Analisis Faktor Lingkungan Fisik Sebagai Determinan Transmisi Infeksi Nosokomial Di Rumah Sakit: Tinjauan Sistematis
Abstract
Background: Healthcare-associated infections (HAIs) constitute a significant global health challenge, exacerbating morbidity, mortality, and economic burdens. The hospital environment encompassing air quality, water systems, surface contamination, and building design serves as a potential pathogen reservoir and a primary transmission pathway. With HAI prevalence ranging from 3.0% to 20.7% and incidence rates between 5% and 10%,
Aims: this study aims to synthesize scientific evidence from observational studies regarding the influence of environmental factors on the incidence of nosocomial infections..
Methods: This systematic review was conducted in adherence to the PRISMA guidelines. A comprehensive literature search was performed across ScienceDirect, ProQuest, JSTOR, Scopus, Sinta, PubMed, Google Scholar, and Portal Garuda databases. The inclusion criteria prioritized observational studies addressing environmental factors and HAIs. Study quality was evaluated using relevant critical appraisal instruments, followed by a qualitative synthesis of the data.
Results: Thirteen articles met the inclusion criteria. The synthesis indicates that poor air quality, high levels of surface contamination, unmanaged water systems, and suboptimal ward design are significantly correlated with an increased risk of nosocomial infections.
Conclusion: Environmental factors are critical determinants in the transmission of infections within hospital settings. The implementation of strict disinfection protocols, improvements in ventilation systems, and facility designs grounded in infection prevention principles are paramount to enhancing patient safety and ensuring cost-efficiency in healthcare.
References
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Barbosa, B. P. P. (2018). The Role of Engineering Design in the Infection Control for Hospitals. Trends in Civil Engineering and Its Architecture, 1(2).
Berhanu Y. Wondmagegn, J. X., Dear, K., Williams, S., & Hansen, A. (2021). Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia. Science of The Total Environment, 773. https://doi.org/https://doi.org/10.1016/j.scitotenv.2021.145656
Centers for Disease Control and Prevention (CDC). (2024). Global Cleaning in Healthcare: Environmental Cleaning Procedures.
Chan, E. Y. Y., Goggins, W. B., Yue, S. K., & Lee, P. (2013). Hospital admissions as a function of temperature , other weather phenomena and pollution levels in an urban setting in China. Research, September 2012, 576–584. https://doi.org/http://dx.doi.org/10.2471/BLT.12.113035
Chen, C., Zhu, J., Qu, Z., Lin, C., Jiang, Z., & Chen, Q. (2014). Systematic study of person-to-person contaminant transport in mechanically ventilated spaces ( RP-1458 ). HVAC&R Research, 20, 80–91.
Collins, A. S. (1991). Preventing Health Care–Associated Infections. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses (2nd ed., pp. 547–576). National Library of Medicine.
Dara, C., Darivemula, S. B., Sandepogu, T. S., Saranya, M., Vijayalakshmi, N., & Swetha, S. (2024). Nosocomial Infection in MICU : An Observational Study. Journal of Internal Medicine, 12(3), 150–154. https://doi.org/10.4103/ajim.ajim
Dawson Zulveritha, Yuli Peristipwati, N. A. A. (2025). Pengaruh Pengetahuan, Motivasi, Supervisi Dengan Kinerja Perawat Terhadap Pencegahan Infeksi Nasokomial Di Ruang Rawat Gawat Darurat Rsud Tarutung. Research & Learning in Nursing Science, 9(3), 3793–3807.
Emmanuel, U., Osondu, E. D., & Kalu, K. C. (2020). Architectural design strategies for infection prevention and control ( IPC ) in health-care facilities : towards curbing the spread of Covid-19. Journal of Environmental Health Science and Engineering, 18, 1699–1707. https://doi.org/doi.org/10.1007/s40201-020-00580-y
Escombe, A. R., Oeser, C. C., Gilman, R. H., Navincopa, M., Ticona, E., Pan, W., Chacaltana, J., Rodrı, R., Moore, D. A. J., & Friedland, J. S. (2007). Natural Ventilation for the Prevention of Airborne Contagion. PLoS MEDICINE, 4(2). https://doi.org/10.1371/journal.pmed.0040068
Halaby, T., Naiemi, N., Beishuizen, B., Verkooijen, R., Ferreira, J. A., & Klont, R. (2017). Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit. Antimicrobial Resistance and Infection Control, 6(117), 1–10. https://doi.org/10.1186/s13756-017-0275-z
Han, J., Sullivan, N., Leas, B. F., & Pegues, D. A. (2015). Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections: A Technical Brief. Annals of Internal Medicine, 163(8). https://doi.org/https://doi.org/10.7326/M15-1192
Isigi, S. S., Parsa, A. D., Alasqah, I., Mahmud, I., Kabir, R., & Bukairiyah, A. (2023). Predisposing Factors of Nosocomial Infections in Hospitalized Patients in the United Kingdom : Systematic Review. JMIR Public Health Surveill, 9(9), 1–15. https://doi.org/10.2196/43743
Kementerian Kesehatan RI. (2019). PERMENKES RI NOMOR 7 TAHUN 2019 TENTANG KESEHATAN LINGKUNGAN RUMAH SAKIT.
Knelson, L. P., Williams, D. A., Gergen, M. F., Ascp, M. T., Carolina, N., Hill, C., & Carolina, N. (2015). HHS Public Access. 35(7), 872–875. https://doi.org/10.1086/676861.A
Konoralma, K., Analis, P. D., Poltekkes, K., & Manado, K. (2019). Identifikasi Bakteri Penyebab Infeksi Nosokomial Di Rumah Sakit Umum Gmim Pancaran Kasih Manado. Jurnal Kesmas, 8(1), 23–35.
Limaylla, D. C., Silva, M. D. O., Magno, C., & Branco, C. (2019). Temperature, humidity, and climate control in hospital units: A clue for understanding the seasonality of healthcare-associated pathogens. Infection Control & Hospital Epidemiology, 40, 829–830. https://doi.org/10.1017/ice.2019.97
Liou, R. J., Earley, M. J., & Forrester, J. D. (2022). Effect of climate on surgical site infections and anticipated increases in the United States. Scientific Reports, 0123456789, 1–9. https://doi.org/10.1038/s41598-022-24255-w
Mehtar, S., Hopman, J., & Duse, A. (2018). GUIDE TO INFECTION CONTROL IN THE HEALTHCARE SETTING Patient Areas and Environmental Cleaning.
Moameri, H., Salehi, S., & Haghdoost, A. A. (2025). The Future of Nosocomial Infections. Iran J Public Health, 54(4), 881–884. https://doi.org/10.18502/ijph.v54i4.18427
Ningsih, T. A., & Assagaff, F. (2022). Kualitas udara di ruangan rsud namlea kabupaten buru provinsi maluku. Jurnal Ilmu Dan Teknologi Kesehatan Terpadu (JITKT, 2(1), 46–54.
Noya, L. Y. J., W, N. E., & Joko, T. (2020). Pemeriksaan Kualitas Udara Ruang Yang Berhubungan Dengan Angka Kuman Di Ruang Operasi Rumah Sakit Sumber Hidup Di Kota Ambon 2020. Jurnal Kesehatan Masyarakat, 8(5), 679–687.
Nur, H., Parlayan, K., Aksoy, F., Ozdemir, M. N., & Ozkaya, E. (2025). A Nosocomial Outbreak of Burkholderia cepacia complex Linked to Contaminated Intravenous Medications in a Tertiary Care Hospital. Antibiotics, 14(774), 1–11. https://doi.org/https://doi.org/10.3390/antibiotics14080774
Ohannessian, Robin MD; Gustin, Marie-Paule PhD; Bénet, T. M. (2018). Estimation of Extra Length of Stay Attributable to Hospital-Acquired Infections in Adult ICUs Using a Time-Dependent Multistate Model. Critical Care Medicine, 46(7). https://doi.org/10.1097/CCM.0000000000003131
Otter, J. A., Yezli, S., & French, G. L. (2015). The Role Played by Contaminated Surfaces in the Transmission of Nosocomial Pathogens. Infection Control & Hospital Epidemiology, 32(7). https://doi.org/https://doi.org/10.1086/660363
Page, M. J., Mckenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-wilson, E., Mcdonald, S., … Moher, D. (2021). The PRISMA 2020 statement : an updated guideline for reporting systematic reviews Systematic reviews. Research Methods and Reporting. https://doi.org/10.1136/bmj.n71
Ray, S. M., Thompson, D. L., & Wilson, L. E. (2015). Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med, 370(13), 1198–1208. https://doi.org/10.1056/NEJMoa1306801.Multistate
Sahli, Indra Taufik; Kurniawan, Fajar Bakti; Setiani, Dwi; Asrianto, Asrianto; Hartati, R. (2021). Kualitas Bakteri Udara Ruang Operasi Rumah Sakit di Wilayah Kota Jayapura. Health Information, 13(2).
Samira Raoofi, Kan, F. P., Rafiei, S., Hosseinipalangi, Z., Mejareh, Z. N., Khani, S., Abdollahi, B., Talab, F. S., Id, M. S., Zarabi, F., Dolati, Y., Ahmadi, N., Raoofi, N., Sarhadi, Y., Masoumi, M., Hosseini, B., Vali, N., Gholamali, N., Asadi, S., … Id, A. G. (2023). PLOS ONE Global prevalence of nosocomial infection : A systematic review and meta-analysis. PLOS ONE, June 2021, 1–17. https://doi.org/10.1371/journal.pone.0274248
Sandu, A. M., Chifiriuc, M. C., Vrancianu, C. O., Cristian, R. E., Alistar, C. F., Constantin, M., Paun, M., Alistar, A., Popa, L. G., Popa, M. I., Tantu, A. C., Sidoroff, M. E., Mihai, M. M., Marcu, A., Popescu, G., & Tantu, M. M. (2025). Healthcare ‑ Associated Infections : The Role of Microbial and Environmental Factors in Infection Control — A Narrative Review. In Infectious Diseases and Therapy (Vol. 14, Issue 5). Springer Healthcare. https://doi.org/10.1007/s40121-025-01143-0
Sherif, A., & Iskandar, M. (2025). Design of hospitals for the post-pandemic era : an international survey of design professionals on infection control design strategies. Architectural Engineering and Design Management, 21(4), 705–720. https://doi.org/10.1080/17452007.2024.2385689
Sintawati. (2020). Hubungan berbagai faktor dengan jumlah kuman udara di ruang Perawatan Intensif di Rumah Sakit Telogorejo Semarang. Forikes Journal, 11(2).
Suarmayasa, I. N. (2023). Pola Kuman Pada Manset Sphygmomanometer : Studi Deskriptif Di Rsd Mangusada. Jurnal Riset Kesehatan Nasional, 7(2), 163–168.
Tobin, E. H., & Zahra., F. (2025). Nosocomial Infections (StatPearls). StatPearls.
Weber, D. J., & Anderson, Deverickc Rutala, W. (2013). The role of the surface environment in healthcare-associated infections. Current Opinion in Infectious Diseases, 4(26). https://doi.org/10.1097/QCO.0b013e3283630f04
Weber, D. J., Rutala, W. A., Miller, M. B., & Huslage, K. (2010). Role of hospital surfaces in the transmission of emerging health care- associated pathogens : Norovirus , Clostridium difficile , and Acinetobacter species. American Journal of Infection Control, 38(5), S25–S33. https://doi.org/10.1016/j.ajic.2010.04.196
World Health Organization. (2016). Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. World Health Organization 2016.
Wulandari, E. T., Sari, D., & Yohanan, A. (2024). Kebersihan Dengan Angka Kuman Lantai Ruang Rawat Inap. Jurnal Ilmiah Kesehatan Media Husada, 13(2), 152–161.
Barbosa, B. P. P. (2018). The Role of Engineering Design in the Infection Control for Hospitals. Trends in Civil Engineering and Its Architecture, 1(2).
Berhanu Y. Wondmagegn, J. X., Dear, K., Williams, S., & Hansen, A. (2021). Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia. Science of The Total Environment, 773. https://doi.org/https://doi.org/10.1016/j.scitotenv.2021.145656
Centers for Disease Control and Prevention (CDC). (2024). Global Cleaning in Healthcare: Environmental Cleaning Procedures.
Chan, E. Y. Y., Goggins, W. B., Yue, S. K., & Lee, P. (2013). Hospital admissions as a function of temperature , other weather phenomena and pollution levels in an urban setting in China. Research, September 2012, 576–584. https://doi.org/http://dx.doi.org/10.2471/BLT.12.113035
Chen, C., Zhu, J., Qu, Z., Lin, C., Jiang, Z., & Chen, Q. (2014). Systematic study of person-to-person contaminant transport in mechanically ventilated spaces ( RP-1458 ). HVAC&R Research, 20, 80–91.
Collins, A. S. (1991). Preventing Health Care–Associated Infections. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses (2nd ed., pp. 547–576). National Library of Medicine.
Dara, C., Darivemula, S. B., Sandepogu, T. S., Saranya, M., Vijayalakshmi, N., & Swetha, S. (2024). Nosocomial Infection in MICU : An Observational Study. Journal of Internal Medicine, 12(3), 150–154. https://doi.org/10.4103/ajim.ajim
Dawson Zulveritha, Yuli Peristipwati, N. A. A. (2025). Pengaruh Pengetahuan, Motivasi, Supervisi Dengan Kinerja Perawat Terhadap Pencegahan Infeksi Nasokomial Di Ruang Rawat Gawat Darurat Rsud Tarutung. Research & Learning in Nursing Science, 9(3), 3793–3807.
Emmanuel, U., Osondu, E. D., & Kalu, K. C. (2020). Architectural design strategies for infection prevention and control ( IPC ) in health-care facilities : towards curbing the spread of Covid-19. Journal of Environmental Health Science and Engineering, 18, 1699–1707. https://doi.org/doi.org/10.1007/s40201-020-00580-y
Escombe, A. R., Oeser, C. C., Gilman, R. H., Navincopa, M., Ticona, E., Pan, W., Chacaltana, J., Rodrı, R., Moore, D. A. J., & Friedland, J. S. (2007). Natural Ventilation for the Prevention of Airborne Contagion. PLoS MEDICINE, 4(2). https://doi.org/10.1371/journal.pmed.0040068
Halaby, T., Naiemi, N., Beishuizen, B., Verkooijen, R., Ferreira, J. A., & Klont, R. (2017). Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit. Antimicrobial Resistance and Infection Control, 6(117), 1–10. https://doi.org/10.1186/s13756-017-0275-z
Han, J., Sullivan, N., Leas, B. F., & Pegues, D. A. (2015). Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections: A Technical Brief. Annals of Internal Medicine, 163(8). https://doi.org/https://doi.org/10.7326/M15-1192
Isigi, S. S., Parsa, A. D., Alasqah, I., Mahmud, I., Kabir, R., & Bukairiyah, A. (2023). Predisposing Factors of Nosocomial Infections in Hospitalized Patients in the United Kingdom : Systematic Review. JMIR Public Health Surveill, 9(9), 1–15. https://doi.org/10.2196/43743
Kementerian Kesehatan RI. (2019). PERMENKES RI NOMOR 7 TAHUN 2019 TENTANG KESEHATAN LINGKUNGAN RUMAH SAKIT.
Knelson, L. P., Williams, D. A., Gergen, M. F., Ascp, M. T., Carolina, N., Hill, C., & Carolina, N. (2015). HHS Public Access. 35(7), 872–875. https://doi.org/10.1086/676861.A
Konoralma, K., Analis, P. D., Poltekkes, K., & Manado, K. (2019). Identifikasi Bakteri Penyebab Infeksi Nosokomial Di Rumah Sakit Umum Gmim Pancaran Kasih Manado. Jurnal Kesmas, 8(1), 23–35.
Limaylla, D. C., Silva, M. D. O., Magno, C., & Branco, C. (2019). Temperature, humidity, and climate control in hospital units: A clue for understanding the seasonality of healthcare-associated pathogens. Infection Control & Hospital Epidemiology, 40, 829–830. https://doi.org/10.1017/ice.2019.97
Liou, R. J., Earley, M. J., & Forrester, J. D. (2022). Effect of climate on surgical site infections and anticipated increases in the United States. Scientific Reports, 0123456789, 1–9. https://doi.org/10.1038/s41598-022-24255-w
Mehtar, S., Hopman, J., & Duse, A. (2018). GUIDE TO INFECTION CONTROL IN THE HEALTHCARE SETTING Patient Areas and Environmental Cleaning.
Moameri, H., Salehi, S., & Haghdoost, A. A. (2025). The Future of Nosocomial Infections. Iran J Public Health, 54(4), 881–884. https://doi.org/10.18502/ijph.v54i4.18427
Ningsih, T. A., & Assagaff, F. (2022). Kualitas udara di ruangan rsud namlea kabupaten buru provinsi maluku. Jurnal Ilmu Dan Teknologi Kesehatan Terpadu (JITKT, 2(1), 46–54.
Noya, L. Y. J., W, N. E., & Joko, T. (2020). Pemeriksaan Kualitas Udara Ruang Yang Berhubungan Dengan Angka Kuman Di Ruang Operasi Rumah Sakit Sumber Hidup Di Kota Ambon 2020. Jurnal Kesehatan Masyarakat, 8(5), 679–687.
Nur, H., Parlayan, K., Aksoy, F., Ozdemir, M. N., & Ozkaya, E. (2025). A Nosocomial Outbreak of Burkholderia cepacia complex Linked to Contaminated Intravenous Medications in a Tertiary Care Hospital. Antibiotics, 14(774), 1–11. https://doi.org/https://doi.org/10.3390/antibiotics14080774
Ohannessian, Robin MD; Gustin, Marie-Paule PhD; Bénet, T. M. (2018). Estimation of Extra Length of Stay Attributable to Hospital-Acquired Infections in Adult ICUs Using a Time-Dependent Multistate Model. Critical Care Medicine, 46(7). https://doi.org/10.1097/CCM.0000000000003131
Otter, J. A., Yezli, S., & French, G. L. (2015). The Role Played by Contaminated Surfaces in the Transmission of Nosocomial Pathogens. Infection Control & Hospital Epidemiology, 32(7). https://doi.org/https://doi.org/10.1086/660363
Page, M. J., Mckenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-wilson, E., Mcdonald, S., … Moher, D. (2021). The PRISMA 2020 statement : an updated guideline for reporting systematic reviews Systematic reviews. Research Methods and Reporting. https://doi.org/10.1136/bmj.n71
Ray, S. M., Thompson, D. L., & Wilson, L. E. (2015). Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med, 370(13), 1198–1208. https://doi.org/10.1056/NEJMoa1306801.Multistate
Sahli, Indra Taufik; Kurniawan, Fajar Bakti; Setiani, Dwi; Asrianto, Asrianto; Hartati, R. (2021). Kualitas Bakteri Udara Ruang Operasi Rumah Sakit di Wilayah Kota Jayapura. Health Information, 13(2).
Samira Raoofi, Kan, F. P., Rafiei, S., Hosseinipalangi, Z., Mejareh, Z. N., Khani, S., Abdollahi, B., Talab, F. S., Id, M. S., Zarabi, F., Dolati, Y., Ahmadi, N., Raoofi, N., Sarhadi, Y., Masoumi, M., Hosseini, B., Vali, N., Gholamali, N., Asadi, S., … Id, A. G. (2023). PLOS ONE Global prevalence of nosocomial infection : A systematic review and meta-analysis. PLOS ONE, June 2021, 1–17. https://doi.org/10.1371/journal.pone.0274248
Sandu, A. M., Chifiriuc, M. C., Vrancianu, C. O., Cristian, R. E., Alistar, C. F., Constantin, M., Paun, M., Alistar, A., Popa, L. G., Popa, M. I., Tantu, A. C., Sidoroff, M. E., Mihai, M. M., Marcu, A., Popescu, G., & Tantu, M. M. (2025). Healthcare ‑ Associated Infections : The Role of Microbial and Environmental Factors in Infection Control — A Narrative Review. In Infectious Diseases and Therapy (Vol. 14, Issue 5). Springer Healthcare. https://doi.org/10.1007/s40121-025-01143-0
Sherif, A., & Iskandar, M. (2025). Design of hospitals for the post-pandemic era : an international survey of design professionals on infection control design strategies. Architectural Engineering and Design Management, 21(4), 705–720. https://doi.org/10.1080/17452007.2024.2385689
Sintawati. (2020). Hubungan berbagai faktor dengan jumlah kuman udara di ruang Perawatan Intensif di Rumah Sakit Telogorejo Semarang. Forikes Journal, 11(2).
Suarmayasa, I. N. (2023). Pola Kuman Pada Manset Sphygmomanometer : Studi Deskriptif Di Rsd Mangusada. Jurnal Riset Kesehatan Nasional, 7(2), 163–168.
Tobin, E. H., & Zahra., F. (2025). Nosocomial Infections (StatPearls). StatPearls.
Weber, D. J., & Anderson, Deverickc Rutala, W. (2013). The role of the surface environment in healthcare-associated infections. Current Opinion in Infectious Diseases, 4(26). https://doi.org/10.1097/QCO.0b013e3283630f04
Weber, D. J., Rutala, W. A., Miller, M. B., & Huslage, K. (2010). Role of hospital surfaces in the transmission of emerging health care- associated pathogens : Norovirus , Clostridium difficile , and Acinetobacter species. American Journal of Infection Control, 38(5), S25–S33. https://doi.org/10.1016/j.ajic.2010.04.196
World Health Organization. (2016). Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. World Health Organization 2016.
Wulandari, E. T., Sari, D., & Yohanan, A. (2024). Kebersihan Dengan Angka Kuman Lantai Ruang Rawat Inap. Jurnal Ilmiah Kesehatan Media Husada, 13(2), 152–161.
Published
2026-03-26
How to Cite
ARUMDANI, Intan Sekar; FITRIANI, Dwi.
Analisis Faktor Lingkungan Fisik Sebagai Determinan Transmisi Infeksi Nosokomial Di Rumah Sakit: Tinjauan Sistematis.
Journal of Health Management Research, [S.l.], v. 5, n. 1, p. 1-16, mar. 2026.
ISSN 2963-4229.
Available at: <https://adihusada.ac.id/jurnal/index.php/JHMR/article/view/676>. Date accessed: 20 apr. 2026.
doi: https://doi.org/10.37036/jhmr.v5i1.676.
Section
Artikel
Keywords
Environmental factors, Healthcare-associated infections (HAIs), Hospital hygiene, Nosocomial infections, Systematic review
