Category: Infection

Communicable diseases pose significant challenges to medical practitioners all over the world. The diseases spread at a rapid rate. Additionally, they can quickly reoccur in regions they were previously controlled. Globalization and infrastructural development have made it hard for health care personnel to deal with communicable diseases like measles, influenza, and meningitis. Even though most developed nations can control infectious diseases, they face an immense threat from developing countries.

Infected persons from developing countries can efficiently transfer the disease to the developed states. Globalization has eased the movement of individuals from one country to another. The free movement of people creates an opportunity for the spread of communicable diseases. This paper examines the case of a meningococcal disease outbreak. It will also discuss how to contain the epidemic.

Description of the Outbreak

The meningococcal outbreak was reported in Europe in 2000 after the return of the Hajj pilgrims. The disease was first discovered in Saudi Arabia. From there, it spread to European countries via air travel. Individuals who traveled to Saudi Arabia for Hajj brought back the disease. In Europe, the disease was spread as a result of local travel. The infected persons spread the disease as they traveled within the country. The strain of the disease that the pilgrims suffered from was serogroup W135 meningococcal. It was reported in nine European countries. They included the United Kingdom, Sweden, Denmark, Germany, France, Finland, Belgium, Norway, and Switzerland (Abubakar et al., 2012).

The meningococcal outbreak was not evenly spread. Instead, ninety people who attended the Hajj pilgrimage suffered from the disease across the nine countries. According to a report by the Center for Disease Control (CDC), the first case of the disease was noticed one week after the pilgrims came back from the Hajj. The pilgrimage happened between 15^th and 18^th March 2000. It was the eleventh week of the year. The first case was reported in the United Kingdom in the twelfth week of the year. By the fourteenth week, the disease had started to spread across the country. In France, the first case of meningococcal disease was detected in the thirteenth week.

The disease began spreading within the same week (Aguilera, Perrocheau, Meffre, & Hahnes, 2002). Aguilera et al. (2002) maintain that the outbreaks in the other seven countries were sporadic and isolated. Some states reported only three cases. The first cases were detected in the twelfth week. The common factor about the outbreaks is that all the victims had attended the Hajj pilgrimage.

Epidemiological Determinant

A bacterial infection causes meningitis diseases. The disease is spread through contact with individuals suffering from meningococcal. The disease is spread through coughing, sneezing, mucus secretion, and other forms of contact (Jafri et al., 2013). According to Jafri et al. (2013), meningococcal disease is easily spread. One can quickly get the disease upon coming into contact with an infected person. The incubation period of the disease is one week.

After a week, an infected individual starts to exhibit signs of the disease. The Hajj provides a venue for large gatherings. Some of the people who attend the pilgrimage carry different types of communicable diseases. Thus, individuals with weak immunity are likely to contract diseases when they come into contact with infected persons. On the other hand, pilgrims from different nations have varied levels of hygiene (Jafri et al., 2013). Some pilgrims engage in unhygienic behaviors like spitting in public that contribute to the spreading of the disease.

According to Jafri et al. (2013), meningococcal disease has several risk factors. They include alcoholism, age, immune deficiency disorders, and drug abuse among others. Chances of an outbreak to happen when people live in congregated areas like dormitories or military barracks are high. Meningococcal is not highly virulence. However, the disease can be fatal if not detected and treated on time. Climate plays a significant role in the spread of the disease. Jafri et al. (2013) posit that Meningococcal thrives in arid conditions. Countries with high temperatures like Sudan are prone to the disease.

Effects of the Outbreak at Systems Level

Meningococcal disease outbreak requires quick intervention from the medical personnel because it poses a significant threat to peoples life. Once an outbreak has been declared, medical facilities and staff and encouraged to stay vigilant and screen all patients that visit the health care centers. Additionally, the medical staff is invited to take preventive measures to ensure that they do not contract the disease as they handle patients.

They are also supposed to make sure that the infected individuals do not spread the disease to other patients in the health facilities (Obaro & Habib, 2016). The medical personnel is required to liaise with colleagues from different health care settings and alert the public of the outbreak. Besides, hospitals work with the government to come up with ways to contain the disease and prevent possible spread.

Meningococcal disease is not highly infectious like Ebola (Obaro & Habib, 2016). Therefore, it may not require a complete shutdown of institutions in the affected area. Members of the community may be encouraged to go for vaccination. However, an outbreak of the disease would not affect business operations. The most drastic measure that the government or health personnel can take is to quarantine individuals who have come into contact with sick persons to facilitate their observation. Such a precautionary measure is necessary because the disease has an incubation period of about seven days.

The Reporting Protocol

Meningococcal disease outbreak is a grave risk to the health of the entire public. Other than treating the disease, public health management systems need to be put on high alert to contain the outbreak. Although medical facilities play the biggest role in treating patients, the public health department has a responsibility to inform the public and come up with measures to resolve the problem. During an outbreak, the public health incident command system is activated (Qureshi, Gebbie, & Gebbie, 2006).

The decision to enable the incident command system is reached once the health personnel reports the first case of meningococcal disease. The incident commander mobilizes the health staff to take precautionary measures. The liaison officer coordinates internal and external activities in collaboration with other agencies. Once the health workers are confident about the possible outbreak, the public information officer is given the green light to inform the community (Qureshi et al., 2006). The health personnel monitors the situation. The planning and intelligence officer collects information about the progress of the outbreak and reports directly to the incident commander.

Education Strategies

Education strategies that can be used to prevent an outbreak of meningococcal disease include patient and community sensitization programs. The government in partnership with the public health department can organize for community education programs (Bastable, 2016). The programs would equip society with skills on how to detect the signs of meningococcal disease as well as how to prevent an outbreak. On the other hand, the health care personnel can come up with a program aimed at enlightening patients on how to deal with the disease to prevent further spread.

Conclusion

Meningococcal disease is fatal and can pose a significant threat to society if not contained on time. The disease is communicable and can spread at a high rate. The good news is that the disease is easy to control if detected in advance. The health department and government agencies need to work in partnership in the case of an outbreak. Additionally, they need to inform the public about the epidemic and train it on how to deal with the incident.

References

Abubakar, I., Gautret, P., Brunette, G., Blumberg, L., Johnson, D., Poumerol, G., Memish, Z., Berbeschi, M., & Khan, A. (2012). Global perspective for prevention of infectious diseases associated with mass gatherings. The Lancet Infectious diseases, 12(1), 66-74.

Aguilera, J., Perrocheau, A., Meffre, C., & Hahnes, S. (2002). Outbreak of serogroup W135 meningococcal disease after the Hajj pilgrimage, Europe 2000. Emerging Infectious Diseases Journal, 8(8), 17- 36.

Bastable, S. (2016). Essentials of patient education. New York: Jones & Bartlett Publishers.

Jafri, R., Ali, A., Messonnier, N., Tevi-Benissan, C., Durrheim, D., Eskola, J., & Zhujun, S. (2013). Global epidemiology of invasive meningococcal disease. Population health metrics, 11(1), 11-17.

Obaro, S., & Habib, A. (2016). Control of meningitis outbreaks in the African meningitis belt. The Lancet Infectious Diseases, 16(4), 400-402.

Qureshi, K., Gebbie, K., & Gebbie, E. (2006). Implementing ICS within public health agencies. Web.

The urinary tract is composed of different parts including the kidney, urethra, ureters and urinary bladder. Human beings have two kidneys that help in body excretion and blood purification. The kidney is usually brown in color and has a small size of around 10-12 cm. The outer cover of the kidney is called the renal capsule (Baskin & Kogan 38).

The renal capsule is tough because it has fibrous tissues on its surfaces. The capsules are covered by two layers of fat to cushion the kidneys from any form of shock. There is also the urethra which is a muscular tube used to remove different wastes including urine from our bodies.

The system also has the ureters that help to remove urine to the bladder. The bladder has several valves that help to prevent the backward of urine to the ureter (Kunin 46).The urinary bladder is a void, well-built elastic reproductive organ that is placed on the pelvic floor. The kidneys have functional units known as nephrons. The nephrons in the body help to regulate water and other soluble substances in the body (Pappas 64).

Glomerulus

The kidney contains numerous glomerulis that help in the purification of blood in the body (Pappas 67). The glomerulus is loop of capillary tuft and receives incoming blood from arterioles.

Function of the Urinary System

The urinary system plays an important role of excretion in the body. Although the main function of the urinary tract is excretion, it has other functions that include like:

• Regulation of plasma in the form of ionic composition
• Maintaining osmolarity of plasma
• Maintaining the volume of plasma
• Maintenance of the hydrogen ionic concentration of plasma
• Secretion of hormones

Urinary Tract Infection

Urinary tract infections are diseases caused by pathogens such as bacteria, fungi, and infectious parasites. Experts recommend that the use of specified terms when referring to particular urinary infections (Baskin & Kogan 39). For example, an infection affecting the urethritis is urethra infection.

Urinary tract infections are common in women than in men. The infections can harm different body organs and cause death. Any damage on the kidneys will affect other parts of the body and processes associated to the kidney. For instance, kidneys play a huge role of regulating substances and water in the body, excretion of wastes, and production of body hormones (Baskin & Kogan 63). Any injury to the kidney can potentially affect many processes in the human body.

Epidemiology

According to statistics, UTIs are common among women than men. Females between 16 and 30 years of age have a high risk of getting these infections. Currently, 10 per cent of women have UTIs. The infections may reoccur from time to time depending on hygiene. According to research findings, women are four times prone to urinary infections than men. At childhood stage, statistics show that 10 per cent of people get STI infections. Non-circumcised males have a higher chance of contracting the infections (Baskin & Kogan 57).

Causes of UTIs

Researchers have identified a number of organisms known to cause urinary tract infections. The leading cause of these infections is Escherichia coli and accounts for more than 80 per cent of the infections. About 80 per cent of urinary tract infections are caused by bacterium known as E. coli. The bacterial strains occur in the colon.

Other bacteria strains that cause infection like Mycoplasma, Pseudomonas, Proteus, and Staphylococcus species (Baskin & Kogan 57). In addition, there are UTIs resulting from fungi like Cryptococcus and Candida fungal species. Some parasites like Schistosoma and Trichomonas also cause urinary tract infections. Proper treatment for urinary tract infection depends on the knowledge of these causing organisms.

UTI Symptoms/signs

The signs and symptoms of urinary tract infections differ from one person to another. This depends on gender, age and the location of infection (Davey 72). In advances cases of urinary infections, the individual has severe when urinating. Another sign of urinary infection is the change in urine color from clear to cloudy. Sometimes the urine may reddish when there is presence of blood (West 99).

Any unpleasant smell from urine can be another sign of urinary infections and therefore immediate medication is necessary. Some women infected with urinary diseases may complain of increased abdominal pains or feel fatigued and tired. Vaginal discharge can also be a common sign of urinary infection in women. Urinary discharges occur when the Urethra is infected, or the individual has contracted STDs.

In children, the common signs of urinary infection include the presence of blood in urine. Sometimes they may complain of abdominal pains, increased fever, and frequent vomiting. General body weakness is also common in women and children with urinary tract infections (Davey 73).

How STIs are Diagnosed

When carrying out the diagnosis for STIs, the physician or doctor should get a comprehensive medical history of the patient. Fresh urine samples are obtained from the individual to determine if there are any potential disease-causing organisms (Davey 75). When conducting the analysis in young children, infants, and aged patients, urine samples are through a method known as catheterization. Laboratory verification helps to determine the possible cause of the urinary infection (Pappas 78).

UTIs Diagnosis

Classification

If a UTI infection occurs in the lower Urinary tract, experts and medical practitioners refer to it as bladder infection. On the other hand, if the infection occurs in the upper urinary tract the condition is pyelonephritis. Infection in the upper track can be a sign of Diabetes Mellitus (Davey 102).

In children

It is also notable that Health Organizations do not approve urine bags in of samples from children. This is because this tends to increase cases of contamination. Because of this, catheterization is used by those who are not trained (Kunin 54). The American academy of pediatrics recommends the use of voiding cystourethrogram for children below the age of two years. This involves the use of real time x-ray as the children urinate, or renal ultrasound for affected children (Pappas 317).

Differential diagnosis

Some organisms causing Chlamydia and gonorrhea can result in urinary tract infections. These are STDs and cause vaginitis or cervicitis in women and cause complications in males with urinary tract infection symptoms. Studies have shown that a yeast infection can cause vaginitis (Davey 103). It is important to test individuals having multiple infections of their urinary tract for interstitial cystitis. This is required even when the urine cultures are negative.

UTI risk factors

The risk factors for urinary tract infections are many. Generally, a blockage of normal urine flow, which is normally 50cc per hour for a normal adult, is one of the risk factors for UTI. An abnormality within the urinary tract creates infection risk thereby increasing the risks for diseases like kidney stones (Porth 92).

Other complications include abnormal prostates, anatomy disorder and urethral stricture. The reason why there is increased potential for these risks is the washout effect when the blood flows into the kidney (Kunin 46). Women are more predisposed to UTIs compared to men. This is because women have a naturally shorter urethra that opens more closely to the anus. It becomes easier for pathogens to get inside the urinary tract easily.

The use of catheters increases the risk to about 30% higher since it has none of the systems for protective immunity that eliminate bacteria and also it connects directly to the bladder. Statistics have revealed that majority of the women using diaphragms or condoms develop spermicidal foam which is known to increase the risks for urinary tract infections in the body (Porth 52).

Individuals who are engaged in active sex also increase their chances for getting urinary tract infections. This explains the reason why sexual behaviors are discouraged because they can increase STDs and other urinary tract infections (Kunin 84).

Male individuals with over 60 years of age have a higher risk for the same since the prostrate enlarges at that age and the bladder is unable to empty fully. Occasionally individuals with bacteremia have this bacterium in the kidney, a phenomenon termed as hematogenous spread.

This is the same case for people with infections in areas connected to the urinary tract. People who have ever had a urologic surgery also have an increased risk of UTIs (Pappas 325). Between weeks six to 26 of during pregnancy, there is an increased risk of infection even though it is not the case always. However, due to pyelophritis a UTI may progress in seriousness as various researchers have confirmed and reports (West 83).

Possible Complications UTIs

Most of the urinary tract infections have no complications if the individuals get quick medication. Early intervention is necessary to prevent further complications because of the infections. If this is not done, the disease becomes chronic and the individual might realize that his or her life is at risk (Porth 97). This does not mean that there are no complications. Some complications can occur later in life and probably result in death.

Some of the complications might include urinary strictures, fistulas, abscesses, and kidney damage. The more advanced is the infection, the more the complication. More complications can result in dehydration and failure of body organs especially the kidney. If a woman is pregnant and has such infections that remain untreated, chances are high that she might have a premature delivery. As well, the newborn child might be underweight or poorly developed (Pappas 325).

UTI Treatment

The treatment regimes for urinary tract infections depend on the level of infection and the causing organism. Individuals with advanced urinary tract infections require strong antibiotics to kill the disease-causing organisms and treat the condition completely. Individuals who are not highly affected require oral antibiotics because the infection is mild (Pappas 302).

Individuals infected with STDs should be carefully treated and provide them with appropriate medication and antibiotics. Children require necessary treatment depending on the UTI and its level of development. Children and pregnant women should not take ciproflaxin or other related antibiotics (Kunin 454).

Patients who have fungal or parasitic pathogens need antifungals to treat their condition. However, patients should consult with their doctors before they receive any form of treatment (Porth 48). Medicines obtained from the counter do not cure STI bacteria even though they relieve the pain and discomfort. Some medications that contain Phenazopyridine cause urine to turn orange work to relieve pain in the bladder or stain the contact lenses (Pappas 325).

Prevention of UTIs

The first step to prevent urinary tract infections is through good hygiene. Good hygiene for men and women helps prevent infections of the urinary tract. It is important that women clean their genitals as frequently as possible because they stand a higher risk of getting the infections. They should do so by wiping their genitals backwards to prevent pathogens in the anal passage from entering into the urinary tract.

For men, retracting the fore skin will help prevent UTIs because urine will not linger at urethra opening (Porth 92). It is important that people empty the bladder completely because residues will allows pathogens to survive or replicate in the tract. Experts also encourage people to take a shower or urinate immediately after having sex because this will reduce susceptibility to infections such as urethritis.

UTI prognosis

A good prognosis is normal for spontaneous resolution and easy-to-treat infections. Patients having rapid infections can have a good prognosis if they seek immediate and adequate medication (Kunin 87). This will help to reduce chances of disease development. Aged or people with suppressed immunity have a poor prognosis depending on the kind of damage done by the infection.

Works Cited

Baskin, Laurence. & Kogan, Barry. Handbook of pediatric urology. New York: Oxford University Press, 2009. Print.

Davey, Patrick. Medicine at a Glance. New Jersey: Prentice Hall, 2012. Print.

Kunin, Calvin. A reassessment of the importance of low-count bacteriuria in young women with acute urinary symptoms, New York: Ann Intern Med, 1993. Print.

Pappas, Panzer. Laboratory in the diagnosis and management of urinary, tract infections, New York: Med Clin North Am, 1991. Print.

Porth, Mattson. Essentials of Patho-physiology: Concepts of Altered Health States. New York: John Wiley and Sons, 2010. Print.

West, Krista. Urinary Tract Infections, USA: The Rosen Publishing Group, 2006. Print.

Required information

This paper is a research proposal aimed at drafting the information about the purpose of the research, the strategies, and techniques used for the research. The research is aimed at considering the nosocomial infections transmitted by all staff within the Skilled Nursing Facility with the help of quantitative research after the consideration of the medical journals and some sources on the Internet.

Appropriateness of approach

The research is important, and it should be conducted as nosocomial infections are easily transmitted and may be a cause of a serious epidemic if the specific measures are not considered in detail. This research aims to check two specific ways of how to combat the disease in case it is already spread in one particular environment. The research is appropriate as it corresponds to the requirements of the course, and all the necessary procedures are followed, including the literature review, the methodology, the results, and the discussion of the research results. Nosocomial infections are considered a serious problem for hospitals, which requires more financial support and more time of hospitalization (Baghaei, Mikaili, Nourani, & Khalkhali, 2011).

Purpose of the research proposal

The research is aimed at considering the measures which may be taken when the nosocomial infections are transmitted by all staff within the Skilled Nursing Facility. Particularly, the research is directed at checking whether the implementation of the preventive alert and pause system is effective in the situation. The purpose of the research is based on measuring the number of the occurred cases and considering how many cases were treated by means of the mentioned techniques.

Researcher

The main role of the researcher is to create the sample for the research, to describe in detail the methodology and the research procedure, and to observe the research by noting all the results. Having quantitative research as the method used in this case, the researcher should gather all the data, systemize it, and after a detailed consideration to structure the results to make those easy for consideration. The role of the researcher, in this case, bears practical importance along with the theoretical participant who is responsible for the research procedure and results in analysis.

Sampling techniques

Quantitative research is based on the number of occurrences of the cases of nosocomial infections, and the strategies for decreasing the number of cases are going to be considered.

Appropriateness of sampling techniques

This type of research is the most appropriate as being aimed at considering the most effective strategy for dealing with nosocomial infections; the number of cases should be explored with the observation of the strategies used with the consideration of the most effective measures taken.

The target audience of participants

The target audience is the medical staff, nurses, doctors, and other participants of the treatment process who may deal with nosocomial infections at the workplace. The research may also be interesting for organizations that should accept many people. The measures for preventing infectious disease are going to be useful for the medical staff in schools, kindergartens, and other organizations where many people are gathered.

Hypothesis statement

Nosocomial infections transmitted by all staff within the Skilled Nursing Facility may be successfully prevented if the staff implements the preventive alert and pause system during the predicted peak of the disease.

Reference List

Baghaei, R., Mikaili, P., Nourani, D., & Khalkhali, H. R. (2011). An epidemiological study of nosocomial infections in the patients admitted in the intensive care unit of Urmia Imam Reza Hospital: An etiological investigation. Annals of Biological Research, 2(5), pp. 172-178.

Introduction

Chronic hepatitis B virus infection has been proved a usual source of death link to liver failure, cirrhosis and liver cancer. Internationally, more than 345 million individuals have chronic hepatitis B virus (HBV) with more than 619,000 individuals dying each year from hepatitis B virus associated liver illness.

Vaccination for HBV is greatly efficient for prevention of infection with hepatitis B virus and subsequent acute and severe liver illness. In the US, the cases of newly acquired hepatitis B virus infections have reduced significantly due to the success of public health management in the execution of an intensive national immunization policy. Nevertheless, the prevalence of hepatitis B virus infection is still high. In 2006, about one million residents of the United States were living with hepatitis B virus infection (Shetty, & Wu, 2009, pp. 34-38).

Moreover, hepatitis B virus infection is the current core reason behind an approximated 3,000 deaths annually in the US. Thus, more needs to be done to curb hepatitis B virus infection effectively. This paper discusses public health management of hepatitis B virus infection and gives some suggestions for medical assessment and administration of infected individuals and their contacts.

Public health management of hepatitis B virus infection

Hepatitis B cannot be transmitted through contaminated food and water or even kissing; hepatitis B virus is present in blood as well as body fluids like saliva, semen, vaginal discharges and breast milk and could be transmitted in the following manners (Zein, & Edwards, 2009, pp. 98-101).

• Kid-to-kid spreading through domestic contacts like biting
• Needle injuries in health care surroundings
• Re-utilization of unsterilized or poorly sterilized needles
• Sexual contact
• Sharing of personal things like razor blade, toothbrush and nail cutters
• Sharing of sharp tools like needles

Enhancing the recognition and public health management of individuals with chronic hepatitis B virus infection may assist in preventing severe liver illness and harmonize immunization policies to eradicate hepatitis B virus infection in the US. Individuals having severe hepatitis B virus infection may stay asymptomatic for a long time, unconscious of the infection as well as their risks for spreading the virus to other individuals and for having severe liver illness afterward in life.

Early recognition of individuals with hepatitis B virus infection allows the detection and vaccination of vulnerable family unit contacts as well as spouse with whom they have sexual contact (Zein, & Edwards, 2009, pp. 102-104). In this way, successful disruption of the potential infection is achieved. Every individual with chronic hepatitis B virus infection requires obtaining public health management to assess the inception and development of both liver cancer and liver illness.

Secure and efficient antiviral means are currently accessible to cure hepatitis B virus infections. This presents a higher standard of recognizing individuals that could gain from medical assessment, public health management, antiviral remedy as well as other treatment when designated.

The Food and Drug Administration (FDA) has endorsed most of the medications currently being employed for HBV treatment. For instance, FDA has endorsed two kinds of alfa 2 interferon and five oral nucleotide analogs whereas other medicines are in experimental tests.

Serologic trials for hepatitis B surface antigen (HBsAg) are the basic means of recognizing individuals with hepatitis B virus infection. Owing to the accessibility of efficient vaccine as well as post exposure prophylaxis (PEP), Centre for Disease Control (CDC) earlier suggested the significance of hepatitis B surface antigen testing for expectant females and children born by hepatitis B antigen-positive mothers.

Additionally, CDC recommended testing of family unit contacts and spouses of hepatitis B virus infected individuals, individuals living with human immunodeficiency virus (HIV) and individuals born in nations with hepatitis B surface antigen prevalence of more than 7 %.

Moreover, CDC suggested testing of individuals from who blood or other body fluid that could necessitate PEP comes, for instance, in case of needle injury to a public health care provider or in a sexual assault (Zein, & Edwards, 2009, pp. 99-102). Habitual hepatitis B surface antigen testing is currently recommended for individuals born in areas where its prevalence is more than one percent, in men who have sex with men (MSM) as well as in injected drug users (IDUs).

The present strategies to enhance patient safety and avoid transmission of hepatitis B virus in public health care environments include vaccination of vulnerable health care providers and the application of primary prevention (avoiding exposures and thus transmission) through stringent observance of the general principles of infection management safety measures.

More ways on this prevention include application of safer tools and the execution of public health practice managements (for instance, failure to re-cap needles) to curb injuries that present dangers for hepatitis B virus spread to both the patients and the care givers. Public health providers in the US anchor standard safety measures on the foundation that every blood as well as blood-having body fluids are liable of transmitting infections (Heather, Colvin, Abigail, & Mitchell, 2010, pp. 56-58).

From 1996, Centre for Disease Control has outlined the habitual application of standard safety measures that encompass utilization of protective tools in suitable situations, execution of both career practice measures and engineering managements, and observance of thorough standards for sterilizing and re-applying patient care tools.

For instance, using of double gloves is currently being done in different parts of the US and the world at large with the proof of illustrating the effectiveness and value of this and other interventions being wide-ranging.

Nevertheless, Centre for Disease Control has been able to discover some cases of patient-to-patient transmission of hepatitis B virus attributed to risky injection and dialysis processes, use of the same blood-sugar checking tools among patients in addition to other unhealthy practices. However, from 1991, minimal cases of hepatitis B spread attributed to public health providers have been detected in the US and in developed nations (Heather et al., 2010, pp. 57-59).

Recommendations

• All hospitals and medical institutions must have easily accessible written strategies and procedures for the detection and management of hepatitis B virus infected care givers, educators and students.
• Every health care giver and student ought to obtain HBV vaccine in accordance with the present Centre for Disease Control recommendations of 3 dose sequence. Immunization must be reinforced by evaluation of hepatitis B surface antibody to establish vaccination immunogenicity and re-immunization if possible.
• Standard safety measures must be followed thoroughly in every public health care setting for the safety of both patients and care givers (Heather et al., 2010, pp. 59-60).

Conclusion

Hepatitis B virus infection has been confirmed to be cause of death associated with liver illnesses. Enhancing detection and public health management of people with hepatitis B virus infection might aid in preventing severe liver illnesses and promote the success of immunization policies to eradicate hepatitis B virus infection.

Through adherence of safety precautions and given recommendations for public health assessment and management of infected individuals and other vulnerable individuals will assist in effectively preventing the spread of HBV.

References

Heather, M., Colvin, H. M., Abigail, E., & Mitchell, A. E. (2010). Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Washington, DC: National Academies Press.

Shetty, K., & Wu, G. Y. (2009). Chronic viral hepatitis. New York: Springer.

Zein, N., & Edwards, K. M. (2009). The Cleveland Clinic Guide to Liver Disorders. UK: Kaplan.

Methicillin-resistant Staphylococcus aureus (MRSA) can cause a wide range of infections. Such infections can result in mortality and morbidity. Staphylococcus aureus is a common pathogen widely common in prosthetic joint infections (Ng & Awad, 2015, p. 2). The purpose of this study is to understand how an effective preoperative MRSA screening protocol can be used as a powerful strategy to minimize orthopedic surgical site infections (Alexander & Wang, 2015).

Search Method

A rigorous strategy was used to select the most desirable peer-reviewed journal articles for this study. The major databases used to collect the required information included Science-Direct, the British Medical Journal (BMJ), and Evidence-Based Nursing (EBN). Several keywords were also used to select quality articles for the study. The keywords used are presented below.

• Methicillin-resistant Staphylococcus aureus (MRSA)
• MRSA screening
• Orthopedic site infection
• Quality improvement
• Quality healthcare delivery

On top of that, a powerful criterion for exclusion and inclusion was used. For instance, articles published within the last five years were considered for inclusion. The other consideration was to ensure the articles addressed the issue of MRSA infection. The selected articles presented evidence-based ideas and arguments. A total of 10 peer-reviewed journal articles were selected for the study.

Summary of Research Studies

Akhtar, A., Kadir, H., & Chandran, P. (2014). Surgical site infection risk following pre-operative MRSA detection in elective orthopedic surgery. Journal of Orthopaedics, 1(1), 11117-11120.

This article indicates that patients undergoing orthopedic surgery have higher chances of MRSA infection. Over 80 percent of the targeted patients had been colonized with MRSA. The study shows clearly that a preventative or screening strategy can minimize the risk of MRSA infection. Patients should therefore be sensitized about the increased surgical site infection if colonized with MRSA pre-operatively (Akhtar, Kadir, & Chandran, 2014, p. 11117). However, the article fails to propose adequate solutions to deal with this problem.

Alexander, C., & Wang, L. (2015). Infection control: methicillin-resistant Staphylococcus aureus. American Journal of Infectious Diseases, 11(3), 74-82.

The scholars conducted an extensive literature review to understand the problem of MRSA infection. After conducting the study, the authors indicated that early isolation and identification for the pathogen could deal with the health problem (Alexander & Wang, 2015). This should also be done at the point of entry. The main strength is that the study offers new approaches towards dealing with various healthcare-associated infections (HAIs).

Charles, K., Nathan, L., Blake, B., Maureen, S., Gary, S., & David, L. (2016). Is staphylococcal screening and suppression an effective interventional strategy for the reduction of surgical site infection? Surgical Infections, 17(2), 158-166.

The study analyzed the current use of topical mupirocin in many hospitals as the best procedure for nasal decolonization. According to the authors, the screening methods were selective and controversial. However, studies have indicated that suppression and screening reduce SSI infections. The scholars proposed that the best surveillance strategy should be based on the risk-levels of patients undergoing surgical procedures (Charles et al., 2016). The study, however, fails to offer the best alternative for dealing with MRSA infections.

Duerden, B., Fry, C., Johnson, A., & Wilcox, M. (2015). The control of methicillin-resistant Staphylococcus aureus bloodstream infections in England. Open Forum Infectious Diseases, 2(2), 1-12.

A powerful research approach was used by the scholars. This was done by analyzing the major campaigns that managed to reduce MRSA infections. That being the case, the study also explains how the implementation of national infection prevention directions and expert improvement teams can deliver positive results. However, the authors fail to outline new screening strategies for MRSA (Duerden, Fry, Johnson, & Wilcox, 2015).

Jokinen, E., Laine, J., Huttunen, R., Arvola, P., Vuopio, J., Lindholm, L.,&Syrjanen, J. (2015). Combined interventions are effective in MRSA control. Infectious Diseases, 47(11), 801-807.

This study entailed the use of various infection prevention measures and screening protocols. The scholars wanted to understand how the MRSA pandemic could be minimized. They concluded that the use of universal screening methods was effective in containing the epidemic (Jokinen et al., 2015). As well, they indicated that the Pirkanmaa epidemic (PE-MRSA) was becoming a major challenge.

MacFadden, D., Elligsen, M., Robicsek, A., Ricciuto, D., & Daneman, N. (2013). Utility for prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections. CMAJ, 185(15), 725-730.

The purpose of the study was to evaluate the effectiveness of MRSA screening in predicting the resistance of clinical isolates of S. aureus (MacFadden, Elligsen, Robicsek, Ricciuto, & Daneman, 2013, p. 726). The method can be used to minimize MRSA infection in every healthcare setting. The main weakness of the study is that it fails to describe how medical professionals can improve the nature of screening for MRSA to minimize nosocomial spread (MacFadden et al., 2013).

Mehta, S., Hadley, S., Hutzler, L., Slover, J., Phillips, M., & Bosco, J. (2013). Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden. Clinical Orthopaedics and Related Research, 471(7), 2367-2371.

The authors used a power study design to come up with their findings. They wanted to understand the best ways to decolonize the MRSA burden. The study showed conclusively that the implementation of a staphylococcal decolonization protocol at a single specialty orthopaedic hospital decreased the prevalence density of MRSA (Mehta et al., 2013, p. 2367). The ideas can be replicated elsewhere to address this health concern.

Ng, W., & Awad, N. (2015). Performance improvement initiative: prevention of surgical site infection (SSI). BMJ Quality Improvement Programme, 4(1), 1-3.

Hospitals performing numerous surgical procedures should have safety measures to prevent SSIs (Ng & Awad, 2015). Mafraq Hospital, therefore, developed a multidisciplinary team to implement the best measures to eliminate surgical site infections (SSIs). The authors, therefore, show that the continued use of proper medical practices can help prevent the major causes of SSIs. These evidence-based ideas are applicable in many hospitals.

Thompson, P., & Houston, S. (2013). Decreasing methicillin-resistant Staphylococcus aureus surgical site infections with chlorhexidine and mupirocin. American Journal of Infectious Diseases, 41(7), 629-633.

The authors outlined the best ways that can be used to eliminate MRSA SSIs. The authors used past studies to examine how various hospitals used different strategies to deal with the MRSA epidemic. The analysis showed that intranasal mupirocin and non-rinse 2% chlorhexidine gluconate cloths were beneficial in preventing MRSA infections in the non-general surgery population (Thompson & Houston, 2013, p. 630).

Al-Mulhim, F., Baragbah, M., Sadat-Ali, M., Alomran, A., & Azam, M. (2014). Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. International Surgery, 99(3), 264-268.

This outstanding article explains why emergency surgical operations carry the greatest share of MRSA risk. Many patients record new health problems and death due to such infections. The scholars, therefore, propose the use of proper measures to control MRSA infection (Al-Mulhim, Baragbah, Sadat-Ali, Alomran, & Azam, 2014). The article also shows clearly that the use of antibiotics may not be sufficient for dealing with the problem.

List of References

Akhtar, A., Kadir, H., & Chandran, P. (2014). Surgical site infection risk following pre-operative MRSA detection in elective orthopaedic surgery. Journal of Orthopaedics, 1(1), 11117-11120.

Alexander, C., & Wang, L. (2015). Infection control: methicillin-resistant Staphylococcus aureus. American Journal of Infectious Diseases, 11(3), 74-82.

Al-Mulhim, F., Baragbah, M., Sadat-Ali, M., Alomran, A., & Azam, M. (2014). Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. International Surgery, 99(3), 264-268.

Charles, K., Nathan, L., Blake, B., Maureen, S., Gary, S., & David, L. (2016). Is staphylococcal screening and suppression an effective interventional strategy for reduction of surgical site infection. Surgical Infections, 17(2), 158-166.

Duerden, B., Fry, C., Johnson, A., & Wilcox, M. (2015). The control of methicillin-resistant Staphylococcus aureus bloodstream infections in England. Open Forum Infectious Diseases, 2(2), 1-12.

Jokinen, E., Laine, J., Huttunen, R., Arvola, P., Vuopio, J., Lindholm, L.,&Syrjanen, J. (2015). Combined interventions are effective in MRSA control. Infectious Diseases, 47(11), 801-807.

MacFadden, D., Elligsen, M., Robicsek, A., Ricciuto, D., & Daneman, N. (2013). Utility for prior screening for methicillin-resistant Staphylococcus aureus in predicting resistance of S. aureus infections. CMAJ, 185(15), 725-730.

Mehta, S., Hadley, S., Hutzler, L., Slover, J., Phillips, M., & Bosco, J. (2013). Impact of preoperative MRSA screening and decolonization on hospital-acquired MRSA burden. Clinical Orthopaedics and Related Research, 471(7), 2367-2371.

Ng, W., & Awad, N. (2015). Performance improvement initiative: prevention of surgical site infection (SSI). BMJ Quality Improvement Programme, 4(1), 1-3.

Thompson, P., & Houston, S. (2013). Decreasing methicillin-resistant Staphylococcus aureus surgical site infections with chlorhexidine and mupirocin. American Journal of Infectious Diseases, 41(7), 629-633.

Introduction

According to the Center for Disease Control (CDC), Georgia has one of the highest rates of Sexually Transmitted Infections in the United States. For instance, the region is ranked third for syphilis rates, sixth for gonorrhea rates, and seventh for Chlamydia rates. In 2010, more than 52,000 cases of STIs were reported while more than 18500 people were living with HIV. Further, the 15-24 age group has the highest risk of infection in the region, as it accounts for 50% of all newly reported infections.

Another major risk factor for infection is evident among Men who have Sex with Men (MSM) and among the minority groups. In light of the increasing health problem concerning sexually transmitted infections in Atlanta, there is a need for an effective community health intervention program to control or eliminate the health issue. The main aim of this paper is to propose a community health intervention program that is targeted at reducing the prevalence of sexually transmitted infections in Atlanta.

To accomplish the task, the paper will prove the appropriateness of the proposed intervention programs using the existing peer-reviewed research that has supported the various intervention programs for STIs. The health intercession plan will focus on preventing the transmission of STIs through awareness and behavioral change initiatives. The outline of the awareness and behavioral change initiatives toward STIs prevention will be as follows:

• A summary of the status of STIs in Atlanta
• An overview of the proposed awareness and behavioral change initiatives
• Peer-reviewed support for the initiative
• Implementation of the initiative in Atlanta

Methodology

The main goals of the intervention plan are as follows:

• To propose education programs towards the prevention of STIs
• To propose education programs for specific groups in the population
• To propose an education program on behavior change

There is a need to have an education program that focuses on reducing the prevalence of sexually transmitted infections in Atlanta, Georgia, which has one of the highest prevalence of STIs and HIV in the state. With 50% of all new infections that are recorded among young people of 15-24 years, there is a need to have more effective programs that will ensure that the current trend is reduced to safeguard the future of young people in the state. The health program will focus on creating awareness on the various approaches to preventing STI and HIV among all the populations, although more focus will be on the groups that have the highest risk.

To achieve the intended goals of the program, the health awareness and behavioral change initiatives will center on the creation of relevant messages that are effective among each specific age group and target populations. Further, such messages will be conveyed through effective mediums. For instance, to young people in the 15-24 age bracket, the use of social media and other digital platforms will be of a great priority since research has shown that such a medium is more effective in this specific age group.

The program will also involve the creation of awareness on the ways of STI and HIV prevention among the target groups. Such consciousness will majorly focus on the promotion of condom use among the target population, especially the youths, to reduce the risk of infection and hence greatly reduce the current trends of STIs in Atlanta. The use of the Partner Notification (PN) program will also be a central program that will be used to ensure better health outcomes for the infected and those at risk as a way of reducing the risk of re-infection.

To evaluate the success of the program, the education program will focus on identifying the level of awareness among the target groups on the prevention measures of STI and HIV. Further, the education plan will utilize data from health care institutions such as CDC to identify the changes in trends of infection in the target population.

The ethical issues that arise from the program include the privacy of the people who will be actively involved in the research. The three key stakeholders of the program will be local communities, local health institutions, and the state government. The proposed program will focus on administering and managing health education, which is a responsibility of the Certified Health Education Specialist (CHES). In this case, the focus of the program is to create awareness in a specific area of health concern.

Hence, it will require adequate management to ensure the best outcomes for the target population. Lastly, the program brings about positive social change since it advocates the change that promotes healthy behaviors and thus longer living for all people in the population. The creation of awareness on the various sexually transmitted diseases that are prevalent among the young people is also a major positive social change scheme that will lead to positive behavioral change, as well as ensuring that the target population takes informed choices of protecting themselves from the risk of infection.

Reference List

Crosby, R., Charnigo, R., Salazar, L., Pasternak, R., Terrell, I., Ricks, J., Smith, R., & Taylor, S. (2014). Enhancing Condom Use among Black Male Youths: A Randomized Controlled Trial. American Journal of Public Health, 104(11), 2219-2225.

Guse, K., Levine, D., Martins, S., Lira, A., Gaarde, J., Westmorland, W., & Gilliam, M. (2012). Intervention using new digital media to improve adolescent sexual health: A systematic review, implications and contribution. Journal of Adolescent Health, 51(6), 535-543.

Lee, Y., Dancy, B., Florez, E., & Holm, K. (2013). Factors Related to Sexual Practices and Successfully Transmitted Infection/ HIV Intervention Programs for Latino Adolescents. Public Health Nursing, 30(5), 390-401.

LeFevre, M. (2008). Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 161(12), 894-902.

Rahman, M., Khan, M., & Gruber, D. (2015). A low-cost partner notification strategy for the control of sexually transmitted diseases: A case study from Louisiana. American Journal of Public Health, 105(8), 1675-1680.

Yzette, L., & Madeline, S. (2013). Reframing the context of preventive health care services and prevention of HIV and Other sexually transmitted infections for young men: New opportunities to reduce racial/ethnic sexual health disparities. American Journal of Public Health, 103(2), 262-269.

Introduction

Every practitioner wants to develop new skills. Training in nursing is an endless process. Caregivers should be ready to gain new skills and competencies in order to provide the best support to their patients. One of the best practices is working with other professionals. In this essay, I will reflect on my experience in a visit to an external organization to improve my skills. The practice made it easier for me to achieve the objectives of my project. I am planning to build better relationships and offer the best care to my patients. This paper uses Gibbs Model to reflect on my experiences gained during the planning stage of my project (Gibbs (1988) Reflective Cycle 2014).

Description

My project focused on every issue associated with infection control. I needed some help in order to review every educational resource for my project. I also wanted to gain new skills in order to come up with the best project (Vargas 2007). The organization had already formed an infection control committee recently. I was unable to get the best support from this new committee. Our readings encouraged every learner to seek the best support from experts in different organizations.

The above scenario encouraged me to contact the head of an infection control committee in one of the biggest hospitals in our city. The first thing was to request a visit. The manager advised me to send an official request. The second step was to meet with the manager. I explained to him why my visit was relevant to the success of my project and the dental department. I was happy to interact with the head of the infection control committee. The meeting was informative, cooperative, and interactive. The head of the committee answered most of my questions. The person also reviewed my questions and educational materials. This approach was relevant for supporting my project (Vargas 2007). My team also interacted with the committee in order to gain new skills and competencies.

Feelings

I was anxious and uncomfortable at the beginning of this project. I was not happy with the idea to get help from an external organization. I was also not very enthusiastic. I am not very intrusive. I have always encountered difficulties whenever contacting powerful people or building new relationships. The experience changed my views completely. I gained new ideas and skills from this organization. This experience made it easier for me to form new relationships with experts (Vargas 2007, p. 38). I have greatly benefited from this experience. I have also gained new ideas from this experience. I am planning to interact with more professionals and experts throughout my project.

Evaluation

This exercise was successful because I gained the best support from the head of the committee. I was happy because the head of the infection control committee answered most of my questions. This hospital also equipped me with the best educational materials. I also gained new training in order to make my project successful. The good thing about the experience was that it equipped me with practical ideas. I will use these ideas throughout the project. I also established meaningful relationships with different professionals in the hospital. I also visited different departments in order to improve my competencies. The best approach towards the success of every project is using proper leadership (Heldman 2011, p. 67). Every team leader should present the best standards and follow every policy (Heldman 2011). It is also appropriate to train every member and monitor the operations of the team. According to Heldman (2011), every project requires the best decision-making skills and preparation. I gained new ideas from this exercise. I now understand how to share information and ideas. I also understand the relevance of positive relationships in every organization.

Analysis

The decision to cooperate with different organization widened my skills. I also formed new relationships with different experts. I also improved my communication skills. These practices will improve the quality of healthcare in every organization. Communication can improve the quality of care in every hospital (Vargas 2007). This practice was relevant towards improving my writing skills. I will get better marks from this reflective writing. This practice is necessary for eliminating every geographic or organizational boundary. Every hospital or organization should form the best relationships with other firms. This collaboration will ensure every company improves its business practices (Vargas 2007).

The decision to cooperate with different organizations widened my ideas. I also improved my communication skills. These practices can improve the quality of care in every healthcare organization. This practice was relevant towards improving my writing skills. I will also get better marks from this reflective writing. This exercise explains why both collaboration and conferencing are essential whenever conducting a project (Vargas 2007).

Conclusion

Every person can gain new skills from different organizations. The best thing is to consider the best strategies in order to learn from these organizations. I have formed new relationships with different leaders and experts. This collaboration will make me successful. Every student should use this strategy in order to achieve his or her goals.

Action Plan

I am looking forward to interacting with this infection control team. I am also planning to visit more organizations in order to gain the best support and ideas. I will improve my communication skills and build new relationships in the future. This practice will make me successful in my current project and future career.

Reference List

Gibbs (1988) Reflective Cycle 2014, Web.

Heldman, K 2011, Project Management Jumpstart, Wiley, New York.

Vargas, R 2007, Practical Guide to Project Planning, Auerbach Publications, New York.

Urinary tract infection (UTI) cab be defined as the presence of pathogens in the urinary tract (Rane & Dasgupta, 2013, p. 1). In fact, UTI is an inflammation of the urinary epithelium commonly conditioned by gut flora bacteria (Huether & McCance, 2017, p. 2263). The most frequent cause of UTI is Escherichia coli. Nevertheless, UTI can develop as a result of certain viruses, fungi or parasites. Moreover, UTI is among prevalent reasons for the prescription of antibiotics. The infection can affect the lower and upper urinary tract. In addition, it can be affected by different factors such as age, gender or lifestyles. Consequently, it is crucial to have a clear picture of UTIs and understand the factors that influence its development to provide a proper timely diagnosis.

Pathophysiology of Urinary Tract Infections

UTI can develop in lower and upper urinary tracts. The infection can locate in the urethra, bladder, prostate (in male patients), ureter, and kidney (Huether & McCance, 2017). Although the causes of UTI are often similar, pathophysiology can differ depending on the location of infection.

Lower UTI includes cystitis and urethritis. It can be described as a benign state that provokes such characteristic symptoms as dysuria, suprapubic pain, frequency of micturition, urgency, hesitancy, and incomplete voiding (Rane & Dasgupta, 2013, p. 1). Cystitis is mainly caused by such infecting microorganisms as Escherichia coli and Staphylococcus saprophyticus. Other infection matters include Klebsiella, Proteus, Pseudomonas, parasites, viruses, fungi, or tubercular bacilli (Huether & McCance, 2017).

Upper UTI is represented by pyelonephritis. It is an invasive infection of the renal parenchyma, classically presenting with the triad of fever, renal angle tenderness, and nausea and vomiting (Rane & Dasgupta, 2013, p. 1). Pyelonephritis is frequently caused by Escherichia coli, Proteus, and Pseudomonas (Huether & McCance, 2017). In both lower and upper UTI the infection is commonly spread by uropathic microorganisms that ascend along the ureters. Still, bloodstream is another possible way for dissemination. The inflammatory process usually is of irregular and focal character. It mainly influences the pelvis, calyces, and medulla (Huether & McCance, 2017).

On the whole, infections of lower and upper urinary tracts have some similar causes such as Escherichia coli, Proteus, and Pseudomonas. However, infection is located in different parts of UT and the symptoms are different. Moreover, upper tract infections can cause urosepsis and other complications such as abscess formation, kidney damage, or renal failure (Flores-Mireles, Walker, Caparon, & Hultgren, 2015).

Gender and Behavior as Factors Influencing the Pathophysiology of UTI

Among the factors that have impact on UTI, gender and behavior are probably among the most significant. Thus, women are more exposed to UTI, sexually active, pregnant, or treated with antibiotics women in particular. Bacteria causing UTI are moving into the urinary tract from the bowel, vaginal cavity, and periurethral area (Foxman, 2017). Women have a shorted distance between vaginal cavity and anal and the urethral opening. Thus, bacteria reach the bladder quicker. Cystitis is frequent among women due to the shorter urethra which increases the probability of bacterial contamination. Lower UTI affects about half of women at some time in their life (Huether & McCance, 2017).

Peoples behavior or lifestyles also have a significant influence on the development of UTI. Thus, poor hygiene stimulates pathological processes and increases the risk of bacterial contamination. Active sexual life is also a factor that increases the probability of developing a UTI because it assists the movement of bacteria into the urethra thus causing infection.

Conclusions

On the whole, UTI is among the most common diseases. It can develop in different locations and have diverse causes or be influenced by many factors. Although it is successfully treated with antibiotics, UTI has a high rate of recurrence.

References

Flores-Mireles, A., Walker, J., Caparon, M., & Hultgren, S. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284. Web.

Foxman, B. (2017). Urinary tract infection syndromes. Occurrence, reoccurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North America, 28(1), 1-13. Web.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Rane, A., & Dasgupta, R. (Eds.). (2013). Urinary tract infection. Clinical perspectives on urinary tract infection. London, UK: Springer.

Categories of Antimicrobial Agents

Different types of organisms (fungi, bacteria, viruses, etc.) cause different diseases, which implies that each one requires a particular antimicrobial agent to be successfully treated. Antimicrobial agents are used to preventing infections caused by pathogens and can be categorized as follows:

1. Antibacterial drugs. These drugs are meant to stop the pathogenic action of various kinds of bacteria.
2. Antiviral drugs. They are used to stop the pathogenic action of viruses.
3. Antifungal drugs. Such agents are needed to prevent the fungal action in the host.
4. Antiparasitic drugs. They are intended to hinder the growth of pathogenic parasites (Kelesidis & Falagas, 2015).

However, this is not the only possible way of classification. Antimicrobials can also be categorized by their ability to kill bacteria or inhibit their growth:

1. Bactericidal drugs kill harmful organisms (penicillins, quinolones, cephalosporins, aminoglycosides, etc.).
2. Bacteriostatic drugs delay or inhibit bacteria growth or hinder their replication (sulfonamides, tetracyclines, macrolides, etc.).
3. Some drugs can be referred to both groups since they act differently depending on the state of bacteria, duration of exposure, dosage, and other factors (aminoglycosides, metronidazole, fluoroquinolones, etc.) (Khurshid et al., 2016).

Another way to categorize antibacterials is by the spectrum of bacteria that react to them:

1. Narrow-spectrum drugs are used only against particular species of bacteria since their activity is highly limited (polymixins, nitroimidazoles, glycopeptides, aminoglycosides, etc.).
2. Intermediate-spectrum antibacterials are also limited inactivity but can affect several types of microorganisms simultaneously (ticarcillin, carbenicillin, ceftiofur, cephalosporins, etc.).
3. Broad-spectrum drugs are active both against Gram-positive and Gram-negative bacteria (fluoroquinolones, tetracyclines, 4^th-generation cephalosporins, phenols, etc.) (Kelesidis & Falagas, 2015).

Finally, antibacterials may be divided by the site of their activity:

1. inhibitors of cell wall synthesis;
2. inhibitors of cell membrane function;
3. inhibitors of protein synthesis;
4. inhibitors of nucleic acid synthesis;
5. inhibitors of other metabolic processes (Cansizoglu & Toprak, 2017).

Viral and Bacterial Infections

Table 1. Bacterial vs. Viral Infections.

Bacterial infection (caused by bacteria pathogenic in nature). They typically lead to skin infections, sore throat, pneumonia, urinary tract infections, bacterial pneumonia, and suchlike diseases. They are typically more severe than viral infections (Sweeney, Wong, & Khatri, 2016). If they are left untreated, their consequences can be deplorable for the patient.

On the contrary, viral infections are caused by viruses that typically hide in cells and attack the body when the immune system is weakened. They include common colds, viral meningitis, viral pneumonia, measles, AIDS, and other diseases (Silasi et al., 2015).

Why Proper Identification is Important

It is crucial to find out whether the disease is caused by a viral or bacterial infections since their treatments are considerably different. The situation is complicated by the fact that both types of infections may have the same symptoms. Bacterial infections are to be treated with antibiotics, which kill bacteria or hinder their reduplication. For viral infections, antiviral drugs are implemented; however, prevention is the key measure as some viral infections are incurable (such as AIDS). Antibiotics do not work for this type of infection (Talaro & Chess, 2018).

References

Cansizoglu, M. F., & Toprak, E. (2017). Fighting against evolution of antibiotic resistance by utilizing evolvable antimicrobial drugs. Current Genetics, 63(6), 973-976.

Kelesidis, T., & Falagas, M. E. (2015). Substandard/counterfeit antimicrobial drugs. Clinical Microbiology Reviews, 28(2), 443-464.

Khurshid, Z., Naseem, M., Sheikh, Z., Najeeb, S., Shahab, S., & Zafar, M. S. (2016). Oral antimicrobial peptides: Types and role in the oral cavity. Saudi Pharmaceutical Journal, 24(5), 515-524.

Silasi, M., Cardenas, I., Kwon, J. Y., Racicot, K., Aldo, P., & Mor, G. (2015). Viral infections during pregnancy. American Journal of Reproductive Immunology, 73(3), 199-213.

Sweeney, T. E., Wong, H. R., & Khatri, P. (2016). Robust classification of bacterial and viral infections via integrated host gene expression diagnostics. Science Translational Medicine, 8(346), 346ra91-346ra91.

Talaro, K. P., & Chess, B. (2018). Foundations in microbiology. New York, NY: McGraw-Hill.

An 86 year old male patient was admitted to the hospital-based on the diagnostic complaints of fall and urosepsis. He was admitted as he was suffering from post-fall due to Urinary tract infections (UTI) complications with septic stock. The associated clinical conditions observed were a multi-organ failure, and atrial fibrillation with the repetitive ventricular response (RVR) complicated with non-ST elevation myocardial infarction (NSTEMI), functional decomposition, iatrogenic bladder perforation, and anemia.

UT I occurs due to infections of various parts of the urinary tract that involves the bladder, kidneys, ureters, and urethra(Urinary tract infection, 2008). It was described that patients who had a history of a fall also develop UTI In addition (Rhoads, Clayman & Nelson, 2007). Similarly, patients with UTI are likely to develop acute coronary syndrome where nonST-elevation MI is common (Sim et al.,2005). The present 86 year old male patient had a medical history that is in agreement with the complications studied in the research evidence.

Need

To provide care to the patient, there should be awareness on investigation approaches which is lacking about the UTI case conditions relevant to this patient. I felt the need to provide some teaching-based resource assistance to the patient analogous to an expert clinical practitioner. The basis for this strategy is the problem the patient has been confronted with. In older people, urinary tract infections (UTI) are the most frequent infections that occur in long-term care settings and at the community level. The variety of UTIs ranges from symptomatic bacteriuria to bacteremic infection. In the older individuals, UTI with bacteremia has high mortality in the older population, at a rate of 5% for 28 days.

Diagnosis of UTI was very often done without considering the clinical history and signs and as result, 40% of older individuals have become hospitalized (Beveridge et al., 2012) In addition, the absence of specific evidence-based practice criteria for UTI has also contributed to the misdiagnosis of the older population with UTI. The present patient is in the hospital as he needs a remedy from UTI-associated complications that are seriously making him frail. He needs to be taught from the teaching perspective. The patient needs are more relevant to treatment and complications, improving the quality of life, medication awareness, living activities, feelings about condition, skincare, and community follow-up (Bostrom et al., 1994). His selection is the major determinant of learning outcomes.

We identified the learning needs of the patient by observing him for clinical symptoms and through questionnaires. To better accomplish this, the assistance of baccalaureate program students proved very influential. The attitude of students was judged by giving the work assignment on client selection and their interest to work with the older adults. Their positive set of mind and level of gerontological knowledge were additional key factors.

Based on Kogans Attitude Toward Old People Scale, the students were categorized into groups. Palmores Facts on Aging Quiz was used to measure the knowledge of students. A 50% of students were familiar with the elderly population (Greenhill & Baker, 1986). These students were utilized for approaching the older patients and understanding their needs. The patient was in an urge to talk to the intervening student group and reveal the problems he has been confronted with. He needs a precise diagnostic remedy such that he could return home.

As such, students were being given a chance to become acquainted and flexible in dealing with the old patients. This was done to enhance their awareness levels on the aging process and implement that knowledge within the domain of nursing, by recognizing the vital components of development utilized in the health assessment of the old patients (Ross, 1985). Hence, motivation from the student group seemed very important to better prepare the client and make him ready

Principals of Motivation and Readiness

Initially, the conditions surrounding the patient were made positive by advising the patient to withstand the negative beliefs, assumptions, and expectations eliminating the failure contributing components of the learning environment. This was made feasible by developing a congenial ad conducive atmosphere that facilitates prolonged efforts and constructive spirit towards learning. The patient was shown certain posters, booklets that serve as visual aids to draw his curiosity and attention for motivation. Occasionally, the patient was subjected to receive incentives in the form of praise and privilege from the students which was determined by the teacher. This could be because in the absence of rewards self-motivation would fail. Motivational interviewing was done to enable the patient learn novel skills of behavior.

This was mostly focused on open-ended questions, reflective listening, affirmation, and summarization in order for the patient to tell his opinion about change (Miller,2010). It was observed that through the course of time, the patient has shown readiness which made the teacher to promote its development. An expected change, at the earliest moment, in the behavior of patient was supervised to guarantee its occurrence. Very often, when the patient was not ready to learn and unreliable in assimilating the given instructions, he was supervised and the instructions were said again (General principles of motivation, n.d.).

The patient was exposed to a neatly organized instructional material by making the information appear lucid at his level. Here, specific tasks were given in relation to the already familiar ones, assessment was made of the expected outcomes and the patient was finally advised to make comparison of old and new ideas. During the readiness, the patient was not feeling well and emotionally upset with anxiety. It was understood that learning may induce variations in behavior and beliefs and leads to mild anxiety. So, the patient was regularly monitored for the identification of anxiety and its impact on the learning process.

To lessen the anxiety, the patient was not given any unclear and unrealistic goals of high level (General principles of motivation, n.d.). This has strengthened a report that described the reliability of written and verbal information on health while during patient communication on care issues and hospital discharge. Satisfied care in a standard format is the outcome expected from the combination of written and verbal health information.

In addition this approach enhances knowledge not only in patients but also in care providers. The literacy level of the patient determines the communication approach of motivation and needs thorough evaluation (Johnson, Sandford &Tyndall, 2003). In the present context, the information imparted or instructed to the patient was in agreement with his literacy level. It is essential to understand that the motivation strategies implented for the present client may coincide with the research evidence provided through studies on other age groups, very often. Hence, while implementing the principles of motivation, a balance was maintained between the

patients active participation stimulation and respecting his autonomy in the care. More probably, face-to-face coaching sessions has worked out regardless of written materials (Wetzels et al., 2007). On the whole benefit derived was more in the patient identification of needs.

Objectives

Next, the patient admitted to the hospital needs some behavioral change about improved self-care (Alywahby, 1989). So, identifying certain behavioral objectives is a new challenge. The present old patient with UTI is having falls as an important associated complication. Patients with falls are at risk of serious injuries and need some rehabilitation care. In the rehabilitation care center, the old patient was suspected to receive an improper and undiagnosed UTI, and the resulting infection was likely associated with catheter use. A questionnaire was conducted by students in a nursing format about the use of catheters and their removal.

The students were showing interest in deciding about the use of catheters and supporting the patient (Romito, Beaudoin & Stein, 2011). A measurement approach was utilized at baseline and after treatment on urinary parameters like bladder voiding efficiency (BVE), postvoid residual urine volume (PVR), and Q-max, average flow rate (Q-ave) (Hiroo et al., 2009). The screening of old UTI patients for measurable objectives was performed daily for one month.

Especially, this routine screening made the student to learn about the connection between UTI and the amount of post-void residual urine (PVR). In detail, the students measured the PVR with portable ultrasound. It was found that incidence rate correlated with the level of function. The students concluded that good amounts of PVR and decreased functional level are risk factors for prevalence and incidence of UTI in elderly patients in a rehabilitation day-hospital.

Therefore, it was concluded that routine measurement of parameters in UTI patients was important in a rehabilitation setting (Hershkovitza et al., 2002).Fall management is another objective in the UTI risk measurement. It can be overcome by training inbalance and strength related to Tai Chi and Otago Exercise Programme, supplementation of Vitamin D, review of medications to minimize the psychotropic medications, correcting vision defects and its assessment and monitoring of home hazards (Falls in older people,2011).The patient when used the drug phenazopyridine developed side effects like skin rash and unusual tiredness or weakness.

The impact of medication side effect was also considered during rehabilitation care and appropriate monitoring was also done.VI. Teaching/Learning Principals: The patient was able to learn best from the teaching strategies focused on verbal and written communications. He was regularly assessed through questionnaire and feedbacks. Students enrolled for the job are kept under constant surveillance by the teacher. The aged UTI patient may have some barriers to learning.

It was reported that problems related to vision, hearing, memory deficits occur gradually and become unavoidable in older individuals. As such, the principles of teaching are emphasized on assessing and overcoming the interference of these barriers by teaching the client to achieve objectives. This is to expect an enhanced self care and functioning in the elderly patient (Alywahby,1989). Videos that boost the patients confidence have been shown to the patient daily for one hour followed by related colorful pamphlets. Videos involve clips on the patient active participation in the UTI management program. Likewise the pamphlets involved cartoons that reflected patient participation.

Overall,the environment provided to the patient was very conducive to learning.

Teaching Plan

The teaching plan of nearly 28 days, proceeded from studying the physical appearance of patient, reviewing the personal medical record, identification of patient problems in the first week; interaction with the patient, motivational interviewing which is a style of counseling

based on client for invoking a change in behavior by making them discover and solve the uncertainties they encounter in their life (Motivational interviewing,2006), showing patient friendly organized materials for motivation, post analysis of behavior and outcome in a rehabilitation style from second week to fourth week.

Evaluation

Finally, the teaching strategy was evaluated fro several perspectives. Firstly, the identification of patients symptom was difficult. It was done through careful monitoring of behavior in relation to the developed symptoms and medication use. The patient was very anxious and emotionally upset in the initial stages of the teaching based intervention. He was appreciated and gradually monitored which made him perfectly fit for the participation. He was ready to move to a new location and hardly needs the interference of care providers. The patient was discharged and at home, the student group used to visit the patient and feedback was obtained. The patient problems have almost subsided and he was able to perform routine tasks of movement.

Differently, I could have concentrated more on the previous history of the patient.An investigation of the conditions that led to UTI might have given much more information like diabetes, hear ailments, reproductive disorders etc. Medication history could have been sought in detail like the dose regimen, any changes in the treatment plan or doctor change. Family members might have approached and questionnaires would have been conducted to find out the actual care provided to the old patient, his behavior, symptom and societal interaction. An evaluation of previous medical visits of unrelated UTI complaints could have been sought to find an association between the previous medical problems and the current UTI. Severities of UTI infection coud have been assessed by the utilization of specific biochemical or modern genetic markers. Nurse care provided to the patient in the past could have been reviewed to asses the actual medical aid he received in the past.

Handout

• Need  There need was to provide some teaching-based resource assistance to the patient analogous to an expert clinical practitioner. The rationale for the need was the UTI problem the patient has been confronting with. The patient needs are information on treatment and complications, quality of life improvement, medication awareness, living activities, feelings about condition, skincare, and community follow-up.
• Principles of Motivation/Readiness: The principles of motivation are more emphasized on looking for the readiness in patients to participate in UTI management intervention led by the teaching staff. For a better outcome, motivational interviewing was applied to enable the patient to learn novel behavior skills and express his thoughts.
• Objectives: The measurable and behavioral objectives for the patient involve looking for the baseline and after treatment analysis of parameters like postvoid residual urine volume and assessing fall severity and movement-oriented tasks by training in balance and strength related to Tai Chi and Otago Exercise Programme.
• Teaching/Learning Principles: The principles of teaching have been emphasized on enabling the patient to achieve goals to expect changes related to vision, hearing, memory deficits that might interfere in the aging old patient with the UTI and become an obstacle to learning.
• The Teaching Plan: It involves patient observation about his physical behavior and mental keenness to cope with the intervening group and review of his past medical history in the initial first week. Implementing motivational interviews and measuring objectives/ clinical parameters in the second week. Analysis of outcome and behavioral change in a rehabilitation model.
• Evaluation: This task involves the assessment of all strategies beginning from the identification of learners needs, subsiding symptoms, gain in endurance and strength which were declined due to the combined effect of UTI and fall and behavior change.

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