructure
and
ICU
equipment.
3) Improve efficiency and utilization of services efektitas ICU especially critical
for stable patients who only require the supervisory ministry.
3.
Scope
of
ICU
The scope of services provided in the ICU are as follows:
a. Diagnosis and management of acute specific diseases are life-threatening and
can
cause
death.
b. Provide assistance and take over the vital functions of the body and perform
the necessary actions immediately useful and effective for survival.
c. Monitoring of vital functions and management of the complications caused
by
the
disease.
d. Provide psychological support to patients and families whose lives depend on
drugs,
devices
and
machines
(MOH,
2011).
4.
ICU
nurse
According to (MOH, 2006) nurses in ICU aims to save lives, prevent worsening
of the condition and its complications through observation and close monitoring
with the ability of interpreting any data obtained, and conduct follow-up.
Improve the patient's quality of life and sustain life as well as in reducing
mortality and disability critically ill patients and accelerate the healing process
of the patient.
Characteristics
of
ICU
nurses
include:
a. Manage patients based on standards consistent with intensive nursing
b.
Respect
for
fellow
colleagues
and
other
team
c. Integrating scientific capabilities and special skills, and followed by the value
of
ethics
and
legal
in
providing
nursing
care
d.
Continually
respond
to
the
changing
environment
e.
Apply
effective
communication
skills
f.
Clinical
skills
that
demonstrate
the
ability
of
high
g.
Interpret
complex
situation
analysis
h.
Develop
health
education
for
patients
and
families
i.
critical
thinking
j.
Able
to
face
the
challenges
k.
Develop
knowledge
and
research

7. l.
m. Innovative
Thinking
ahead
D.
oral
Hygiene
1.
Understanding
Oral
Hygiene
Oral hygiene is an act done which seeks to clean and freshen the mouth, teeth
and gums (Clark, the Shocker, 2008). According to Taylor, (the Shocker, 2008),
the oral hygiene measures designed to maintain continuity of the lips, tongue
and oral mucosa, prevent infection and moisten the membranes of the mouth
and
lips.
Meanwhile, according to Hidayat and Uliyah (2005), oral hygiene is nursing
actions performed on patients who are hospitalized. This can be done by a
conscious patient independently or with the help of a nurse. For patients who
are unable to maintain oral hygiene and tooth independently should be fully
monitored by nurses. Then the provision of nursing care to clean the patient's
mouth at least be done at least twice a day (Potter & Perry, 2005.
2.
The
purpose
Oral
Hygiene
The importance of oral hygiene performed on patients. The multiple objectives
of Oral Hygiene is to prevent oral disease, prevents disease transmission
through the mouth, enhance immunity, improve the function of the mouth to
enhance appetite by Clark (in Shocker, 2008). Pelakanaan Oral Hygiene by
Hidayat and Uliyah (2005), the purpose of oral hygiene measures does aim to
prevent gum and tooth infections. Maintain freshness and comfort of the mouth
of
the
oral
cavity.
3.
Lack
of
Cleanliness
danger
Mouth
Oral Hygiene main purpose of which is to improve oral health. Prevent the
buildup of plaque and prevent stickiness of bacteria that forms on teeth.
Accumulation of bacterial plaque on the teeth due to poor oral hygiene are the
main causes of oral health issues, especially the tooth. Poor oral hygiene allows
the accumulation of acid-producing bacteria to the tooth surface. Demineralizes
acid enamel causing tooth decay (cavities). Dental plaque can also invade and
infect the gums causing gum disease and periodontitis. Many oral health
problems, such as thrush, mouth sores, bad breath and others considered the
effects of poor oral health. Most of the teeth and mouth problems can be
avoided simply by maintaining good oral hygiene (Forthnet, 2010).
Clients who do not obey the Oral Hygiene sometimes have a bad gum tissue,
inflamed gums, coated tongue, tooth discoloration (especially the gums), dental
caries, tooth loss, and halitosis (bad breath). Pain and local infection is a
common symptom of gum disease and tooth abnormalities (Potter & Ferry,

8. 2010).
4.
How
to
Maintain
Oral
Hygiene
a.
do
it
Yourself
According Denstisty (2010), in ways that can be done alone, and effective in
keeping
the
Oral
Hygiene,
is
as
follows:
1)
Brush
your
teeth
Introduction of appropriate toothbrush, motivating to brush your teeth regularly
with toothpaste and the selection of the right. Toothbrush technique is
commonly performed horizontally and it is a mistake because in this way can
eventually lead to tooth abrasion and gingival recession. In patients who are not
aware, brush teeth replaced with wrapping cloth towel or gauze on the finger tip
of
the
stem.
Toothpaste
helps
but
is
not
necessary.
According to Potter & Perry (2005) perfectly done brushing teeth at least four
times a day (after meals and at bedtime). Toothbrush should have a straight
stem and a small brush to reach all areas. Brush the surface of a flat, round and
soft nylon bristle brush is the best option.
Antiseptic
mouth
rinse
There are a variety of active ingredients that are often used as a mouth rinse,
such as metal salicylate, chlorhexidine 0.20% H2O2 and 1.5% or 3.0%. Garglegargle cheaper and quite effective is with warm salt water.
3)
Dental
floss
or
dental
floss
This method was introduced and started being powerful enough to clean in
between
teeth.
4)
Wash
the
tongue
Piles of debris on the dorsum of the tongue is full of germs and candida
opportunists
who
live
as
normal
flora
and
transient.
b. Performed in patients with decreased level of consciousness According to
Potter
&
Perry
(2005)
equipment
1)
Fresh
Air
2)
spatel
tongue
with
pads
or
sponges
3)
face
towels,
paper
towels
4)
small
Kom
5)
Crooked
6)
glass
with
cold
water
7)
Spuit
small
air-bulb
8)
suction
catheter
connected
to
a
vacuum
9)
Disposable
gloves

9. 10)
11) Depper
Tweezers
BAB 3
CHAPTER III
METHODS
A. Research Design
This study uses a non-experimental research design was descriptive crosssectional approach is the design of the study by taking measurements or
observations
at
the
same
time
(all
the
time).
B.
population
Research
1.
population
Is the subject of the study population overall. If one wants to examine all the
elements that exist in the area of research, the research is the study population
(Arikunto, 2006). The population in this study were all nurses in the ICU RSU
PKU Muhammadiyah Bantul which in total amounted to 12 people.
2.
samples
Sampling technique in this study used purposive sampling. Purposive sampling
is a technique of determination among the sample population according to the
researchers desired so that the samples can represent the characteristics of the
population that has been known previously (Nursalam, 2003). Samples taken as
many as 12 people.
C.
Location
and
Time
Research
1.
Research
Sites
The research was conducted in the ICU RSU PKU Muhammadiyah Bantul.
2.
Research
time
This study was conducted on May 10, 2013 until the date of June 10, 2013.
D.
Research
Variables

10. Variables used in this study is a variable that is the implementation of standard
operating
procedures
Oral
Hygiene.
E.
Operational
definition
Standard Operating Procedure (SOP) Oral Hygiene conducted by nurses on
patients in the ICU RSU PKU Muhammadiyah Bantul. Consists of several
stages: pre-interaction, orientation, employment and termination. Ordinal scale
used is said to be good if all the points of procedure Oral Hygiene persetase is
achieving 76-100%, enough if the percentage of 56-75%, said to be less if the
percentage of 40-55%, and no good if the percentage ˂40%.
F.
Research
instrument
Instrument used in this study is the observation sheet by SOP Oral Hygiene ICU
consisting of several checklist. SOP Oral Hygiene in the unconscious patient
and Oral Hygiene with a toothbrush and modified by the researcher.
G.
Data
Collection
Method
Implementation of observations carried out on schedule Oral Hygiene in ICU
patients in RSU PKU Muhammadiyah Bantul. Data retrieval is taken once a day
for a full month. Before conducting the study researchers write biographical
data of each ICU nurse and given full informed consent.
H.
Data
analysis
In this study, a descriptive analysis of the data revealed that the frequency
distribution both in absolute and percentage. Then use the formula Average
(mean)
as
follows:
Description:
x:
fx:
n: number of data
the
frequency
average
of
mean
data
I.
Research
Ethics
Researchers must protect the rights of the respondents during the research
process, ethical issues that must be considered is memnerikan researchers
informed consent (consent form) that the respondent understands the intent and
purpose of the research, ethics, and the other is anonymous confidetiality

11. (confidentiality), in this study did not use names of the respondents, but only in
the form of code, so that the confidentiality of respondents maintained (Azis,
2007).
J.
Test
Validity
and
Reliability
Validity is a measure that indicates the level of validity or authenticity of
something instrumental in collecting the data (Nursalam, 2003). Test the
validity of the instrument in this study using the formula Pearson product
moment
correlation
formula,
as
follows:
Pearson
product
moment
formula
Description:
rxy: the correlation coefficient between variables X and Y
NΣXY:
number
multiplication
X
and
Y
Σx:
sum
score
of
items
(X)
Σy:
item
total
score
(Y)
N:
the
number
of
respondents
Valid
instrument
if
the
correlation
index
(r)
0.800
to
1.000
=
very
high
.600
To
.799
=
high
0.400
to
0.599
=
high
0.200
to
0.399
=
low
0.000
to
0.199
=
very
low
(not
valid)
Reliability was calculated using Cronbach Alpha coefficient formula as follows:
Description:
Σ:
Mean
:
k: Mean squared inter-subject
squared
Variance
error
total
K.
The
course
of
study
1.
Preparation
Phase
Includes study of the literature to capture the data, preliminary study, the
research permit administration, preparation of proposals, consult a tutor, test
proposal.
2.
Implementation
phase
Conduct primary research data collection using valid and reliable instruments
are held every day from May 10 2013 until June 10, 2013.