Category: Infection

Introduction

The following is a research proposal on the epidemiology of Hepatitis B infections in the dialysis units. The dialysis units are the sources of the Hepatitis B virus. This knowledge helps to look for ways of preventing kidney dialysis patients from hepatitis infection which will be the concern of this research proposal.

Justification

The dialysis procedures are costly to most kidney transplant patients and it is practically impossible to allocate all patients their own dialyzer, which makes reuse of dialyzer machines common (1). While it reduces the costs, it exposes the patient to the risk of contracting the virus. There is an increased hepatitis infection among patients undergoing dialysis treatment as well as nurses treating them (2). It is imperative to look for ways of containing the dialysis process such that it is safe from viral infections. The safety of dialysis procedures must be of utmost importance in the administration of dialysis to ensure that patients do not contract the virus (5).

While the vaccine method is still effective, most dialysis patients are usually ambivalent to the process and they end up contracting the virus (6). Studies do indicate that people with occult hepatitis B virus test negative when subjected to the Hepatitis B surface Antigen tests (4). When the dialysis patients have occult Hepatitis B virus it may not be detected early enough making the patient a threat. Many tests have to be done on kidney dialysis patients to establish their hepatitis status (3). Infections can be minimized by dedicating specific units for hepatitis positive patients and others for hepatitis virus-negative patients. The challenge is identifying the patients with occult hepatitis B that is currently not identified through the Hepatitis testing procedures (2).

Research objectives

The objectives of this research are to identify shortcomings of dialysis procedures that make dialysis patients susceptible to the Hepatitis B and C viruses.

• To identify ways of reducing Hepatitis B infections in the dialysis units
• To identify sterilization techniques for the dialysis machines

Methodology

The first methodology that this research will use is the case study. The researcher will work in a dialysis unit to explore the procedures that kidney dialysis patients go through. In the process, the research will also examine the safety measures applied in the units to prevent viral infections from the fluids (1). This will give the researcher first-hand information on what are the predisposing factors that lead to the contraction of the hepatitis virus in the dialysis units. In the case study methodology, different cases help in identifying patterns making it easy to draw conclusions and findings (3).

Working in two or three dialysis units in different hospitals will provide the required information. The other procedure will involve laboratory experiments on the cleanliness of the dialysis machines to establish how safe they are from contaminating hepatitiss virus. The third methodology will involve quantitative data collection on the number of kidney dialysis patients diagnosed with Hepatitis B after the dialysis tests and they had tested negative before (7).

Conclusion

The research will provide information on the number of patients infected with hepatitis B after undergoing kidney dialysis. The other outcome expected from this research is detailed information about how and why dialysis units are sources of hepatitis infections among dialysis patients. The research will address how these factors can be controlled. The other outcome expected from the research is on how the vaccination procedures assist patients from contracting the hepatitis virus (2). The research findings will outline how current dialysis procedures may decrease the current rate of hepatitis infections from dialysis procedures (6). By identifying ways of identifying occult Hepatitis B virus status this research will have achieved the purpose.

References

1. Barker F. Transmission of serum hepatitis. Journal of the American Medical Association. 2006; 276 (10): 841-844.
2. Williams R. Global challenges in liver disease. Hepatology (Baltimore, Md.). 2006; 44 (3): 521-526.
3. Coopstead C. Pathophysiology. Missouri: Saunders; 2010.
4. Zuckerman A. Hepatitis Viruses- In Baron S, et al. Barons Medical Microbiology (4th ed.). University of Texas Medical Branch. 1996.
5. Harrison T. Desk Encyclopedia of General Virology. Boston: Academic Press; 2009.
6. Howard C. The Biology of Hepadnaviruses. Journal of General Virology. 1986; 67 (7): 1215-1235.
7. Kay A, Zoulim F. (2007). Hepatitis B virus genetic variability and evolution. Virus research. 2007; 127 (2): 164-176.

Introduction

This study aims to identify the association between perioperative hypothermia and surgical site infection (SSI). I will begin by conducting some research to critically analyze evidenced-based data collected. My objective is to contribute some measures in my department in the management and prevention of perioperative hypothermia, thus reducing SSI in all surgical patients. Maintaining a core temperature is essential to prevent complications from hypothermia. WHO (2018) advised warming equipment should be utilized during surgical procedures to keep the patients body warm and reduce SSI. Hypothermia happens when the core body temperature drops below 36C and a patients susceptibility to infection increases (Wicker and Dalby, 2017). Wound infection is the most common cause of wound healing complications (NICE, 2008). SSI is an infection that occurs as a complication after surgery in the area where the surgery was performed (CDC 2019). SSI has been found to account for up to 20% of all infections in healthcare (Anderson et al., 2014, p. 605). SSI remains a serious problem linked to mortality and morbidity and putting a strain on healthcare resources (NICE 2020). Thus, effective prevention and management of perioperative hypothermia is essential to reduce SSI in surgical patients and achieve better patient outcomes.

Review of Findings

Research results on the relationship between perioperative hypothermia and SSI are contradictory. These inconsistent findings have sparked a debate about whether perioperative hypothermia is linked to an increased risk of SSI in surgical patients. In their meta-analysis, Bu et al. (2019) have concluded that there is no association between perioperative hypothermia and SSI. However, the number of randomized controlled trials (RCTs) used in this research is minimal, which makes the results of the study inconclusive. As a consequence, the RCTs pooled OR (Odd Ratio) results have minimal strength.

However, their observational studies found no link between perioperative hypothermia and the risk of SSI in the postoperative population. Melton et al. (2013) investigated the relationship between intraoperative hypothermia and SSI in 1008 patients undergoing colorectal surgery from 2008 to 2013, finding a 17.4% (n=175) incidence rate for this type of infection and no link between temperature measurements and SSI. Melton et al. (2013) investigated the relationship between intraoperative hypothermia and SSI in 1008 patients undergoing colorectal surgery from 2008 to 2013, finding a 17.4% (n=175) incidence rate for this type of infection and no link between temperature measurements and SSI. Baucom et al. (2013) found no relation between perioperative hypothermia and 30-day SSI in patients who had a ventral hernia repaired. Their recent study also looked at the connection between perioperative hypothermia and SSI in patients who had elective segmental colectomy, using reliable perioperative temperature measurement and four definitions of hypothermia.

Temperature did not predict SSI in multivariable analysis, regardless of how hypothermia was defined, and it was the least influential factor in each model evaluated. The variable predicting SSI was body mass index (BMI) (Baucom et al., 2015). Siddiqiui et al. (2020) conducted a prospective cohort analysis of adult patients who underwent elective laparotomy with a 30-day follow-up to detect SSI, however their findings failed to reveal a statistically significant link between hypothermia and SSI. The study comprised a total of 183 patients who met the eligibility requirements. In the perioperative hypothermia cohort, 90 patients (49%) had perioperative hypothermia, while in the normothermia cohort, 93 patients (51%) remained normothermic during the surgical phase. The patients were 49.77+/-14 years old on average. Females made up over two-thirds of the participants (63.9 percent). Hypothermia patients were substantially older and had a lower BMI.

In the normothermic cohort, the proportion of female patients was also much greater. With a p-value of 0.867, the rate of SSI was identical in both groups (10 percent versus 10.8 percent). Hypothermia and SSI were similarly found to have no significant relationship in multivariable regression analysis. Hypothermia is a frequent multifactorial event, and age was a critical factor for the occurrence of hypothermia (Peixoto et al, 2020). Patients who develop hypothermia were considerably older and had a lower BMI in the study of Siddiqiui et al. (2020), however increased BMI was strongly related with SSI in all four logistic regression models in the study of Baucom et al. (2015).

Despite advances in surgical methods, SSI is still one of the most common surgical complications. According to Ribeiro et al. (2020), perioperative hypothermia can increase the risk of SSI. The team did a prospective cohort research with 484 patients from a prominent private hospital. To investigate the effect of this exposure on SSI, crude and adjusted models for hypothermia indicators were created. Perioperative hypothermia was discovered to be an independent risk factor for SSI. According to the attributable fractions to the exposed, more than 40% of SSI cases could be averted if the main exposure of interest (perioperative hypothermia) could be avoided during surgical anaesthetic operations.

The prevention of SSI requires consideration of multiple contributing factors by perioperative practitioners (Korol et al., 2013). Health practitioners must take appropriate efforts to sustain patients normothermia during the perioperative phase, resulting in improved care and surgical safety. Half of all SSIs are thought to be prevented using evidence-based measures (Berrios-Torres, 2017). Future research initiatives that use a prospective design can help to strengthen the consistency of the findings in order to gain a better grasp of the SSI problem on a global scale (Rebeiro et al., 2020). Hypothermia may play a role in the development of SSI, according to Cengiz et al. (2021), depending on the degree of hypothermia, the kind and duration of operation, anaesthetic type, and patient characteristics. Severe hypothermia (below 35.0°C) can increase the risk of SSI (Cengiz et al., 2021).

Researchers discovered that patients receiving emergency post-traumatic surgical treatments had the highest prevalence of SSI in their review. SSI development may have occurred during emergent trauma laparotomies, contaminated open wounds, the patients critical state, and various factors such as blood loss or procedure time. In a systematic review and meta-analysis of SSI epidemiology, it was discovered that 52.7 percent of patients with infected wounds and 24.0 percent of patients with contaminated wounds had SSI. Patients undergoing elective segmental colectomy and gastrointestinal system surgery under general anaesthesia had a high incidence of SSI, according to the research they conducted. Studies on the impact of longer procedures on SSI development have yielded mixed results. Longer operations were reported to enhance the chance of SSI development by some researchers, whereas one study found no influence of operating duration on the formation of SSI. These variances could be related to hospital variability, surgeon and surgical team member skills, patient demographics, sample size, and surgical operation kinds.

The most important finding of the study by Seamon et al. (2012) is that intraoperative hypothermia below 35C had a substantial impact on SSI, and that a single temperature measurement below 35C during a trauma laparotomy doubled the chance of SSI. The study included 524 patients ranging in age from 18 to 88 years old who had a trauma laparotomy regardless of the aetiology of damage. A cut-point study was used to determine which intraoperative nadir temperature value is the most predictable for SSI development. SSI patients had a longer operative time and a lower mean temperature nadir (34.5C +/-1.0C versus 35C +/-1.1C). Intraoperative temperature of 35°C was shown to be the best model fit and consequently the most predictive of SSI development. According to the findings, intensive intraoperative warming will help prevent SSI and enhance outcomes after trauma laparotomy. Hypothermia during surgery lowers peripheral circulation, increasing the risk of SSI.

Hypothermia in patients was associated with a higher rate of postoperative complications when compared with normothermic patients (Akers et al., 2019). Hypothermia is associated with vascular complications; vasoconstriction is thought to alter protein metabolism resulting in a decrease in subcutaneous oxygen tension. These effects have shown an increase in surgical wound infection (Scott, 2012). The sympathetic nervous system is activated by hypothermia, which results in a rise in serum norepinephrine, which causes peripheral vasoconstriction. Vasoconstriction reduces the amount of oxygen delivered to the surgical site, resulting in lower oxygen tension and relative wound hypoxia. Hypoxia in the wound then affects the immune system. During surgical procedures, neutrophils are the primary line of defence against bacterial infection. Hypothermic patients neutrophils require oxygen, which is depleted in hypothermic individuals. Therefore, intraoperative normothermia in patients having surgical procedures should be carefully managed (Seamon et al., 2012).

The differences in these results can be attributed to the diverse study designs, the year in which the studies were conducted, and the small number of cases recruited. If the sample size is too small, it will either fail to detect major effects that are genuinely present in a population (false negative results, also known as Type 2 error) or may provide a false positive result by chance (Type 1 errors). To avoid these two inaccuracies, it is critical that the researchers calculate the sample size required (Bowers et al 2021). According to some studies, prewarming can help prevent SSI by maintaining circulation and oxygen transport at the incision while also preserving the immune response. However, research by Baucom et al. (2013) found that perioperative heat has no effect on infection growth. A total of seven RCTs were included in the study conducted by Zheng et al. (2020), and the results showed that prewarming could reduce the incidence of SSI by 40%. The thermoregulatory system is inhibited by general anaesthesia, which prevents cellular metabolism and causes the body to lose its ability to generate heat (Knaepel, 2012).

Hypothermia is caused mostly by the cool temperature maintained in most operating rooms, other causes include exposure of an open body cavity during surgery, use of cold irrigation solutions, and skin preparations. It is the most preventable complications in surgery (Wicker and Dalby, 2017). Pre-operative warming for at least 20 minutes has been advocated by Zheng et al to lower the occurrence of intraoperative hypothermia. Their meta-analysis also revealed that pre-warming 15-30 minutes ahead of time may be preferable than pre-warming 2 hours ahead of time. According to their research, warming methods have a considerable impact on the occurrence of SSI. The systematic selection and appraisal of the primary studies according to an approve protocol means that the bias is minimised. Smaller studies, which are all too common in some topic areas, may show a trend towards positive impact but lack statistical significance. However, when data from several small studies are summed mathematically in a process called meta-analysis, the combined data may produce a statistically significant finding. Systematic review can help resolve contradictory findings among different studies on the same question if the systematic review has been properly conducted, the results are likely to be robust and generalised. On the negative side, systematic review can replicate and magnify flaws in the original studies-misleading (Greenhalg 2019).

Hypothermia is caused mostly by the cool temperature maintained in most operating rooms, other causes include exposure of an open body cavity during surgery, use of cold irrigation solutions, and skin preparations. It is the most preventable complications in surgery (Wicker and Dalby, 2017; Greenhalgh, Verboon, and Patel, 2021);. But when data from several small studies are summed mathematically in a process called meta-analysis, the combined data may produce a statistically significant finding (Pigott and Polanin, 2020). Systematic review can help resolve contradictory findings among different studies on the same question if the systematic review has been properly conducted, the results are likely to be robust and generalised.

On the negative side, systematic review can replicate and magnify flaws in the original studies, making them misleading (Greenhalg, Thorne, and Malterud, 2018). Knaepel (2012) states that hypothermia is preventable if frequent temperature monitoring and early warming therapy interventions are initiated core body temperature is regulated in the conscious patient by the thermoregulatory system. OHara et al. (2018) state that hypothermia may increase susceptibility to surgical wound infection by prompting subcutaneous vasoconstriction and consequent tissue hypoxia. Hypothermia increase SSI rates by directly impairing neutrophil function. Maintenance of perioperative hypothermia is therefore vital when working to prevent SSI (Guilliamo, 2017). Therefore, hypothermia must be prevented using appropriate measures. The rest of the research is predominantly cohort studies, which based their findings on observational data from patient samples, with minor differences in types of surgery and sample sizes.

The thermoregulatory system in the conscious patient regulates core body temperature. The hypothalamus serves as a thermostat, increasing or reducing body temperature in response to changes in temperature. The thermoregulatory system is inhibited by general anaesthesia, which prevents cellular metabolism and causes the body to lose its ability to generate heat (Knaepel 2012). Hypothermia is caused mostly by the cool temperature maintained in most operating rooms, other causes include exposure of an open body cavity during surgery, use of cold irrigation solutions, and skin preparations. It is the most preventable complications in surgery (Wicker and Dalby, 2017). Pre-operative warming for at least 20 minutes has been advocated by Zheng et al. (2020) to lower the occurrence of intraoperative hypothermia. Their meta-analysis also revealed that pre-warming 15-30 minutes ahead of time may be preferable than pre-warming 2 hours ahead of time. According to their research, warming methods have a considerable impact on the occurrence of SSI.

Inadvertent hypothermia in surgical patients can be avoided. The perioperative nurses knowledge and abilities can help to avoid it from happening and having negative implications for the patients (Giulliano and Hendricks 2017). According to Melton et al. (2013) although rewarming did not reduce SSI rates, it has been linked to benefits such as lower complication rates in earlier research, including numerous rigorous trials. Therefore, the study does not rule out rewarming as a standard of treatment. Although, Bu et al. (2019) and Baucom et al. (2015) also found no link between hypothermia and SSI, they acknowledged that sustaining preoperative hypothermia is crucial for other physiologic reason and since hypothermia has been linked to other negative outcomes. However, in order to avoid waste in the healthcare system, the ideal timing of active warming in postoperative patients should be actively considered.

Conclusion

This essay has presented a comprehensive analysis of the findings from the studies regarding the implications of hypothermia and SSI. SSI constitutes a problem since it is connected significant mortality and morbidity, in addition to being the cause of extra expenses. However, some inconsistencies have been found in the results of studies. Therefore, this topic should be studied more in greater detail. However, given the importance of the consequences of SSI for people with comorbidities and those undergoing recovery from surgery, the author of this study recommends practices to prevent hypothermia such as maintaining a warmer room temperature, using extra blankets, and regular temperature monitoring. More RCTs are likely needed that might be able to prove a direct link between additional risk factor reasons for hypothermia and SSI. Practioners could adjust some hypothermia prevention procedures where they are not required and pay more attention to patients at higher risk situations to save health care costs. As the first surgical assistant, I will need to consider the specified information as essential to further advance my practice and introduce tools for reducing the threat of hypothermia as a possible factor for SSI development as well as the cause of other health issues.

Reference List

Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A. C., Saiman, L., Yokoe, D. S., Maragakis, L.L. and Kaye, K. S. (2015). Strategies to prevent surgical site infections in acute care hospitals: 2014 update, Infection Control & Hospital Epidemiology, 35(6), pp. 605-627. doi: 10.1086/676022.

Baucom, R.B., Phillips, S.E., Ehrenfeld, J.M., Muldoon, R.L., Poulose, B.K., Herline, A.J., Wise, P.E. and Geiger, T.M. (2015) Association of perioperative hypothermia during colectomy with surgical site infection, JAMA Surgery, 150(6), pp. 570-575. doi:10.1001/jamasurg.2015.77

Brown, M.J., Curry, T.B., Hyder, J.A., Berbari, E.F., Truty, M.J., Schroeder, D.R., Hanson, A.C. and Kor, D.J. (2017) Intraoperative hypothermia and surgical site infections in patients with class I/clean wounds: a case-control study, Journal of the American College of Surgeons, 224(2), pp. 160-171.

Bu, N., Zhao, E., Gao, Y., Zhao, S., Bo, W., Kong, Z., Wang, Q. and Gao, W. (2019) Association between perioperative hypothermia and surgical site infection: a meta-analysis, Medicine, 98(6), pp. 1-12. doi:10.1097/MD.0000000000014392

CDC (2019) Surgical site infections, CDC.

Cengiz, H. O., Uçar, S. and Yilmaz, M. (2021) The role of perioperative hypothermia in the development of surgical site infection: a systematic review, AORN Journal, 113(3), pp. 265-275.

Greenhalg, A D., Verboon, L. N., and Patel, H. C. (2021) The immune systems role in the consequences of mild traumatic brain injury (concussion), Frontiers in Immunology, 12, p. 313.

Greenhalgh, T., Thorne, S., and Malterud, K. (2018) Time to challenge the spurious hierarchy of systematic over narrative reviews? European Journal of Clinical Investigation, 48(6)

Hernandez-Gerez, E., Fleming, I. N. and Parson, S. H. (2019) A role for spinal cord hypoxia in neurodegeneration, Cell Death & Disease, 10(11), pp. 1-8.

Jorshery, S. D., Skrip, L., Sarac, T. and Chaar, C. I. O. (2018) Hybrid femoropopliteal procedures are associated with improved perioperative outcomes compared with bypass, Journal of Vascular Surgery, 68(5), pp. 1447-1454.

Knaepel, A. (2012) Inadvertent perioperative hypothermia: a literature review, Journal of Perioperative Practice, 22(3), pp. 86-90.

Korol, E., Johnston, K., Waser, N., Sifakis, F., Jafri, H. S., Lo, M., and Kyaw, M. H. (2013) A systematic review of risk factors associated with surgical site infections among surgical patients, PloS one, 8(12), pp. 1-10.

Melton, G.B., Vogel, J.D., Swenson, B.R., Remzi, F.H., Rothenberger, D.A. and Wick, E.C. (2013) Continuous intraoperative temperature measurement and surgical site infection risk: analysis of anesthesia information system data in 1008 colorectal procedures, Annals of Surgery, 258(4), pp. 606-613.

Mulder, R., Singh, A.B., Hamilton, A., Das, P., Outhred, T., Morris, G., Bassett, D., Baune, B.T., Berk, M., Boyce, P. and Lyndon, B. (2018) The limitations of using randomized controlled trials as a basis for developing treatment guidelines, Evidence-Based Mental Health, 21(1), pp. 4-6. doi:10.1136/eb-2017-102701

NICE (2008) Hypothermia: prevention and management in adults having surgery. NICE.

OHara, L. M., Thom, K. A., and Preas, M. A. (2018) Update to the centers for disease control and prevention and the healthcare infection control practices advisory committee guideline for the prevention of surgical site infection (2017): a summary, review, and strategies for implementation, AJIC: American Journal of Infection Control, 46(6), pp. 602-609.

Peixoto, P. S., Marcondes, D., Peixoto, C., and Oliva, S. M. (2020) Modeling future spread of infections via mobile geolocation data and population dynamics. an application to COVID-19 in Brazil, PloS One, 15(7), pp. 1-14.

Pigott, T. D. and Polanin, J. R. (2020) Methodological guidance paper: high-quality meta-analysis in a systematic review, Review of Educational Research, 90(1), pp. 24-46.

Ribeiro, J.C., Bellusse, G.C., Martins de Freitas, I.C. and Galvão, C.M. (2021) Effect of perioperative hypothermia on surgical site infection in abdominal surgery: a prospective cohort study, International Journal of Nursing Practice, 27(4), pp. 1-14.

Riley, C. and Andrzejowski, J. (2018) Inadvertent perioperative hypothermia, BJA Education, 18(8), p. 227.

Seamon, M.J., Wobb, J., Gaughan, J.P., Kulp, H., Kamel, I. and Dempsey, D.T. (2012) The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies, Annals of Surgery, 255(4), pp. 789-795. doi:10.1097/SLA.0b013e31824b7e35

Siddiqiui, T., Pal, K.I., Shaukat, F., Mubashir, H., Ali, A.A., Malik, M.J.A. and Shahzad, N. (2020) Association between perioperative hypothermia and surgical site infection after elective abdominal surgery: a prospective cohort study, Cureus, 12(10).

Torikoshi, Y., Yokota, A., Kamio, N., Sato, A., Shouji, T., Kashiwagi, T. and Hirai, H. (2018) Impact of hypothermia on differentiation and maturation of Neutrophils, Blood, 132, p. 2393.

Wicker, P., and Dalby, S. (2016). Rapid perioperative care. John Wiley & Sons.

Zabor, E.C., Kaizer, A.M. and Hobbs, B.P. (2020) Randomized controlled trials, Chest, 158(1), pp. 79-87. doi:10.1016/j.chest.2020.03.013

Zheng, X.Q., Huang, J.F., Lin, J.L., Chen, D. and Wu, A.M. (2020) Effects of preoperative warming on the occurrence of surgical site infection: a systematic review and meta- analysis, International Journal of Surgery, 77, pp. 40-47. doi.org/10.1016/j.ijsu.2020.03.016

Introduction

The issue of nurse understaffing is a major problem in many healthcare facilities in the country and around the world. This problem is detrimental as it affects the quality of care that nurses can offer, especially when they are tired due to excess workload. A correlation has been established between nurse understaffing and high incidences of hospital-acquired infections (HAI). Therefore, this study seeks to establish how the presence of strict nursing ratios or the lack thereof affects the incidences of HAI. Five articles were used for the literature review.

Comparison of Research Questions

Wise, Fry, Duffield, Roche, and Buchanan (2015) sought to estimate average staffing levels, skill mix and bed occupancy in New South Wales Emergency Departments, while West, Barron, Rafferty, Rowan, and Sanderson (2014) aimed at determining whether the size of nurses has an impact on the survival chances of critically ill patients. On the other hand, van Oostveen, Mathijssen, and Vermeulen (2015), looked to obtain an in-depth insight into the perceptions of nurses regarding current nurse staffing levels, while Ball et al. (2018) sought to examine if missed nursing care mediates the association between nurse staffing levels and mortality. On their part, Choo et al. (2015) sought to examine the effects of nurse staffing, work environment, and education on patient mortality.

Comparison of Sample Populations

Wise et al. (2015) collected data from three randomly selected census days. Out of the 44 responses, 26 were valid and thus were used as the study sample. In the study carried out by West et al. (2014), data was collected from 65 ICUs and the information obtained was for 38,168 patients. van Oostveen et al. (2015) collected data from four focus groups of 44 nurses. Additionally, 27 interviews were conducted using purposive sampling. Therefore, the sample size entailed 71 participants. In the study by Cho et al. (2015), the study sample involved 1,024 staff nurses and discharge data on 76,036 patients. Finally, Ball et al. (2018) collected data from a sample of 422,730 surgical patients and 26,516 registered nurses.

Comparison of Study Limitations

In the study by Wise et al. (2015), one of the limitations is that patient presentations in the emergency department were highly variable and thus the data collected in the three days of the study may not have been representative. The limitation of the study by West et al. (2014) is that cross-sectional data was used, and thus causal claims could not be made. The study by van Oostveen et al. (2015) was limited because data was collected from only one hospital and thus the results were not generalizable in other populations. Similarly, the study by Cho et al. (2015) used data from 14 teaching hospitals, which is not representative of the situation in different hospitals at the national level. One of the limitations of the study by Ball et al. (2018) is that it used nurses missed care as a single construct, which might have provide biased results.

Conclusion

The relationship between nursing understaffing and HAIs should be studied comprehensively to generate evidence-based data in a bid to improve patient outcomes and quality of care. Five articles were reviewed for this study. Further research is needed specifically to address the common limitations of the available studies. For instance, some studies used small sample sizes, and thus future research should focus on large sample sizes for the generalization of the results in different populations. Furthermore, one study was limited due to using a single construct. Therefore, further research should incorporate multiple constructs to avoid biased results.

References

Ball, J. E., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane D.M., Rafferty, A. M., & Griffiths, P. (2018). Post-operative mortality missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies, 78, 10-15.

Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, Y., & Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies, 52(2), 535-542.

van Oostveen, K. J., Mathijssen, E., & Vermeulen, H. (2015). Nurse staffing issues are just the tip of the iceberg: A qualitative study about nurses perceptions of nurse staffing. International Journal of Nursing Studies, 52(8), 1300-1309.

West, E., Barron, D. N., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing, and mortality in Intensive Care: An observational study. International Journal of Nursing Studies, 51(5), 781-794.

Wise, S., Fry, M., Duffield, C., Roche, M., & Buchanan, J. (2015). Ratios and nurse staffing: The vexed case of emergency departments. Australasian Emergency Nursing Journal, 18(1), 49-55.

Statistics play a major role in epidemiology. Numerous populations of interests in epidemiology require articulate analysis and interpretation using statistics. For instance, vital conclusions in epidemiology can only be made after carrying out statistical analysis on a given database of raw data. Uncertainty is accounted for by the art and science of manipulating statistics (Fendyur, 2011).

Measured observations are contained in epidemiological datasets. The latter also show the degree of exposure to infections and occurrence level of diseases. Due to limited resources that analyze trends in epidemiology in a given area, preparing a statistical sample using knowledge in statistics can be instrumental towards understanding any given dataset in epidemiology (Ziegel, 2005). For instance, the relationship between smoking and cancer outbreak can be best understood when statistical tools are applied.

Within a given population, the link between human behavioral patterns and occurrence of certain diseases can be established using random samples of raw data gathered from the field (Fendyur, 2011). Epidemiologists can easily determine whether the qualitative reference linked to a certain disease is accurate when they employ statistics in the analysis. In most instances, statistics reveal the relationship between the occurrence of diseases and human behavior even if the link is marginal.

Public health science is drawn from the key tenets of epidemiology. As a result, appropriate research methodologies can be used to gather epidemiological data from the field when statistics is embraced in the entire process. Needless to say, disease aspects such as causes, symptoms, risk factors and vulnerability may be comprehended through the application of statistics (Ziegel, 2005). Initially, epidemiology largely dealt with the public health risk of disease outbreaks. In fact, this medical field restricted itself to outbreaks due to lack of analytical tools in statistics. As it stands now, statistics has enabled broad and diversified study of diseases. The discipline no longer roots its objectives on outbreaks alone. Injuries, stroke, cancer and cardio-vascular diseases are also addressed in epidemiology courtesy of statistics.

The onset, development and spread of diseases are also some of the key areas of epidemiology that are aided by knowledge in statistics. The behavioral tendencies of a given type of sickness can be precisely predicted using statistics. A case in point is the development and progress of flu (Fendyur, 2011). Biostatistics can forecast its outbreak, symptoms and mortality rates. In other words, the specific season when a population can contract it may be vividly highlighted by statistics.

It can also be recalled that statistics has been used for several decades in developing necessary vaccines. Through research and development, statistics offers the best platform for researching the most effective measures that may be applied in curbing the spread of diseases. Biostatistics led to the successful invention of polio vaccine during the 1950s. This scientific practice has been replicated over the decades to control some of the most deadly infections in human history (Ziegel, 2005). In any case, vaccines provide the most reliable prevention measure against common infections such as those transferred through water and air.

Apart from vaccines, terminal illnesses such as cancer, hypertension and diabetes have been brought under control through biostatistics in epidemiology. New and effective drugs are continually being formulated to treat and manage terminal conditions (Fendyur, 2011). The latter would not be possible in the absence of statistical knowledge. In the event that ordinary therapies fail to work, scientists are usually left with biostatistics as the most viable option.

References

Fendyur, A. (2011). Applications of operations Research/Statistics in infection outbreak management. The International Business & Economics Research Journal, 10(2), 131-143.

Ziegel, E. R. (2005). Statistics for Epidemiology/Multivariate methods in epidemiology. Technometrics, 47(1), 107.

Approach to synthesizing the evidence

Various search terms, including human papillomavirus, HPV and cancer, papillomavirus prevention and control, papillomavirus immunization, and the incidence of HPV were used to locate suitable evidence. Further, search terms such as papillomavirus infection, prostate cancer, and education on HPV immunization were also included to enhance the search relevance. These search terms applied to various databases such as MedlinePlus and/or PubMed, PsycINFO and/or EBSCOhost, CINAHL, Google, and Google Scholar. Although several related articles were found from these databases, only few were chosen for the study. In addition, no articles were selected for the study from some databases, including Google Scholar.

Variables of Interests

In a systematic review study conducted by Das et al. (2015), the variables of interests included independent variable identified as HPV infection and immunization. On the other hand, sexual history and other risk factors were identified as dependent variables (Das, et al., 2015). These variables showed that the effect of viral factors on the outcome of care for HPV for patients with advanced cervical cancer (Das, et al., 2015).

In another systematic review study, variables of interests were identified as the outcome of the HPV treatment as independent variables while dependent variable were viral factors (Grandahl, et al., 2014). The study focused on why parents refused to allow their daughters to receive HPV vaccination from school-based vaccination programs.

The evidence of rigor shows that the data collected resulted in precise information for the analysis and, thus, the required phenomenon of interests were explored. It was also clear that data collection techniques were appropriate for the levels of details required to address all the research questions that resulted in capturing data with more discernible points. In addition, analytical techniques used were most likely to ensure the discovery of various significant and prominent themes and topics, and determine relationships among variables of HPV. At the same time, it was noted that patterns detected were not superfluous, and the results were based on evidence from the study.

Three studies were chosen to provide the body of evidence for the study on human papilloma virus infection in adolescent and young adult patients.

The quality and level of evidence presented in each study varied significantly and therefore their significance or relevance to practices and policies.

The researchers used a mixed-methods data analysis to determine that the participants had low HPV vaccine knowledge, understanding, identified severity, and perceived susceptibility while a significant percentage (74%) had not received the HPV vaccine (Fontenot, Fantasia, Charyk, & Sutherland, 2014). The researchers used a significantly huge sample, which was vital for generalization. However, they only relied on male participants and, thus, the study was not reliable. In addition, the result was inconclusive because Fontenot et al. (2014) noted disconnect between actual and perceived risks of HPV while challenges to HPV vaccination were noted and, therefore, was not relevant to change practices or policies in interventions except in addressing notable barriers.

Grandahl et al. (2014) used latent content analysis to identify that explanations for the parents choice were intricate on issues of HPV vaccination for their daughters. The analysis led to five major themes, including girls were little; insufficient information; vaccination not recognized in way of life; scepticism; and a lack of trust. It was noted that parents who made these choices were considering the best interests of their daughters. Although the study presented critical themes on HPV vaccination, its major weakness was the use of small sample size. It therefore concluded that a more flexible advance to the HPV immunization was required for girls. Policymakers and practitioners can adopt the five themes in practice to encourage vaccination of girls in Sweden.

A quantitative real time-PCR analysis was conducted to determine viral load and oncogene expression (Das, et al., 2015). Das et al. (2015) noted that both the multivariate and univariate analyses established viral physical aspects as suitable forecasters of the outcome of care after radiation treatment, and the episomal kind of virus was linked to enhanced reappearance free survival (Das, et al., 2015, p. 525). The study was based on a large sample, and it therefore had enhanced generalizability, but the presence of a few episomal forms could have hindered this. In addition, it had fundamental ideas upon which future studies could be based. The study concluded that viral physical factors might function as significant analytical aspects in cervical cancer. These findings showed that viral load, physical status and oncogene expression were important in HPV treatment and therefore important for change initiatives.

References

Das, P., Thomas, A., Kannan, S., Deodhar, K., Shrivastava, S. K., Mahantshetty, U., & Mulherkar, R. (2015). Human papillomavirus (HPV) genome status & cervical cancer outcome  A retrospective study. Indian Journal of Medical Research, 142(5), 525-532. Web.

Fontenot, H. B., Fantasia, H. C., Charyk, A., & Sutherland, M. A. (2014). Human Papillomavirus (HPV) Risk Factors, Vaccination Patterns, and Vaccine Perceptions Among a Sample of Male College Students. Journal of American College Health, 62(3), 186-192. Web.

Grandahl, M., Oscarsson, M., Stenhammar, C., Nev, T., Westerling, R., & Tyd, T. (2014). Not the right time: why parents refuse to let their daughters have the human papillomavirus vaccination. Acta Paediatrica, 103(4), 436-41. Web.

Among the various types of mechanisms intended to counter an infection, white blood cells form the first barrier to its spread after its penetration inside the body. Although white cells, also known as leukocytes, constitute only about one percent of blood contents, their functioning is vital for the immune systems (Smith, 2018). Therefore, monitoring the white blood cell count and detecting its anomalies is a critical step in identifying diseases and assessing the response to them.

In most cases, an increased number of leukocytes is a direct sign of an infection. The growing trend can be identified either for all white blood cells or a specific type. Among the elements, which demonstrate the presence of inflammation and its current stage, it is worth mentioning neutrophils. At the disease onset, their consumption rapidly increases at the infection site, driving the overall white blood cell count under the normal reference range (Honda et al., 2016, p. 49). However, it takes only a few hours for the bone marrow to respond to the initial drop and start an increased production of neutrophils. This leads to a rise in the total white blood cell count, usually detected when a person consults a physician. It needs to be noted that it is a positive indication at this stage, showing that the host is able to control the bacterial infection (Honda et al., 2016, p. 49). Later on, the production of neutrophils decreases along with their consumption, and the total quantity of leukocytes returns to a standard value.

The process mentioned above demonstrates the causes of an increased white blood count during an infection and the way it can indicate its severity. Still, it is necessary to admit that, in some cases, the production of leukocytes may be suppressed by medications or immune disorders (Smith, 2018). Besides, physical and emotional stresses can be a factor causing a rise in their quantity. Therefore, an elevated white blood cell count is a valuable indication of an infection, but it should be used carefully in combination with other diagnostic means.

References

Honda, T., Uehara, T., Matsumoto, G., Arai, S., & Sugano, M. (2016). Neutrophil left shift and white blood cell count as markers of bacterial infection. Clinica Chimica Acta, 457, 4653. Web.

Smith, L. (2018). What to know about high white blood cell count? Medical News Today. Web.

Introduction

Healthcare-associated infections (HCAI) are the main contributors to mortality and death and hospitals sickness rates. In recent years, there has been a success in the control of infections in the hospital setting. However, HCAI is one of the significant burdens facing the healthcare sector globally (Swanson, 2020). The public and the policymakers are also concerned about the ever-increasing rates of infections in medical facilities. The HCAI study used a qualitative data analysis method within an isolation section in two extensive health services in Wales in the United Kingdom. The study took 18 months, and it involved the patient safety framework and workshops with all the hospitals, including the health workers (Maria et al., 2018). Interviews with patients and their relatives or caregivers were also conducted and observations made in the isolation wards.

Discussion

The present study aimed at investigating how engaging the health workers in infection prevention care (IPC) principles and strategies would inform and shape patient safety in health facilities. The research is in the context of an admission hospital setting and isolation surgical ward (Maria et al., 2018). The study aims to understand how health workers own and employ IPC and how the IPC nursing teams do their work when challenges arise in their duties.

Study Participants

The patients were discharged four to eight weeks before the senior hospital staff identified the study. The study ensured that there was a diversity of the subjects to make the investigations reliable. Other respondents were the hospitals responsible for patient safety and IPC (Maria et al., 2018). Other participants included the ward staff that spent most of the time attending to patients in the isolation and admission units.

Data Analysis

The primary data collected involved case study analysis, interviews, discussions, and Manchester Patient Safety Framework (MaPSaF) Workshops that were transcribed and anonymously saved (Swanson, 2020). The notes that were written from observations were proofread anonymously and saved as well. The data set was obtained from MaPSaF, and the case studies were stored electronically in a shared database. The data was evaluated and analyzed using computer-aided recommended qualitative software. Different themes were created to identify and save the data in an organized and comprehensive way (Maria et al., 2018). In describing the relationship between the patients safety and IPC, the analysis was done on a ward per ward basis.

Methods and Design

The investigation involved nurses and other healthcare professionals under the IPC. The first step in data collection entailed adopting a qualitative design that incorporated the MaPSaF, which was to help in the observation of the patient safety culture in the isolation rooms. The case investigation entailed collecting secondary data through case studies, using semi-structured qualitative interviews and some periods of observation (Maria et al., 2018). These qualitative study strategies were employed to get a detailed comprehension of the experience from the viewpoint of all the stakeholders in the health sector.

To make this study valid and reliable, interviews were conducted as observations continued in the hospital rooms. The initial data analysis took place concurrently with the collection of data. The case study involved two inpatient rooms within the medical, surgical, and admission units. Therefore six wards in the two medical facilities were observed to unravel the hospital characteristics that might impact the safety culture and the IPC (Maria et al., 2018). The wards were chosen after consulting with the senior medical facility staff. Observations were conducted on the public areas of these two units without any infringement of the patients rights.

Best Practice

Nursing best practices entail giving quality care to patients to mitigate the effects of hospitalization. Service excellence contributes to the efficiency of the nursing profession, leading to good outcomes for the patients. The article under study deals with nursing best practices because it investigates how patient infections can be controlled and prevented by healthcare workers (Rout, 2020). Giving patients the best possible care so that reinfection does not occur is one of the healthcare sectors fundamental requirements. If nurses and other healthcare workers do not adopt the practices, the quality of care will be compromised. The research findings showed that effective implementation of the IPC and its innovations and implementing a safety culture in hospitals would improve healthcare services (Maria et al., 2018). Gaining knowledge and understanding of the change of culture in the hospital setting will help provide improved healthcare.

Conclusion

The research findings indeed supported the conclusions about infection prevention and care. The IPC study showed that nurses and other healthcare professionals need to gain knowledge on how to implement the IPC so that the quality of services offered to the patients can be improved. When nurses offer their best in ensuring that patients recover, it is a distinguished practice since it improves patient outcomes.

References

Maria, L., Cristiano, A., Marina, S., Valeria, F., Anna, M., Valerio, D., Giovanni, C., Anna, M., Maria, P., Gianluca, O., Elisa, S., Giuliano, L., Luigi, C., Claudio, V., Andrea, O., Daniele. R. & Giancarlo. I. (2018). Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area, Journal of Infection and Public Health, 11(2), pp. 71-177, Web.

Rout, U. B. (2020). Emerging co-infections in dengue: A hospital-based study. Journal of Medical Science and Clinical Research, 8(02), pp. 836-841. Web.

Swanson, S., Baken, L., & Bor, B. (2020). Implementation of hospital-wide electronic hand hygiene monitoring program reduces healthcare-acquired infections in a level I trauma hospital. American Journal of Infection Control, 48(8), S55. Web.

Statement of the Problem

Human papilloma virus (HPV) denotes the most widespread sexually transmitted infection (STI). It is so widespread that almost every sexually active person acquires it at some point in the course of their lives (Giuliano et al., 2015). It can be transmitted even in cases that an infected individual has no signs or symptoms. HPV occurs in many diverse kinds with some having the ability to cause health issues such as cancers and genital warts. In the majority of instances, HPV disappears on its own without causing any health issues and only affects ones healthiness if it fails to ebb out. Nonetheless, there are vaccines with the ability to prevent or curing HPV and its associated health problems. Genital warts occur as tiny or huge lumps or a group of lumps in the genital region. If not treated opportunely, HPV could result in cancers such as cervical, cancer of the vagina, anus, vulva or penis to mention a few.

Significance of the Problem

Approximately 79 million people in the US suffer human papilloma virus infection where approximately 14 million individuals get newly infected every year. All sexually active people have a likelihood of having HPV or suffering the health problems associated with it (Forman et al., 2012). The lifetime outlay for the treatment of HPV is roughly 16 billion dollars; because HPV is the most widely acquired sexually transmitted infection, it is extremely expensive to treat as the level of new infections every year is huge. Evidence-based practice (EBP) projects are required for the development of strategies to educate parents and adolescents regarding HPV and available vaccinations. In the carrying out of a research project that tackles concerns associated with sex and sexually transmitted infections, researchers ought to be ready to obtain a broad scope of views and sentiments. On this note, discourse on sex and sexually transmitted infections could be a critical subject for parents. Emotional prompts could be parents failure to decipher the best means of talking to their children regarding sex and withstanding the embarrassment of engaging in discussions concerning sex. Most of the adolescents are exposed to human papilloma virus in their first year of getting sexually active. In this regard, boosting awareness of vaccinations against human papilloma virus ought to be a public health matter that health professionals have to tackle effortlessly. Through such awareness and vaccination programs, the rate of HPV infection amid adolescents and adults will reduce as most of them will embark on effective measures to prevent and address the problem.

Relevance

This study is relevant to my career as a nurse practitioner as it has greatly enlightened me on tackling HPV infection and ensuring low chances on infectivity. Vaccinations against HPV are safe and efficient as they offer protection for both females and males against infection and the development of associated problems such as cancers. Getting screened for cervical cancer regularly for women between the ages of twenty-one and sixty-five could play a crucial role in the prevention of the disease. As a means of preventing HPV infection, all sexually active adolescents and unmarried adults ought to use a condom each time they engage in sex (Crowcroft, Hamid, Deeks, & Frank, 2012). This greatly reduces the chances of infection though HPV can infect the parts not covered by the condom thus minimizing the likelihood of complete protection. For the married couples, monogamous relationships could help in the prevention of HPV infection.

References

Crowcroft, N. S., Hamid, J. S., Deeks, S. L., & Frank, J. (2012). Human papilloma virus vaccination programs reduce health inequity in most scenarios: A simulation study. BMC public health, 12(1), 935.

Forman, D., de Martel, C., Lacey, C. J., Soerjomataram, I., Lortet-Tieulent, J., Bruni, L., & Franceschi, S. (2012). Global burden of human papillomavirus and related diseases. Vaccine, 30(1), 12-23.

Giuliano, A. R., Nyitray, A. G., Kreimer, A. R., Pierce Campbell, C. M., Goodman, M. T., Sudenga, S. L., & Franceschi, S. (2015). Differences in human papillomavirus infection natural history, transmission and human papillomavirusrelated cancer incidence by gender and anatomic site of infection. International Journal of Cancer, 136(12), 2752-2760.

Introduction

Fungi are both plant and animal pathogens that can be harmful or beneficial to both organisms. Although fungi may be very few in type and number, they cause a spectrum of many infections and diseases. These infections and diseases have been found to be very difficult to treat as compared to those caused by bacteria. The main reason behind their adamancy in treatment is based on their cellular make-up and arrangement. Fungi are eukaryotes hence very difficult to destroy their cells, unlike bacteria which are prokaryotes (Wong, 2010, p.1). This paper is a description of one of the fungal infections which are ringworm infection.

However, there are other fungal infections including; Candida, athletes foot, jock itch occurring in animals. In plants, we have tomato and potato blight, mycotoxin, aflatoxin just to mention but a few. Ringworm is, therefore, a fungal that affects the skin or scalp as well as nails of an animal. The fungus-causing ringworm is known to survive only in the external environment hence the reason why ringworms occur on the surface of the skin and other organs. We, therefore, have ringworm of the skin, scalp, nails, and groin classified according to the part of the body it affects.

Causative agents of Ringworms

Fungi in the genera of Microsporum and Trichophyton are responsible for causing ringworm infection. The fungi in these genera are classified as those that reproduce asexually in that they produce asexual spores. Reproduction is therefore by binary fusion. These causative agents of ringworm can be found living in animals like cows, poultry, dogs, etcetera hence known as zoophilic (Ryan, 2010. P.1). Fungi in this class are the Microsporum canis which are very common in pets from where they

find their way to man. The anthropophilic are those that are present in man only. The last class is the geophilic which are present in the soil, and other inorganic matter like stones.

Epidemiology of Ringworm

As mentioned above, fungi is a wide spread pathogen. Because of this, there are many reservoirs of the fungi causing ringworm. It is an infection that can be found in people of different ages (Wong, 2010, p.1). However, research has shown that this disease is common in children living in slums or the poorly hygienic environments.

Transmission of Ringworm

Once a person or an animal is infected, the chances of transmitting the infection to the others are high as long as fungus is on the lesion of the skin. The fungus that causes ringworm has the ability to be transmitted among people and animals by means of direct contact. This contact can be through sharing of personal items like towels, clothes, combs or even by direct touch. Ringworm infection is sped up in moist conditions as well as high temperatures and dirty environments. People suffering from diabetes mellitus become susceptible to the ringworm infection, thus they should be able to observe strict hygiene and avoid close contact with other people to reduce the risk. In animals, pets usually get the fungus from the soil when they are in contact with the soil or even in burrowed holes of rodents. Thereafter they infect the other animals or human beings that are close to them.

Signs and symptoms of ringworms

The major symptom of the ringworm infection is a small lesion that is found on the skin or scalp. However there are other signs and symptoms of the infection which include; itching and inflammation of the part affected and sometimes scaling especially of the skin and scalp. Further diagnosis is usually by scrapping off some lesions of the infected parts then having them examined through a microscope for confirmation of the infection. At other times the infected area may be examined under the ultraviolet light.

Prevention and Treatment of Ringworm infection

As mentioned above that the ringworm infection is very difficult to treat because of its persistence it is better to prevent the infection than the treating process. To prevent contracting the infection one should be aware of the possible ways of transmission and avoid them (Peterson, 2010, p.1). One should therefore avoid sharing of personal items and being in close contacts with infected persons or even suspected persons. When in moist environments one should avoid being barefooted and be in slippers or shoes. The other way of preventing infection of ringworm is by avoiding putting on socks in wet feet. Pets should also be handled with care to avoid contracting the infection from them. Lastly, use of antifungal soaps and antiseptics is necessary especially on young children.

Treatment of the infection is very important so as to prevent further spread of the disease. The infections may at times disappear on their own especially after observation of strict hygiene but others will only disappear after medication. Anti fungal medications in the form of drugs or application creams are mostly prescribed. During treatment, the patients are usually advised to put on loose clothing to aerate the body so as to keep the infected parts dry.

Glossary

• Jock itch- This is a fungal infection that affects parts of the groin and the thighs on the upper side.
• Microsporum- Spore forming fungus that causes the ringworm infection
• Zoophilic- These are disease or infections that are communicable between animals and human beings.
• Anthropophilic-These are infections and diseases that only occur in human beings and not transferable to other animals.
• Lesions- These are the parts of the body surface that indicate presence of infection.
• Prokaryotic- These are animal cells that do not have a membrane surrounding the nucleus.
• Eukaryotic- These are animal cell at that have a membrane surrounding their nuclei.
• Afflatoxin- It is specie of fungus that is carcinogenic and it is mostly found in grains.
• Mycotoxin-This is a toxin produced by a fungus.
• Trichophyton- This is the genus of the fungus responsible for causing ringworm.
• Geophilics- These are disease and pathogens that are found in the environment like the in the rocks, soils.
• Pathogen-This is a microorganism responsible for causing infections and diseases, for example virus, fungi, bacteria.
• Diabetes mellitus- It is a condition characterized by high levels of blood sugar in the body.

Reference List

Peterson, M. (2010). Causes of Ring Worm. 

Ryan, J. (2010). Ringworms: Why and How They Occur. 

Wong, G. (2010). Fungi as Human Pathogens. Web.

Introduction

Chlamydia is a common bacteria infection which is mainly spread through sexual contacts with infected persons. The bacterium that transmits this genital infection is known as Chlamydia trachomatis and when this bacterium is transmitted sexually, it can infect the reproductive and urinary organs. Generally, Chlamydia trachomatis is an obligate intracellular human pathogen which is one species in the genus of Chlamydia. Chlamydia is the most common STD with an estimated 50 million cases reported every year world wide and in the US alone 3 million people are infected annually. In most of these cases, the infection is found to occur in adolescents and the young adults between the ages of 15 and 24 (Ghadirian, 2009).

Most of these individuals are found to either have new sexual partners or multiple sexual partners whereby they do not use protection consistently. The people with Chlamydia trachomatis are usually diagnosed with rectum, genital tract, and eye infections. Usually, the incubation period for the Chlamydia trachomatis ranges from one week to five weeks. The symptoms of Chlamydia trachomatis do not show in most people; approximately 50% of men and 75% of women do not show any signs and symptoms of this disease (Sleet, 2001). For this reason, most infected people are not usually aware of these infections therefore they may not get medical attention. All the same, males who show signs of the disease experience itching which is accompanied by burning sensation when urinating.

Discharge from their genital organs which can be in small and or moderate amount is experienced. Females infected by Chlamydia have symptoms which include vaginal discharges and pain when urinating (Grunbaum, 2004). Advanced cases of this infection result to proctitis, urethritis, infertility, and trachoma in both sexes. In men only, cases of epididymitis and prostatitis are pronounced while in women, pelvic inflammatory disease, cervicitis, and ectopic pregnancies are some of the complications they develop.

The humanities field that reflects Chlamydia trachomatis is the music industry because the fun which comes with all the music hype results to people having unprotected sex with new and multiple partners. Across the globe, the more pronounced disease caused by Chlamydia trachoma is trachoma which affects the cornea and inner upper eyelid causing blindness if not attended to. It is estimated that 90% of people in the developing countries have the trachoma eye disease. It is a fact that control effects have been put in place but half a million people are still at risk of getting infected. World wide, 140 million people are infected with 6 million people in Africa, central Asia, middle east, Latin America and south east Asia found to be blind.

According to Morbidity, CDC. (2004), a person infected with these bacteria can spread it from the time they themselves are infected and may continue spreading it until they get proper treatment. Chlamydia trachomatis is treated using antibiotics and the most recommended antibiotic is doxycycline or azrithromycin. Alternative medication can be administered but through this period the infected person should not have sexual contact with their partners because re-infection can occur.

Epidemiological triangle

Epidemiological triangle is a model used to establish the causation of a certain disease and it mainly involves three elements namely: the agent, the host, and the environment. This model is used to put emphasis on the relationship between the three elements in both infectious and non-infectious diseases. In the case of Chlamydia trachomatis, the agent is the Chlamydia trachomatis bacterium; the host factors will include unprotected sex with infected persons, conducive environment for the bacterium to grow, weakened resistance, and lack of treatment. The environmental factors will include sexual contacts with new or multiple partners without protection, and poor hygiene and sanitation. Chlamydia trachomatis is passed through sexual contact from person to person; therefore the agent which is the bacterium will be transmitted to the host who is having unprotected intercourse with another infected person (Sleet, 2001).

The circle continues with support from the environment which surrounds the host. From this summary, it is clear that the agent causes the disease; the host is the human being who is exposed to and harbors the disease. The human being gets sick and develops symptoms like burning sensation when urinating and discharge from either the vagina or penis. The environment is the favorable conditions or surrounding where the disease is transmitted. In the center of the triangle, there is time which demonstrates the incubation period of the particular disease. In this case, the incubation period for Chlamydia trachomatis is one to five weeks.

Levels of prevention of Chlamydia trachomatis

The primary level of preventing Chlamydia trachomatis involves the infected limiting his or her number of sexual partners they have. The secondary level of prevention requires the infected to use the female or male condom to protect against possible transmission of the bacteria. The tertiary level of prevention requires the infected to seek medical care; both partners should accompany each other to the clinic to get treatment (Fortenberry, 1999).

Recent research

In 2008, the United Kingdom carried out research to determine the rates of infection regarding Chlamydia infections by region and sex. The study found that the distribution of Chlamydia trachomatis had less variation as compared to syphilis and gonorrhea. The rates of infection were found to be high in London, North West, and Yorkshire. The infected in a population of 100,000males and females in London were 272 and 271 respectively, while in Yorkshire 175 and 215 males and females were infected. In North West, 152 males and 191 females were infected; these regional variations reflected the provision of services just as disease prevalence (Fenton, 2001).

The World Health Organization is the main organization that addresses the Chlamydia trachomatis disease with the various governments in the countries of the world developing their means to do the same as well. World Health Organization helps in putting up long standing control measures against the disease (Sleet, 2001).

Nursing role of surveillance

In a group of 100,000 males and females, screening was done to establish and identify the risk factors of contracting Chlamydia trachomatis. The national surveillance system had the nurses detect the signs and symptoms of Chlamydia trachomatis in all individuals. The roles played by the nurses were determined by the health care needs of the patients in the population. The data collection systems required the nurses to enter the patients variables into the electronic medical records (EMRs). The data was then used to do the surveillance; by defining the disease, and establishing the routes of its transmission so as to provide the care required (www.nursingworld.org)

Conclusion

Chlamydia trachomatis is an infection affecting the young and sexually active individuals. The risk factors include having multiple sexual partners and the failure to use protection or rather condom. Study fro World Health Organization shows that, incidences of infection have increased in the period of the last ten years. Screening intervenes to control the infections which most of the times is asymptomatic.

Works Cited

Fenton, K. (2001). Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. The Lancet, 358 (9296), 1851-1854.

Fortenberry, D. (1999). Subsequent sexually transmitted infections among adolescent women with genital infection due to Chlamydia trachomatis, Neisseria

gonorrhoeae, or Trichomonas vaginalis. Sexually transmitted diseases, 26 (1), 26.

Ghadirian, F. (2009). Chlamydia trachomatis genital infections. The British Journal of Venereal Diseases, 55 (6), 415.

Grunbaum, J. (2004). Youth risk behavior surveillanceUnited States. MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries/CDC, 53 (2), 1.

Morbidity, CDC. (2004) Mortality Weekly Report. Quick Stats: Life Expectancy Ranking at Birth by SexSelected Countries and Territories, 1 (1), 1-5.

Sleet, D. (2001). Centers For Disease Control And Prevention (CDC). Proceedings of WHO Meeting to Develop a 5-year Strategy for Road Traffic Injury Prevention, 26 (1), 51.