Eukaryotes are living organisms that can be either unicellular or multicellular. An important feature of these organisms is the presence of a nucleus, which is separated from the cytoplasm by a double membrane. Proteins are synthesized inside the nucleus and moved to the cytoplasm. Inside the nucleolus of the cell, organisms have chromosomes representing their DNA, which are completely surrounded by proteins. At the same time, organelles are located in the cytoplasm: mitochondria, ribosomes, endoplasmic reticulum, Golgi apparatus, lysosomes.
Mitochondria perform an energy function by oxidizing organic compounds and using their energy for synthesis, etc. Ribosomes are non-membrane organelles that have a significant function in the organism. Its main function is to conduct protein biosynthesis from the amino acids that the cell finds in RNA (van Leeuwen & Rabouille, 2019). The endoplasmic reticulum produces lipids and carbohydrates important for cell structure. In addition, proteins, fats and carbohydrates, called organic substances of the cell, are stored and transported in its cavities. The Golgi apparatus is intended for further use by the cell itself of the accumulated substances or in order to leave its boundaries (van Leeuwen & Rabouille, 2019). Lysosomes perform the function of degradation of cellular components and play the role of the digestive system of the cell.
The role of the cell membrane is due to the fact that it acts as a wire for the internal integrity of the cell. It lets the necessary substances into the organism and does not allow vital matters to come out of it. Additionally, eukaryotes have a cytoskeleton that maintains their shape and keeps organelles close by (van Leeuwen & Rabouille, 2019). Centrioles, which are located near the nucleus, play a vital function in the process of cell division.
The simplest eukaryotes cause many infections and affect different parts of the human body. The most common diseases include malaria or the so-called swamp fever. The disease is transmitted from a sick person to a healthy person by the bites of female mosquitoes (Norman et al., 2020). The disease is highly resilient and current vaccines are only partially effective, with little to no immunity. The protozoa cause diseases such as amoebiasis, which are spread through dirty water and unwashed hands (Norman et al., 2020). or the most part, the disease affects the intestines and the body does not form immunity to it. The protozoa are the cause of trichomoniasis, which is transmitted sexually or from mother to fetus. It is treatable, but may increase the risk of cervical cancer and a number of other complications.
Another disease caused by protozoa is giardiasis, which is transmitted through the household, fecal-oral route and through water and causes damage to the intestines. In most cases, it is asymptomatic, and it is difficult to talk about the number of infected people (Norman et al., 2020). However, the disease is treatable, despite the fact that the methods of parasitization have not been fully studied (Norman et al., 2020). Toxoplasmosis does not pose a great danger to a healthy person, since they develop stable lifelong immunity. Nevertheless, for immunocompromised people, the disease can be fatal and affect the nervous system. The protozoa become the cause of dysentery, due to which inflammatory changes occur in the intestines. People can catch dysentery at any age through dirty hands and household items, but the disease is most dangerous for children under five years of age and debilitated elderly people.
Moreover, protozoa cause infections with parasitic worms known as helminths. One of the common species are fluke worms, which are the cause of opisthorchiasis and are transmitted through raw or insufficiently processed fish (Okwa, 2020). Additionally, tapeworms cause taeniasis, or tapeworm, which is transmitted through undercooked pork meat (Okwa, 2020). Roundworms are the causative agent of ascariasis, which parasitizes in the intestines and is transmitted through unwashed vegetables and fruits. Thus, eukaryotes are the most important cells and represent not only animals and plants, but also dangerous diseases for humans.
According to Paulo, Wolfgang, and Gilmore (1), infections caused by fungal or bacterial biofilms have become a major public health concern not only in the developing nations but also the developed countries around the world. The biofilm infections are often immune both to the host immune defenses and antibiotics, making them very dangerous. Conlon, Rowe, and Lewis (2) define bacterial biofilm as “a structured community of bacterial cells enclosed in a self-produced polymeric matrix and adherent to an inert or living surface.” These bacteria communities start by joining to form a small protective matrix on a given surface. In the beginning, these bacteria are joined by weak van der Waals forces that can easily be destroyed. They need an aqueous environment to start their community. If left uninterrupted, they start excreting a slimy substance that is glue-like which helps them to anchor on any material such as metals, soil particles, plastics, medical equipment, and animal or human tissues. These bacterial then form permanent bonds using what Fang (3) refer to as cell adhesion molecules. The molecules and proteins in nature and the cell formed are often referred to as adhesion cells.
The bacterial pioneers that form the initial biofilms create a perfect environment that facilitates entry of other pathogens. They pathogens are provided with diverse adhesion sites. The pathogens quickly form a colony, and if it happens within the body of a human being or an animal, it can cause serious disease that may not be easy to treat. A study by Shi and Ryan (4) found out that success of the bacterial or fungal biofilms within various surfaces is enhanced by a phenomenon they refer to as quorum sensing. In this paper, the researcher sees to conduct a review of the literature on the current state of knowledge of the role of bacterial biofilms in medical infections.
Review of the Literature
O’Toole, Kaplan, and Kolter (5) define biofilm is a system consisting of a bacterial aggregate and associated with extracellular bacteria polymer matrix. According to Ciofua et al. (6), the formation of biofilms is a critical step in the progression of cystic fibrosis. The bacteria find its way into the intestines and use it as a breeding ground. If detected and treated early, the host often survives because the weak van der Waals forces can be easily destroyed using antibiotics. However, the problem is that, in most of the cases, the host may not exhibit early symptoms of infection. It allows the bacteria time to form strong biofilms that allow them to colonize the intestines. At such advanced stages, it is easy for the host to succumb to the disease because of the resistance to the immune system and multiple antibiotics. As stated by Lewis (7), it may be provoked by the presence of specific persistent in biofilms that are characterized by inhibited metabolism. The increased metabolic inertia inherent with such cells results in a greater level of survival in contacts with antibiotic agents.
According to Ghannoum, Roilides, Katragkou, Petraitis, and Walsh (8), the bonds which are created in the biofilms are often strong because they are anchored to a surface they colonize with the help of glue-like slimy substance that they create. Lee et al. (9) mention that the initial attachment of bacterial cells to the surface of a substrate is mediated through the process of non-specific adhesion which, in its turn, is defined by the non-specific interactions between adhesin proteins or bacterial lectins and receptors or particular areas of membrane surface of a target cell. The mechanism of adhesion may be supported by different elements in different types of bacteria, e.g., Polysaccharide Intercellular Adhesin in staphylococci adhesion (10) and type IV pili or flagella in some gram-negative organisms (11). As stated by Craig, Pique, and Tainer (11) flagella movements promote the formation of a cellular monolayer on a substrate, and type IV pili are involved in cell aggregation through the lectin interaction. As a result of bacteria multiplication, the cells adhere to the surface more firmly, differentiate, and exchange genes. This process increases their antibiotic resistance.
The figure below shows a bacterial biofilm that has developed in a catheter.
Figure 1: Bacterial biofilm in a catheter [Electron micrograph of a fully developed crystalline biofilm around eyehole of silver coated latex catheter after 14 days caused by MRSA strain 1024×696]. Source: Zapotoczna, O’Neill, O’Gara, (12).
Organisms Common and Uncommon Causes of Biofilm‐Related Infections
According to Rybtke, Hultqvist, Givskov, and Nielsen (13), in order to effective deal with this problem, it is important to start by understanding causes of biofilm-related infections. There are a number of organisms believed to be common causes of biofilm-related infection.
Staphylococcus aureus biofilm is one of the main biofilm-related bacterial infections which are responsible for some diseases. The growth of Staphylococcus aureus biofilm is closely controlled by very complex generic factors (14). If this occurs within the intestines, the community can develop into a biofilm within a very short time. The bacterium is very dangerous within the body and can cause death within a very short time (15). One of the unique characteristics of biofilm is their ability to coordinate and systematically leave the body of one host to find a new host to colonize. This characteristic makes it very dangerous in environments where sanitation is very poor.
Neisseria gonorrhoeae, an organism that causes gonorrhea is also a common cause of biofilm-related infection. Palese (16) note that the bacteria finds its way into a surface within the reproductive system. If detected in a timely manner, the bacteria can easily be destroyed without having a devastating impact on the host. However, if left untreated, it can cause serious damage to the reproductive system. The organism can easily move from a host to a new host when there is an exchange of body fluids. Some people can even acquire the disease when using washrooms that had been previously used by an infected person but poorly maintained (17). Escherichia coli, commonly known as E. coli, Clostridium difficile, Campylobacter, and Shigella are other common organisms that cause biofilm-related infections (18). Diarrhea is often caused by these bacteria in an environment where hygiene is poor. Dysentery, another common disease in the developing countries, is also associated with biofilm-related organisms such as Campylobacter and Shigella.
Pseudomonas aeruginosa is a major causative agent in the development of opportunistic infections. It causes about 10% of all nosocomial infections (19). The major feature of Pseudomonas infections is their chronic nature; in cases when the infection reaches a certain level of development in patients with reduced immune defenses, lifelong antibiotic therapy is recommended because the complete elimination of the causative agent in such cases is not possible. Researchers reveal that Pseudomonas is associated with intracellular parasitism, i.e., the process in which the cells of the host organism used as a reservoir for bacteria (19). In Ps. aeruginosa this type of infestation is usually observed in epithelial cells during the urogenital tract infection, typically, near the entrance gate of infection where the concentration of the pathogen is particularly large.
Possible Sources of Infection and Clinical Outcomes in Different Patient Groups
In a hospital setting, there is a great number of possible sources of infections that nurses and other clinical staff must understand and come up with ways of dealing with effectively. The operations and surgical equipment and surfaces are often a good environment for the formation of fungal and bacterial biofilms. It is a requirement that after these equipment and surfaces are used, there must be a standard way of cleaning them to ensure that they are safe for future use. However, Wu, Moser, Wang, Høiby, and Song (20) note that sometimes those trusted with this responsibility fail to follow the set standards when cleaning and sterilizing such environment. Poor level of hygiene in the surgical environment may expose a patient to bacterial and fungal infections. The outcome of surgical-related biofilm infection may vary from one patient to another depending on one’s immune system and the magnitude of the infection. When the internal organs are infected, the impact can be dire, and it may force the patient to undergo a similar procedure to correct the mistake (21). In other cases, the patient may be subjected to serious medication to deal with the infection.
Wounds such as surgical cuts, burns, ulcers, and accident wounds provide a perfect ground for bacterial and fungal biofilm infections. The aqueous environment in surgical cuts and wounds is a characteristic that is perfect for the development of the biofilms. Hengzhuanga et al. (22) state that the important feature of such infections is that the developed biofilm can bear any physical conditions: it is highly resistant to drying, and it is actively evolve in the moist environments (e.g., in the closed bandages). Moreover, in the conditions of the closed bandages, the risks for the reproduction of the anaerobic infection agents. When such wounds get infected, it becomes almost impossible for them to heal, which means that they may turn chronic. Especially enduring chronic biofilm-related infections may be observed in patients with the reduced immune status.
Due to the capacity of the biofilms to survive in different types of environments, they can persist in the hospital environment even if it is thoroughly and regularly serialized. Thus, there is a high risk for the occurrence of hospital-acquired infections especially in long-stay patients. Although anti-microbial medicines are the common methods of treatment in such situations, the excessive use of antibiotics can only increase bacterial persistence (14). It happens because of the presence of the dormant cells in biofilms. These non-active cells may activate mechanisms of the adaptive mutagenesis such as the multidrug resistance. Under these conditions, antibiotics may destroy the majority of independent planctonic cells of pathogen in the macroorganism, as well as most of the sesnsitive microorganisms in a biofilm. The innate immune system then gets rid of the residuals of the planctonic cells. However, persister cells localized in biofilms are unavailable for the immune system and, as soon as the antibiotic treatment is ceased, those cells commence reproduction again and provoke the repeated outbreak of an infectious process (14). Biofilms are formed on almost all types of invasive medical devices: catheters, prostheses, etc. Therefore, the issues of bacterial persistence is of great significance in the modern medicine.
What is known of the structure of biofilms
Biofilm structure is formed in a consistent manner, starting with two or more bacteria or fungi being joined through the weak van der Waals forces. The bacteria or fungi will need an aqueous environment that can enable them to float in a free manner and be easily reproduced. The organisms start by reproducing on a given surface. They then start excreting, forming a protective cover over the bacterial community. For instance, in E. coli biofilm matrix, curli fibers develop to help in creating a strong bond between one bacterium and another. The early structure then attaches itself to a given surface. In the case of E. coli, their preferred surface is often the intestine where they reproduce very fast. The weak van der Waals forces are then replaced by very strong molecular forces that create permanent attachment among the cells and with the surface colonized. The bacteria spread to other parts of the cells from the point of infection as they continue to increase in number. The figure below shows the known structure of biofilm.
Figure 2: Structure of biofilm [Structure of Escherichia coli biofilm matrix after an interrupted prolonged incubation 1280×516]. Source: Vidlak, Kielian (23).
As shown in the above structure, the bacteria or fungi within a biofilm are more concentrated in the inner part of the biofilm, making it difficult for the immune system and the medication administered to destroy them. The cellulose cover, shown in the figure above, also protects the bacteria found in the inner region of the cells. The flagella help in the movement of the pathogens from one part of the cells to the other or even to the external environment. It is believed that curli fibers, the amyloid proteins that help bacteria to attach to surfaces, play a critical role in enabling communication among the pathogens. Curli fibers are involved in bacteria’s adhesion to surfaces, aggregation, and development of biofilm. As stated by Barnhart and Chapman (24), they also “mediate host cell adhesion and invasion, and they are potent inducers of the host inflammatory response” (p. 131).
The figure above also shows different stages of cell division of the pathogens as they progressively increase in numbers and spread to various parts of the body. When the pathogens on the outer age are destroyed, because they lack protection offered by the cellulose, they are often replaced quickly through the rapid reproduction of other cells in the inner region. The mechanism of reproduction used by the pathogen, and the cellulose protection formed when the biofilm develops, makes it difficult to treat some of these bacterial and fungal diseases. According to Núñez and Hancock (25), nowadays, the majority of anti-biofilm peptides used in medical practice are composed of L-amino acids which are ineffective in the treatment of biofilm-related infections as they are easily recognized by bacteria or host proteases. It results in the reduced biological activity of peptides. However, the researchers (25) suggest designing and using D-enantiomeric peptides because their activity is likely not to be inhibited and, in this way, they may be more potent in treatment those diseases.
Known Factors That Are Used By Bacteria to Attach To Surfaces to Establish Biofilms
In the analysis of biofilm conducted above, it is clear the pattern taken by bacteria to form the van der Waals forces that enable them to stick together. However, to survive as a colony, these bacteria or fungi must be strongly attached to a surface. As explained above, the surface may be metallic, plastic, wooden, body cells or soil particles. The best environment for the attachment of the molecules is aqueous in nature.
The figure below shows biofilm’s life cycle:
Figure 3: Biofilm lifecycle [Bacteria switching from planktonic state to sessile state which makes it possible for them to function as communities instead of individuals 750×373]. Source: Buhmann, Stiefel, Weber, Ren (26).
The figure demonstrates that it is easy to destroy the biofilm at the initial stages. However, when it is fully developed, it creates a defense mechanism that cannot be easily destroyed by the immune system.
Overall, the process of biofilm formation can be divided into three stages. The first one is the reversible attachment to the surface. As O’Toole, Kaplan and Kolter (5) state, frequently microorganisms exist as free-swimming masses or sporadic (e.g., planktonic) colonies. But normally, the majority of organisms tend to attach to surfaces and, as a result, form biofilm. At the next stage which can be called as the permanent attachment, bacteria adhere to surface more strongly. Moreover, at this stage differentiation and gene exchange – the processes that ensure bacterial survival, – occur. Finally, bacteria form the protective mucilaginous matrix. As soon as the adhesive process is completed, bacteria start to develop the extracellular polymeric substance or EPS-matrix comprised of proteins, glycoproteins, and glycolipids and which determines “the immediate conditions of life of biofilm cells living in this microenvironment by affecting porosity, density, water content, charge, sorption properties, hydrophobicity, and mechanical stability” (27, p. 7945). Then, the small bacterial colonies start to form the initial biofilm.
The formed matrix cannot be easily destroyed by the immune system or use of antibiotics. However, these pathogens have the capacity to detach themselves from a given surface when they want to move to a new environment.
The figure below shows bacteria attached to the intestinal surface to establish biofilm:
Figure 4: Bacteria biofilm attached to intestinal surface [Biofilm attached to the inner walls of the intestines, creating a layer around mucus of the colon walls 400×272]. Source: Katragkou, Roilides, Walsh (28).
How biofilm formation permits micro‐organisms to evade the immune system
According to Swidsinski, Loening, and Swidsinski (29), treating bacterial and fungal biofilms is not easy, especially when it has reached advanced stages of development because of the layer that it develops to protect it against antibodies. As more of this substance is produce, a layer of the polysaccharide is developed that covers the microorganisms within the colony as shown in figure 2. It acts as a barrier to the immune system. Phagocytes (i.e., neutrophils, macrophages, etc.), the key effectors of the innate immune system in the protection against bacterial infection, detect microorganisms as pathogens that need immediate elimination (30). However, the extracellular matrix of biofilms (regardless of the taxonomic affiliation or forms of microbes) contains structures weakening the phagocytic reactions. The polysaccharide intercellular adhesion (PIA) decreases the activation of phagocytes by inhibiting the phagocytic clearance of biofilm bacteria. Moreover, it can increase the resistance of bacteria to human antibiotic peptides (30).
PIA can be so strong that even antibiotic medication cannot destroy it. According to Uppua et al. (31) who had analyzed the properties of biofilm in A. baumannii, the biofilms may contain some resting and uncultivable forms of bacteria. Their presence in the bacterial aggregate protected from the external influences is important to the protection of the species and survival of microorganisms in the changing and extreme environments. The cells in different physiological condition may trigger the mechanism of adaptive mutagenesis that can be complemented by the interchange of metabolic products and horizontal transfer of genetic information. These processes activate microevolutionary mechanisms including the realization of antibiotic resistance (7). The empirical evidence obtained by the researchers (31) makes it clear that to solve the topical issue of bacterial persistence, and especially in those types of microorganisms which can survive on the artificial surfaces for a long time, it is possible to use polymer substances. It is observed that polymers may be highly toxic to bacteria while being less toxic to mammal cells. Polymers’ efficacy is defined by their capacity to influence the chemical structure of bacteria: depolarize membrane, and deplete energy. In this way, polymers can be recommended for the treatment of clinical device surfaces.
Effects of Treatment with Anti‐Microbial
When it is established that one is suffering from a biofilm infection such as Staphylococcus aureus biofilm, an antimicrobial is often administered. Those suffering from bacterial infection are given antibacterial while those suffering from fungal infection are given antifungal medication. At early stages of the development of the biofilm, the anti-microbial medicines may be effective in destroying the weak van der Waal forces, which would result in complete destruction of the pathogens if the patient follows the prescription as a state by the physician. However, if pathogens are surrounded by a well-developed EPS-matrix, the microbial may have no effect on the patient (32). Such medication may only inhibit further development of the biofilm, but may not destroy it. The majority of modern antibiotic medicines target the secretory and regulatory systems of biofilms, i.e., T3SS and QS processes (33). For instance, such macrolide antibiotic as azithromycin can block QS system of Ps. auruginosa, acting as an inhibitor of LasI- RhlI-synthase (34). Macrolides have a therapeutic effect in multiple chronic lung Ps. aeruginosa-related infections (34). One of their active mechanisms is the blockade of formation of bacterial QS-mediators
Nevertheless, Cole and Lee (35) note that frequent use of antibiotics also affects the immune system. It reduces the capacity of the antimicrobial to fight bacteria and fungi within the body in an effective way. It explains why medical experts highly recommend the use of antibiotics only when it is unavoidable. It is necessary to help in reducing cases where bacteria become resistant to the microbial. When the body gets used to regular doses of antimicrobials, this form of medication becomes infective to the body..
Current Treatment Approaches
Biofilm infections such as Staphylococcus aureus biofilm are known to be resistant to come of the common antibiotics that have been in use for the past several years. It has become necessary to find alternative ways of managing this infection. Medical researchers have been conducting studies to come up with ways of destroying well-established biofilms within the body. At first, medical experts tried the use of high dosages of antibiotics to try and kill the bacterial infections. However, it was established that such medications only weaken biofilm but do not destroy it. As such, doctors have tried to come up with surgical methods as the only way of destroying the infections. Lebeaux et al. (36) say that, through research, antimicrobial therapies are being developed to help in the treatment of biofilm infections, Staphylococcus aureus biofilm, instead of using surgical processes. According to Tafina et al. (14), “in conjunction with surgical intervention such as debridement, incision and drainage, indwelling medical device removal, antimicrobial therapy is often prolonged and often takes place in the outpatient setting” (p. 454) Some doctors prefer biofilm infections through a surgical process often referred to as myringotomy, but anti-biofilm peptides are also becoming common form of medication. It involves placing tubes in the eardrum to drain the infectious fluid. The use of the surgical process is becoming popular because of the strong attachment that the biofilm develops with the body surface and the strong protective cover that makes it impossible for antimicrobial to penetrate. It is clear that that the use of small dosage of antimicrobial is still effective in destroying biofilms at early stages of development.
Status of New Treatments or Prevention Strategies That Are in Development
New studies have been conducted to find better ways of treating biofilms or prevent biofilm infections. The best way of dealing with biofilm infection is through prevention (37). Maintaining a high level of hygiene is the only way of eliminating possible cases of infection. It has been confirmed that biofilms thrive in the unhygienic environment. Maintaining high levels of hygiene makes it difficult for the microbial to move from one host to the other. It is highly recommended that one should be very careful about anything being ingested. Food must be cleaned and if possible properly heated to destroy the pathogens before being ingested. It is apparent that medical experts still have a conflicting opinion about the use of an antimicrobial in the treatment of biofilm infection. Given that it always forms a strong adhesive force that strongly attaches it to the surface, one of the ways destroying biofilm is to surgically cut it out (38). The process destroys the outer protective cover, making it possible to successfully use antimicrobial to complete the treatment. The use of anti-biofilm peptides is also becoming popular as an option for treating biofilm infections..
Conclusion
Biofilm infection has been a major problem in the global society for many years. When scientists discovered this colony of pathogens, measures were put in place to find ways of eradicating it. Antimicrobial was discovered as a medication for the bacterial and fungal infection. However, this medication is only effective when the pathogens have not developed a biofilm. The use of surgical procedures that physically destroys the cells and protective cover before administering antimicrobial has long been considered the only way of treating biofilm infections. However, anti-biofilm peptides are also becoming a popular form of treating biofilm infections. It is a new therapeutic approach to managing biofilm infections. If fully developed, the use of anti-biofilm peptides may make a significant milestone towards finding cost-effective ways of managing biofilm infections.
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The sinuses are tiny bags of air positioned at the back of a person’s forehead, eyes, cheekbones, and nose. Sinus infections are relatively harmless if detected and treated in time. This paper is a patient education material on sinus infections, their symptoms and treatment as well as the risk posed by not treating sinus infections in time.
Forms of Sinus Infections
Acute sinusitis is the form of sinus infection caused by a virus and lasts approximately one or two weeks (Brook, 2007). A sub-acute sinusitis is caused by bacteria or seasonal allergies and can persist for around three months. Chronic sinusitis persists for over three months and is often caused by incessant allergies or problems with the structure of the nose.
Symptoms of Sinusitis
The indications of a sinus infection look like the symptoms of common colds (Thaler & Kennedy, 2009). These signs include nasal discharge, headache, fever, persistent cough, congestion of the nasal cavity, fatigue, foul breath, and facial pain. Frontal sinusitis produces pain in the forehead can result in osteomyelitis if left untreated. The pain in the cheekbone and upper teeth is due to maximal sinusitis.
Treatment for Sinus Infections
The headache and pain on the forehead and upper teeth can be remedied by taking pain relieving drugs such as ibuprofen. If the symptoms persist for more than one week, a healthcare provider can prescribe antibiotics since the infection probably is bacterial. A patient with facial pain probably has bacterial sinusitis and should take antibiotics as prescribed by the doctor. The patient must finish the dosage to prevent re-infection and is advised to visit the doctor for an extra check-up.
The Danger of Untreated Sinusitis
If undiagnosed or untreated for a protracted period, sinusitis can cause other serious problems such as abscesses (puss) in the nasal cavity and meningitis (Josephson, 2006). It can also result in orbital cellulitis, an illness of the aural that causes intense discomfort in the ear and can lead to swelling of the brain. This condition can also damage one’s auditory ability.
Conclusion
The symptoms of sinusitis are often confused with the common cold and may not be diagnosed easily. If left untreated, sinusitis can lead to life-threatening complications, some of which may require surgery.
References
Brook, I. (2007). Acute and chronic bacterial sinusitis. Infect Dis Clin North Am, 21(2):427-448.
Josephson, J. (2006). Sinus relief now: The groundbreaking 5-step program for sinus, allergy, and asthma sufferers. USA: Penguin.
Thaler, E., & Kennedy, D. (2009). Rhinosinusitis: A guide for diagnosis and management. New York: Springer.
This article is a case study of a 20-year-old female patient who presented herself with an abnormal vaginal discharge with a foul smell. The patient reported having multiple sex partners and a sexually active lifestyle since the age of 14 years. The disease was established to be chlamydia. Chlamydia is a type of sexually transmitted infection (STI) caused by a bacterium referred to as Chlamydia trachomatis (Schuiling & Likis, 2013). It is, sometimes, referred to as a silent infection because infected people rarely realize that they are infected. It is mainly transmitted through unprotected sex with an infected person, whether oral, anal, or vaginal (Tharpe, Farley, & Jordan, 2013).
Signs and Symptoms
Consistent with STI
The patient reported abnormal vaginal discharge that was characterized by a foul smell. The patient also reported an irritating sensation during urination, vaginal bleeding following sexual intercourse, regular bleeding in between menstrual periods, and the presence of a swelling in the vagina.
Inconsistent with STI
The patient reported experiencing pains in the abdomen, mild fevers, and an urge for frequent urination.
Patient Notification
The patient was first notified of the fact that chlamydia is a common STI infection that can be cured. She was also informed that the asymptomatic nature of the disease may make it impossible for her to notice an infected person, thereby making the infections more common. As I made the patient aware of the condition, I was also quick to let her know that the case was treatable and that I had designed a plan that would encourage her to recover fully from the disease and protect her from further infections.
The response of the patient revealed lots of disappointment and a lack of satisfaction. It was obvious she did not expect an STI infection. However, the information that the condition was fully manageable restored the hope of the patient.
Impact on the Patient’s Lifestyle
Short-term Impacts
Short-term impacts on the patient include financial strains as the patient struggles to meet the financial needs of the treatment program. Other effects include reduced and poor sexual lifestyle, societal rejection, and abuse owing to the nature of the infection and associated characteristics, poor health and associated pain, reduced self-esteem, and self-denial and suicidal thoughts.
Long-term Impacts
Long-term impacts are mainly the health risks associated with chlamydia. The woman may become infertile. If she gets pregnant, then there is a high possibility of developing recurrent ectopic pregnancies (U.S. Department of Health and Human Services, 2012). There is also a possibility of the mother transmitting the disease to the unborn baby. Finally, there is a lifetime increased risk of developing cervical cancer, as well as HIV co-infection (Chlamydia fact sheet, 2011).
Treatment
Chlamydia, being a bacterial infection, is easily and routinely treated with antibiotics. Azithromycin, Erythromycin, Levofloxacin, Ofloxacin, and Doxycycline are the commonly used antibiotics in the management of the disease (Centers for Disease Control and Prevention, 2015). Whichever the drug one uses, there is a need for complete adherence to the treatment as prescribed to ensure a full recovery. It is important to ensure one is not involved in sexual activity during the treatment period (Centers for Disease Control and Prevention, 2012). One gram of Azithromycin was administered orally in a single dose to this particular patient. Since exposure to the disease would result in a re-infection, a follow-up involving regularly scheduled hospital visits was made to confirm adherence and conformity to lifestyle modifications that were recommended. The recommendations included the use of protection during sexual intercourse and testing the sexual partners.
Conclusion
Chlamydia is one of the common STIs. It is mostly undetected, until the later stages of the disease because it rarely develops identifiable signs and symptoms. Chlamydia is easily treatable following its accurate diagnosis. However, care should be taken when notifying the patient about the outcome due to the detrimental nature of STI infections. Follow-up should be performed to ensure a full recovery and avoidance of re-infection cases.
References
Centers for Disease Control and Prevention. (2012). Women’s health. Web.
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery &Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
U.S. Department of Health and Human Services. (2012). Office of Research on Women’s Health (ORWH). Web.
Usual causes of acute community-acquired pneumonia are S. pneumonia, H. influenza, M. catarrhalis, S. aureus, and Klebsiella pneumonia. The Gram-stained smear for S. pneumonia indicates Gram–positive and lancet-shaped pairs of cocci. For H. influenza, the Gram-stained smear shows Gram–negative small rod-shaped and pleomorphic coccobacilli. M. catarrhalis is characterized by the presence of Gram–negative diplococci (Mahon, Lehman, and Manuselis 388-402). For S. aureus, the smear shows Gram–positive cocci that are often presented in clusters like the grape. The test for Klebsiella pneumonia indicates the presence of Gram-negative encapsulated and rod-shaped bacilli that can be observed as single bacilli or pairs and chains of bacilli (Parija 262).
Complications of Staphylococcal Pneumonia
The complications of Staphylococcal pneumonia can include empyema, the active formation of abscesses, and pleural effusions caused by toxins with the following spread of S. aureus not only in lungs but also in the whole organism (Schaechter 149). The invasion of S. aureus and the formation of colonies in the body are the results of the work of such toxin as Panton-Valentine Leukocidin (PVL). The pathogenesis depends on the colonization of S. aureus caused by the PVL factor (Eisele and Anderson 7).
Pneumococcal Pneumonia
Pneumococcal Surface Protein A (PspA) is the first virulence factor to mention as important to influence S. pneumonia virulence. PspA works to protect pneumococci. The electronegative components of PspA add to the anticomplementary quality of this factor concerning S. pneumonia (Jedrzejas 189). Hyaluronate lyase (Hyl) is the second factor that contributes to the invasion and spread of S. pneumonia by affecting the hyaluronan (Jedrzejas 192). The final factor to mention is Neuraminidase that is effective to influence glycosylation and provoke the active colonization of S. pneumonia.
Development of Bacterial Pneumonia
Bacterial pneumonia develops as a reaction to the invasion of pathogens that disrupt the epithelium with the help of toxins. They can survive during a long period because of intracellular life cycles, and their invasion is possible because of certain virulence factors. In the epithelium, pathogens can replicate and cause the further destruction of epithelial cells. Thus, Francisella tularensis can resist β-defensins, and this aspect promotes its invasion in the epithelium. Staphylococcus aureus is characterized as the antibiotic-resistant strain. In its turn, Yersinia pestis can invade because of changing the LPS structure to adapt to the host (Eisele and Anderson 5-9).
CF Patients
It is hypothesized that possible reasons for the decline in pulmonary function of Cystic Fibrosis (CF) patients can be Pseudomonas aeruginosa and Burkholderia cepacia complex (BCC) organisms. In this case, the reference to Pseudomonas aeruginosa is frequent in the evidence-based literature and studies (Hauser et al. 30). Another frequently mentioned cause is S. aureus. The researchers also mentioned M. abscessus as the possible cause of the discussed problems. (Hauser et al. 35-38)
Infections in CF Patients
The hypermutable phenotype related to H. influenza is significant in terms of guaranteeing the long-term persistence of hypermutable strains. As a result, in CF patients, H. influenza can develop more actively (Hauser et al. 35). The significance of the hypermutable phenotype concerning P. aeruginosa is in the increased adaptation of pathogens, and it can also cause increased resistance to antibiotics (Hauser et al. 45).
Susceptibility to S. Aureus
Mice deficient in Myd88 can be more susceptible to S. aureus because the deficiency in Myd88 is associated with the deficiency in TLR2 that is responsible for recognizing the bacteria. As a result, receptors cannot determine pathogens, and MyD88 serves as an important molecule necessary for this process (Eisele and Anderson 6). The lack of Myd88 indicates the possibly higher susceptibility to S. aureus in people.
Works Cited
Eisele, Nicholas, and Deborah Anderson. “Host Defense and the Airway Epithelium: Frontline Responses That Protect against Bacterial Invasion and Pneumonia.” Journal of Pathogens 2011.1(2011): 1-16. Print.
Hauser, Alan, Manu Jain, Maskit Bar-Meir, and Susanna McColley. “Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis.” Clinical Microbiology Reviews 24.1 (2011): 29-70. Print.
Jedrzejas, Mark. “Pneumococcal Virulence Factors: Structure and Function.” Microbiology and Molecular Biology Reviews 65.2 (2001): 187-207. Print.
Mahon, Connie, Donald Lehman, and George Manuselis. Textbook of Diagnostic Microbiology. New York: Elsevier Health Sciences, 2014. Print.
Parija, Subhash Chandra. Textbook of Microbiology and Immunology. New York: Elsevier Health Sciences, 2014. Print.
Schaechter, Moselio. Schaechter’s Mechanisms of Microbial Disease. New York: Lippincott Williams & Wilkins, 2012. Print.
Central-line associated bloodstream infections rank among the most common causes of death of the U.S. patients, according to the statistical data provided by the Centers for Disease Control and Prevention (2016). By definition, a central-line, also known as a central catheter, is a tube that is inserted into a vein. Traditionally, the areas of the neck, chest, arm, or groin are used as the locations of the catheter (Marshall et al., 2014). Therefore, a central-line associated bloodstream infection occurs in case a germ (e.g., a bacterium) enters the central line and then the bloodstream of the patient (Boyce et al., 2013).
In light of the severity of the issue and the drastic consequences that it may have on the patient’s wellbeing, the problem must be prevented successfully by a nurse. Although designing the tools that will help address the issue successfully is crucial to managing the problem, preventing central-line associated bloodstream infections is a nonetheless essential step toward facilitating a safer nursing environment. At this point, the importance of the role of a nurse educator needs to be brought up.
Providing mentoring and guidance, as well as serving as a role model for students to follow, a nurse educator must instruct the target audience about the means of addressing the issue of nosocomial infections in a manner as efficiently as possible. As stressed above, it is crucial that the strategies for both the prevention of the problem and the management of the issue could be determined. By focusing on the patient surveillance strategies, promoting the safety culture, and providing the necessary education and training for the staff members about a proper way of inserting the catheters and managing the patients’ needs, a nurse educator is likely to reduce the threat of nosocomial infections.
Since nosocomial infections, in general, and CLABSIs, in particular, are at the top of the list of the mortality factors affecting the U.S. population (Centers for Disease Control and Prevention, 2016), a nurse educator must have the skills that will allow training the ability to work with closed medication systems. Indeed, studies show that the lack of the relevant skills observed among nurses working with the target audience is the primary reason for CLABSIs to occur (Krein, Kuhn, Ratz, & Chopra, 2015).
Thus, the promotion of the proper management of closer medication systems is imperative to address the problem. The use of closed systems is crucial to the prevention of CLABSIs from developing in patients as the identified approach isolates the target audience from any outside factors. As a result, the possibility of bacteria to affect the inpatients is bound to drop significantly, reducing nearly to zero. Furthermore, the use of the closed system is supposed to reduce the costs of delivering the required services. Consequently, a nurse becomes capable of allocating the available resources more reasonably so that the process of recovery could be enhanced.
Speaking of which, the issue of resources management must be listed among the crucial competencies of a nurse addressing the CLABSI-related problems. As stressed above, there is an urge to reduce the expenses related to the CLABSI installation and further management. Therefore, among the competencies of a nurse educator, the ability to deploy the core principles of sustainability needs to be mentioned. It is crucial to make sure that the people addressing the CLABSI issue should be able to make efficient use of the resources at their disposal.
Furthermore, a nurse educator must have an excellent understanding of the current educational theories so that the essential information could be delivered to the students and the practitioners successfully. For instance, the importance of promoting a patient-centered approach that will allow for designing unique strategies for addressing the CLABSI-related issues must be conveyed to the nurses operating in the identified environment. About the focus on the patient, the need to establish a proper nurse-patient communication framework must be mentioned among the key priorities. Thus, a nurse educator must have the communication-related competencies that will allow improving the process of data retrieval, analysis, and its further usage as the foundation for shaping the nursing strategy. It is the responsibility of a nurse educator to make sure that the medical services should be evaluated at the patient’s level; otherwise, the premises for quality improvement cannot be created.
Finally, a nurse educator must shed some light on the issue of information visualization. As stressed above, a nursing expert must appropriately manage the available information, facilitating the patient’s safety, addressing the CLABSI issue in a timely and efficient manner, and gathering the relevant data regularly. The visualization of the data retrieved in the course of observations, in its turn, is also an important step toward determining a problem and designing the methods of addressing it successfully. Thus, the ability to use the tools that help visualize the central line can be considered an essential competency of a nurse educator (Rajwan et al., 2013).
Among the key characteristics of the nurse educator who is going to shed some light on the issue of central-line associated bloodstream infections, the ability to instruct the participants about working with the necessary tools should be listed. For instance, the capability of the educator nurse to train the participants to carry out regular observations and file the reports documenting the essential changes is an important feature. In other words, the skill of maintaining a proper time management strategy is an important trait of an educator nurse when it comes to teaching how to handle central-line associated bloodstream infections and related issues.
Furthermore, the nurse educator must have a high level of emotional intelligence (EI) and teach the practitioners how to develop and use related abilities. In other words, a nurse educator must be able to detect possible issues based on the patient’s emotions and expressions. Since customers are prone to facing difficulties in defining and describing their experiences, a nurse must be able to retrieve a significant portion of the relevant information from the emotions displayed by the patients. As a result, a nurse educator should teach the practitioners to read the patient’s emotions successfully to incorporate the retrieved information into the array of data used to diagnose the problem, locate the appropriate treatment strategy, and administer the treatment to the patient successfully (Rankin, 2013).
Resourcefulness is another crucial characteristic of a nurse educator when it comes to addressing the issue of central-line associated bloodstream infections. Although it is necessary to provide the nurses with the information about the standard set of rules for managing the problem, nurses must also be aware of the fact that each case is individual and that one must design a unique strategy for every scenario that they face in the hospital setting. As a result, the chances for addressing the problem in a timely and efficient manner increase.
Furthermore, a nurse educator must explain that one is likely to operate in the environment involving a shortage of resources. Hence, the associated difficulties will have to be detailed to the nurses so that they could handle the possible scenarios. For example, a nurse must bear in mind that, in the environment of developing countries, tools such as insertion bundles are likely to come in restricted numbers:
Some researchers have suggested that use of the insertion bundles, which has been shown to result in reduced CLABSI rates in developed countries, would likely not be sufficient in countries with limited resources, where the use of outdated technology (such as the ongoing use of open rather than closed intravenous infusion systems) is not uncommon and sufficient skilled staffing is lacking. (The Joint Commission, 2012, p. 32)
Finally, the ability to engage in the lifelong learning process and acquire new information should be viewed as an essential characteristic of a nurse educator. Furthermore, the latter must be able to teach the nurses working with patients with nosocomial infections to participate in the lifelong learning process as well. As stressed above, although there are specific rules that the nurses addressing the central-line associated bloodstream infections must know, in most cases, one must develop a unique strategy based on the specifics of the given scenario. Therefore, the ability to acquire new skills and apply them successfully to prevent the infection from spreading is a crucial component of the nursing quality that one must have to provide the services of the required quality.
Although there is an evident need in educating nurses about the means of managing nosocomial infections, in general, and central-line associated bloodstream infections, in particular, the current focus must be placed on the prevention of the issue. Particularly, a nurse educator must shed light on the aspects such as the means of providing the patients with the necessary instructions, as well as supervising the target audience so that the central line should not be damaged. Thus, the threat of infection can be prevented successfully.
Apart from shedding light on the means of building awareness among patients, a nurse educator must also mention the strategies that nurses must use when addressing the problem, though. For instance, the opportunities to retrieve the information about the infection promptly need to be brought up among the crucial steps to take. Therefore, it is the job of a nurse educator to provide nurses with detailed instructions on information management and the acquisition of the relevant competencies.
Seeing that the lack of leadership support is among the key impediments to treating patients successfully, an especial emphasis must be placed on providing nurses and students with the guidance that will allow them to develop confidence and independence required to provide patients with the necessary services and spot the associated problems at the earliest stages of their development. As soon as the target audience learns to apply the required skills to solve practical tasks, a rapid drop in the number of central-line associated bloodstream infections occurrences is expected. Thus, the focus on competencies acquisition and the promotion of a patient-centered approach needs to be kept when addressing the educational needs of nurses.
References
Boyce, J. M., Nadeau, J., Dumigan, D., Miller. D., Dubowsky, C., Reilly, L., & Hannon, C. V. (2013). Obtaining blood cultures by venipuncture versus from central lines: impact on blood culture contamination rates and the potential effect on central line–associated bloodstream infection reporting. Infection Control and Hospital Epidemiology, 34(10), 1042-1047.
The Joint Commission. (2012). Preventing central line–associated bloodstream infections: A global challenge, a global perspective. Oak Brook Terrace, IL: Joint Commission Resources.
Krein, S. L., Kuhn, L., Ratz, D., & Chopra, V. (2015). Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: A survey-based study. Journal of Patient Safety, 39(9), E576-580. Web.
Marshall, J., Mermel, L. A., Fakih, M., Hadaway, L., Kallen, A., O’Grady, N. P., … & Yokoe, D. S. (2014). Strategies to prevent central line–associated bloodstream infections in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology, 35(7), 753-771. Web.
Rajwan, Y. G., Barclay, P. W., Lee, T., Sun, I. F., Passaretti, C., & Lehmann, H. (2013). Visualizing central line-associated blood stream infection (CLABSI) outcome data for decision making by health care consumers and practitioners – An evaluation study. Online Journal of Public Health Informatics, 5(2), 218-235. Web.
Rankin, B. (2013). Emotional intelligence: enhancing values-based practice and compassionate care in nursing. Journal of Advanced Nursing, 69(12), 2717-2725. Web.
Urinary tract infection (UTI) is among the most prevalent infections in senior citizens. The condition is common in long-term care facilities, and it has been noted that UTI is only second to respiratory infections in inpatients and community-dwelling seniors aged above 65 years old (Rowe & Juthani-Mehta, 2013). As many Americans age, the burden associated with the UTI in senior citizens is most likely to escalate, resulting in the need for enhanced diagnostic, management, and prevention practices important to advance the health of older persons. The purpose of this term is to discuss Lower Urinary Tract Infection, which is the infection that occurs at or below the area of the bladder.
Clinical Scenario
A 65-year-old community-dwelling man presents with inflammatory symptoms in the lower urinary tract, such as fever, urinary frequency, urinary agency, dysuria, variable suprapubic discomfort, nocturia ((nighttime frequency), and notably gross hematuria. He complains of low back pain for the last five days while fever has been noted for the last two days.
Over the past two days, the patient has worsened with the symptoms of pain noted as 9/10 and nausea. A culture test has shown the presence of extended-spectrum beta-lactamase Escherichia coli, and the patient had a similar condition more than six months ago noted with a similar organism separated. The patient also responded to nitrofurantoin treatment.
Subjective
Chief Complaint
The patient chief complaints were dysuria. He also complained of urinary frequency, urgency, discomfort, and fever.
History of Present Illness
The patient had complained of a five-month urinary urgency. The condition was characterized by frequent waking per night to void, weak stream and straining. The patient appeared otherwise ill and uncomfortable. While back pain and fever were not specific, they suggested the presence of pyelonephritis. Notably, atypical symptoms were observed in the patient.
The initial assessment of the patient revealed dysuria, at least three nighttime frequencies, urinary urgency, and urinary inconsistence. The further assessment also indicated suprapubic discomfort, mild dehydration, febrile, bladder spasm, incomplete bladder emptying post void, a trace of blood in the urine (hematuria), and foul-smelling urine.
Review of Systems
HEENT
The patient lacked any deformity or swelling in the skull, and the neck was without any deformity. The patient had normal eye dilation and the ear and nose were normal. He, however, presented dry oral mucosa.
Pulmonary
The patient’s lungs were clear to auscultation.
Heart
The patient had a fast resting heart rate of more than 100 per minute, which was noted as abnormal.
Gastrointestinal
The gastrointestinal system was normal in the patient.
Genitourinary
Possible structural and functional abnormalities of the GU system, including obstruction, flank pain, suprapubic pain, genital irritation, low back pain, and tenderness were observed in the patient.
Neurologic
The patient reported confusion and drowsiness.
Past medical history
The patient was previously treated for UTI and hypertension. Recurrent UTI was suspected for the patient.
Immunizations
The patient underwent the required immunizations.
Past Surgical History
There was no case of past surgical history observed or stated.
Allergies
The patient reported no known drug allergies (NKDA).
Medications
The patient is currently on lisinopril 10 mg daily.
Family Medical History
The family has a history of hypertension and diabetes.
Social History
The patient is sexually active and reported having more than one partner in the last six months.
Objective
Lab data
The laboratory workups, including dipstick test and urinalysis, revealed white blood cell count of 10,000, 90% neutrophils while hematocrit, platelets, and electrolytes were within the normal range. The patient had a bun of 24 and a creatinine of 1.0. Further, urinalysis revealed ++LE (leukocyte esterase), TNTC WBCs with clumps and multiple bacteria confirmed as E. coli.
Physical Examination
Vital signs were reported as T 38.9, BP 95/55, HR 115: RR27: and sat 93%RA.
Head
The patient generally had no asymmetrical or deformities in the head.
Eyes
The dilation of the eyes was generally normal.
Ear, Nose, Mouth, and Throat
The examination revealed dry oral mucosa.
Neck
A normal neck was observed in the patient.
Lungs
The lung examination revealed that the patient had normal lungs, which was reported as clear to auscultation and the breath sounds were equal bilaterally (Lungs CTA, BS = B).
Heart
Cases of tachycardic, RR, no m/r/g were reported following cardiovascular examination.
Abdomen
Abdominal pain was noted as burning, constant, localized, and severe. Flank, suprapubic, genital, low back pain was noted. Moderate suprapubic tenderness was also observed in the patient. Additionally, CVA tenderness was also noted.
Genitalia
External genital examination showed meatal stenosis in the patient. Further, the rectal analysis revealed tenderness to show possible acute prostatitis. The penile discharge was not observed during the assessment. Given the sexual history and activity of the patient, further STI screening was recommended. Testicles appeared enlarged.
Extremities
No cyanosis/clubbing/or edema (no c/c/e) was observed in the patient.
Neuromuscular
There was no case of neuromuscular dysfunction observed in the patient.
Assessment / Diagnosis
The patient was diagnosed with lower urinary tract infection based on the presenting features, including urinary urgency, frequency, dysuria, flank, and suprapubic pain, and foul-smelling urine. Additionally, fever, nausea, low back pain, and rigors were also observed and used to confirm the presence of lower urinary tract infection in the patient.
Differential diagnostic
The differential diagnosis for prostatitis, epididymitis, and chlamydial infection was conducted, as well as urothelial carcinoma, pelvic inflammatory disease, STIs, and bladder calculi.
Plan
Acute lower UTI in the male patient was considered as complicated. Antimicrobial treatment for the patient was chosen based on the clinical presentation, known as infecting organisms and susceptibilities. The side effect profile of the antibiotic and renal function influences was also considered.
The patient education focused on the disease, treatment processes, and expected course of the disease. The patient was also advised to visit the clinic if fever increases or symptoms did not improve within two to three days. It was noted that adherence to the use of medication in terms of dose, frequency, side effects and successful completion of the treatment course was extremely important. Enhanced fluid intake to about ten glasses each day was necessary. The patient was also advised to practice voiding after intercourse.
A monitoring and follow-up plan was based on the failure of symptoms to resolve within two to three days irrespective of the treatment. Also, the advanced age of the patient was used to classify him for further consultation with a physician or nurse practitioner.
Order new labs
While the laboratory workups conducted revealed that the disease was positively identified, the notable complicating factors, including fever, flank pain, nausea, and CVA tenderness required further consultation. Hence, further laboratory analysis was necessary to evaluate upper urinary tract infection because of high fever beyond 380C.
Treatment
As previously noted, lower urinary tract infection in men is considered complicated and, thus, goals of treatment included the relief of current symptoms, eradication of infection, and prevention of recurrence and complications.
The medication preferred included cefixime 400 mg po daily 7 – 14 days; Amoxicillin-clavulanate 875 mg po BID for 7-14 days; or trimethoprim 160 mg/sulphamethoxazole 800 mg, 1 tab po bid for 7-14 days.
Non-pharmacological interventions for the patient included rest because of febrile and enhanced intake of fluids.
SOAP Analysis
Subjective Analysis
The lower urinary tract infection is now common in the community and hospitals (Jarvis, Chan, & Gottlieb, 2014), and it is observed that the condition affects about 50% to 90% of men aged 50 years or older (Hale, Choi, & Lohri, 2014). The condition has also been attributed to several cases of bacterial infection in older men (Schaeffer & Nicolle, 2016). Notably, older men who present to the emergency departments or their primary care physicians often complain of urinary urgency, urinary frequency, slowed stream, and nocturia, which are symptoms generally related to benign prostatic hyperplasia (BPH) (Elterman & Kaplan, 2014).
Objective Analysis
An objective analysis of the lower urinary tract infection starts with a physical examination that focuses on vital signs. Also, the suprapubic area of the patient was examined to eliminate possible bladder distention while the neuromuscular examination was conducted to identify possible neuromuscular dysfunction. A digital rectal examination was done to evaluate “anal sphincter tone in addition to prostate gland size, shape, and consistency” (Hale et al., 2014, p. 566). Urinalysis was done for hematuria, proteinuria, pyuria, or other potential abnormalities in the patient. Further, urinary sediment assessment and culture and sensitivity analysis were conducted to identify lower urinary tract infections.
The physician used all abnormalities observed in the patient’s past medical history, physical examination, and laboratory workups to make a treatment decision based on the diagnosis. The referral was vital because of past infection and other complicating conditions, such as fever, nausea, tenderness, and meatal stenosis.
Once all these objective examinations were conducted, it was apparent that the patient had an acute case of lower urinary tract infection from the E. coli – (80-90% of cases) (Elterman & Kaplan, 2014).
Assessment Analysis
The assessment for older men with lower urinary tract infections usually starts with a thorough medical history and physical examinations concentrated on the genitourinary system (Hale et al., 2014), and the findings are later supported with objective assessments.
It was observed that cystitis (bladder infection) is generally common in community-dwelling men. It is presented with irritative symptoms in the lower urinary tract (Schaeffer & Nicolle, 2016). Physicians or nurse practitioners usually focus on dysuria, urinary urgency, urinary frequency, nocturia, gross hematuria, and suprapubic discomfort (Schaeffer & Nicolle, 2016).
Acute bacterial prostatitis is known to reveal itself in the form of fever alongside other signs of lower urinary tract infection. Hence, culture and sensitivity analysis of a urine specimen was necessary for the identification and subsequent management of the lower urinary tract infection. The presence of a large number of bacteria indicated lower urinary tract infection. It also observed that pyuria is not specific to any infection, and it is common among older patients (Schaeffer & Nicolle, 2016). Hence, further analyses of urine specimens were necessary.
It was also noted that the patient was a suitable candidate for upper urinary tract assessment because of his high fever (Schaeffer & Nicolle, 2016). Immediate assessment using computed tomography (CT) or renal ultrasonography was vital to ensure that possible obstruction or some abnormalities were not present.
Given the past treatment of the condition and advanced age of the patient, it was observed that possible bacterial persistence could occur thin the urinary tract and, thus, different medication for complicated lower urinary tract infection was preferred.
Plan Analysis
The antimicrobial treatment for the patient was chosen based on the clinical presentation, identified infecting bacteria and susceptibilities, possible side effects of the medication, and renal activities (Schaeffer & Nicolle, 2016). Treatment agents with relatively high rates of urinary excretion were preferred (Wang, Liao, & Kuo, 2015).
For lower urinary tract infection, the first-line pharmacology intervention involves nitrofurantoin, but cefixime, amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, ciprofloxacin or levofloxacin was preferred to be administered between 7-14 days. Nitrofurantoin was not selected because of its restricted tissue penetration and possible diminished impacts on bacterial prostatitis (Schaeffer & Nicolle, 2016).
The presence of complicating conditions, such as meatal fever, nausea, tenderness, and meatal stenosis, necessitated referral and further consultation.
Patient education included strict adherence to medication, voiding after intercourse, and seeking further medical attention if no improvement was observed within two to three days during medication. Additionally, non-pharmacological interventions for the patient included adequate rest and increased fluid consumption.
Conclusion
Lower urinary tract infection is now common in older people. The patient in the case study was diagnosed with the condition from E. coli that presented itself as an acute case of the lower urinary tract infection. While multiple cases of lower urinary tract infections could be easy to detect and manage, the increasing cases among senior people and resistant bacteria present considerable challenges to physicians and nurse practitioners. Hence, careful assessment with specialists is vital to ensure that effective antimicrobial agents are administered.
References
Elterman, D. S., & Kaplan, S. A. (2014). Lower Urinary Tract Symptoms in a 66-Year-Old Man. Canadian Medical Association Journal, 186(7), 525–527. DOI: 10.1503/cmaj.130449.
Hale, N., Choi, K., & Lohri, J. (2014). Primary Care Evaluation and Treatment of Men With Lower Urinary Tract Symptoms. Journal of the American Osteopathic Association, 114(7), 566-571. DOI: 10.7556/jaoa.2014.110.
Jarvis, T. R., Chan, L., & Gottlieb, T. (2014). Assessment and Management of Lower Urinary Tract Infection in Adults. Australian Prescriber, 37(1), 7-9. DOI: 10.18773/austprescr.2014.002.
Rowe, T. A., & Juthani-Mehta, M. (2013). Urinary Tract Infection in Older Adults. Aging Health, 9(5), 519-528. DOI: 10.2217/ahe.13.38.
Schaeffer, A. J., & Nicolle, L. E. (2016). Urinary Tract Infections in Older Men. New England Journal of Medicine, 374(6), 562-571. DOI: 10.1056/NEJMcp1503950.
Scope and Purpose of the Clinical Practice Guideline
Being one of the most common bacterial infections, the urinary tract infection (UTI) affects a large number of people, causing further health complications and leading to an overall drop in the quality of life among the patients (Prakash & Saxena, 2013).
A recent study on the subject matter addressing the specifics of catering to the needs of women with an uncomplicated UTI, the paper by Hooton (2012) sheds light on the nursing strategies that must be considered when facing the problem in question. Although the scope of the paper is quite small, addressing the issue of a thirty-year-old female patient, the purpose thereof can be deemed as rather broad. Specifically, the paper is aimed at determining the tools for managing recurrent episodes of UTI, as well as designing the framework that will help tend to the needs of patients with UTI in the most successful manner possible.
Furthermore, the author narrows the study down to analyzing the complications related to the recurrent instances UTI, especially recidivism, which is the case in point. Apart from elaborating on the concerns regarding the application of the necessary strategies to managing the needs of patients with UTI, Hooters also touches upon the issue of pyelonephritis; however, the author does not differentiate between the two diagnoses, providing the same combination of nursing strategies to manage the problem. Instead, he offers a general method of treatment, including the use of nitrofurantoin monohydrate macrocrystals (the firs-line therapy stage) and Fluoroquinolones (ciprofloxacin) (the second-line therapy stage) (Hooton, 2012).
Stakeholder Involvement
The stakeholder engagement level of the paper can be viewed as moderate. The paper was designed to promote awareness about the possible treatment methods primarily among nurses, which means that they are likely to be among the key stakeholders. Describing the means of managing the disease, the authors of the article contribute to the stakeholder engagement considerably, since the paper offers an extensive analysis of the available treatment methods.
As stressed above, the paper is aimed primarily at managing the issue of the UTI recidivism in women aged 30. Therefore, the identified population can be considered the key stakeholders. It could be argued that also mentioned the issue of disease prevention, the paper could address the needs of a slightly younger population, providing them with the required precaution strategies for preventing UTI development.
Similarly, slightly older women could consider themselves as the possible target audience since the article helps locate the means of managing UTI at its later stages. However, these are women in their 30s that the article targets primarily at: “Acute uncomplicated pyelonephritis is much less common than cystitis (estimated ratio, 1 case of pyelonephritis to 28 cases of cystitis),7 with a peak annual incidence of 25 cases per 10,000 women 15 to 34 years of age” (Hooton, 2012, p. 1028).
Rigor of Development
The concept of methodological rigor is often viewed as one of the building blocks of nursing guidelines. Although a range of articles claims to provide detailed guidelines for the treatment of a particular disease or address a specific problem, they often lack what is referred to as the methodological rigor (O’Brien, Harris, Beckman, Reed, & Cook, 2014). As a result, the instructions provided by the authors of such papers remain suggestions. Unless the element of rigor is incorporated into the article, it cannot warrant the title of a nursing guideline.
The rigor of the development of the instruction is at a quite appropriate level. Although the authors of the article do not detail the methodological approach that they adopt to study the problem, they provide a scrupulous account of the outcomes of the research. For instance, the study details the clinical efficacy of each medicine suggested for addressing the issue.
Furthermore, the authors of the study outline the crucial aspects of raising awareness among patients. Indeed, the target audience must be able to detect the symptoms of the disease and receive the necessary nursing services before the problem grows more significant. By managing the issue at the earliest stages, one is likely to prevent the instances of recidivism, thus, increasing the quality of life among the target members of the population. Therefore, the rates of the rigor of development can be considered moderately high.
Recommendations
It would be wrong to deny the study certain flaws, however. Even though it provides a detailed overview of the effects that certain tools can have on treating UTI and the related issue, it lacks a comparison with other techniques. The fact that the article adopts an EBP approach by considering the actual case and addressing the needs of a specific patient can be deemed as an obvious advantage also must be brought up. Nevertheless, since the study considers the case of only one patient, the outcomes of the analysis may turn out to be far too specific to view them as implications for the design of a more general approach.
To handle the issues mentioned above, one could suggest a follow-up study that will embrace a wider range of patients and, therefore, make its scope somewhat larger. Moreover, it is recommendable that the researcher should consider the patients of a different age range. For instance, the study could include women aged 20–50; in the identified scenario, it would be a good idea to separate the participants into several groups based on their age, the severity of the problem, the nursing strategy applied to address the issue, etc.
It is expected that the follow-up study should consider the issues related directly to different nursing strategies that can be used to improve the quality of care. Furthermore, the problems regarding organizational behavior and the factors that inhibit the nurses’ positive performance will have to be incorporated into the analysis. Thus, a more detailed overview of the existing alternatives will be delivered.
Application
Much to the author’s credit, one must admit that the framework suggested in the study has a lot of potentials as far as its application in the nursing setting is concerned. Particularly, the outcomes of the study indicate that the patient must be instructed carefully on the issue of detecting the disease symptoms, as well as using the services of the nursing facilities.
Indeed, according to the author, identifying the problem at the earliest stages of its development is vital to the success of the further treatment process. For example, Hooton declares that the early identification of the problem will ultimately lead to a less convoluted process of treatment and, therefore, a faster recovery: “Given the accuracy of a diagnosis that is based on the patient’s symptoms, in selected women with symptoms of cystitis, the infection can be successfully managed without in-person assessment” (Hooton, 2012, p. 1031).
Arguably, the current framework could use some improvements. For example, the author could have made better use of the application of the EBP approach. Although the current study includes a detailed analysis of a UTI case, a more detailed and generally all-embracive study involving a group of participants and an experiment could be considered.
Therefore, at present, the application of the strategy designed by the author of the study should be viewed as an addition to the currently existing approach. Thus, the framework can be tested successfully, and the opportunities that it provides can be used to enhance the effect of the therapy and promote better information management among nurses and patients alike. Particularly, the latter should be offered the tools for accessing the relevant instructions and pieces of advice so that they could detect the problem at the earliest stage and manage it in an appropriate manner (Gupta et al., 2011).
It should be borne in mind, though, that the application will require substantial costs. For instance, it will be necessary to design a new therapy approach that will help address the needs of the target audience more efficiently. Furthermore, the schedule of the nurses involved in the therapy will have to be rearranged to avoid the instances of workplace burnouts. Finally, the resources for increasing the availability of the relevant information to the target audience will have to be considered as a part of the expenses list (Chaurasia, Shrivastava, Shrivastava, Dubey, & Songra, 2015).
Editorial Independence
The article in question touches briefly upon the conflicting interests of healthcare staff members and the patients. For example, Hooton (2012) never brings up the fact about the workplace burnouts rates among healthcare employees, in general, and nurses, in particular. Therefore, the information supplied by the author can be considered as rather one-sided, being primarily the guide to managing the issue of UTI in female patients.
In light of the characteristics described above, the article cannot be considered independent in the editorial context. By considering the needs of other stakeholders, such as nurses, healthcare facilities, the patients’ family members, etc., Hooten (2012) would have made a very powerful statement and redesigned the existing guidelines significantly. However, as is, the article has a rather low editorial independence rate.
Nevertheless, claiming the article to be useless would be inappropriate. It provides a detailed overview of the effects that the suggested treatment provides. More importantly, it outlines the unique needs of the patients, therefore, setting premises for a follow-up study. Finally, it can be described as an EBP study, which means that its results can be used to model an efficient strategy (Kelly, Kutney-Lee, Lake, & Aiken, 2013).
Summary
Hooten (2012) focuses on the means of treating UTI by using traditional treatment tools. Calculating the amount of medicine that the patient will have to consume regularly to recover and outlining the stages of the therapy that the woman will have to undergo, it can be viewed as the framework for designing a unique EBP approach that will help manage the UTI-related issues. Furthermore, the author implicitly views the issue of a patient-centered approach as the essential area that further studies should be focused on. Providing extensive guidelines, the article can be viewed as a rather efficient guide.
Reference List
Chaurasia, D., Shrivastava, R. K., Shrivastava, S. K., Dubey, D., & Songra, M. C. (2015). Bacterial pathogens and their antimicrobial susceptibility pattern isolated from urinary tract infection in a tertiary care centre. International Journal of Pharmacy & Bio-Sciences, 1(1), 1-4.
Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B. I., Colgan, R.,… &. Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Practice Guidelines, 53(1), 103-120. DOI:10.1093/cid/ciq257
Hooton, T. M. (2012). Uncomplicated urinary tract infection. The New England Journal of Medicine, 366(11), 1028–1037.
Kelly, D., Kutney-Lee, A., Lake, E. T., & Aiken, L. H. (2013). The critical care work environment and nurse-reported health care-associated infections. American Journal of Critical Care, 22(6), 482-488. DOI:10.4037/ajcc2013298
Prakash, D., & Saxena, R. S. (2013). Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut City, India. Microbiology, 2013(749629), 1-13. DOI:10.1155/2013/749629
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1-7. DOI:10.1097/ACM.0000000000000388
Addressing risks in the environment of a hospital or a similar facility is an indispensable element of healthcare. Until all the factors that jeopardize patient well-being are identified, quality of service will remain low, and the rates of recovery are likely to drop. One might argue that predicting all scenarios in which the patient may be affected negatively is impossible. A case in point – the instance of a patient contracting a nosocomial infection after surgery – should be viewed as a graphic representation of inadequate delivery of services. The case in question points to the need to focus on compliance with the established regulations as far as the process of surgery is concerned.
Scenario Description
George M. is a 57-year-old Caucasian man who suffers from a multiple myeloma condition. In order to administer the necessary treatment to the patient, the use of a central line, i.e., a central venous catheter, as the means of managing the patient’s condition was suggested. The patient was undergoing chemotherapy in a local facility. A central line was implanted to administer the necessary medications (Cyclophosphamide (Cytoxan)) to the patient. A Broviac catheter was embedded in the course of the surgery. However, because of the lack of proper sanitation in the environment of the operation room, as well as the negligence of staff members, the damage of a blood vessel must have occurred. As a result, the patient contracted a CLABSI, which manifested itself in mild fever during the first several hours after the surgery. After the fever had been followed by swelling and an increase in the patient’s heart rate, George M. was diagnosed with a CLABSI. To be more accurate, the patient contracted Staphylococcus aureus as a result of the surgeon’s and the healthcare assistants’ negligence.
How the Event Was Detected: In Retrospect
The problem was identified shortly after the catheter was implanted due to the unceasing fever and the associated symptoms (i.e., fast heart rate, swelling, etc.). To be more accurate, the incident was detected as the changes in the patient’s heart rate, and the temperature was identified with the help of the hospital equipment (Krein et al. 2015). The incident report can be considered as an essential tool that led to locating the problem and developing a set of measures for addressing it. Particularly, the possibility of the patient developing a CLABSI was suggested after reviewing the information from the report.
Although the identified tool cannot be viewed as the most trustworthy device for acquiring essential information, it does shed light on incidents that do not seem to align with expected patient outcomes (Anderson et al. 2013). Furthermore, the use of the report allows staff to identify the exact point at which the problem started, as well as identifying the factors that may have contributed to the development of the problem. As a case in point, the scenario described above shows that the patient started developing mild fever shortly after the surgery. As it is the case that surgical interventions may cause minor inflammations, the specified phenomenon was not given proper attention, which clearly was a mistake.
One might argue that the lack of concern for the inflammatory response could be justified by the fact that such a reaction typically follows surgery in a range of instances (Visser et al. 2015). However, studies show that the identified scenario requires an immediate analysis of the factors that may have contributed to the inflammation and the ensuing identification of the treatment steps (Loubon et al. 2015). The lack of concern for the information represented in the report, therefore, points directly to the fact that the management of CLABSI and the related issues should start with the redesign of the ethical and quality standards in the environment of the identified healthcare facility.
It should be noted that the lack of emotional intelligence among healthcare experts inhibited the identification of the problem to a considerable extent. Although the patient could not talk, the changes in his facial expression pointed directly to a problem. Therefore, when considering possible risk management strategies, one should consider increasing the staff’s competencies first.
Disclosure
Much to the credit of the members of the facility, the process of disclosure was carried out in a timely and honest manner. The information about the CLABSI issue and the possible means of addressing it was provided to the patient in accordance with the existing standards. The apology, while being rather short and unemotional, was also delivered to the patient. It is suggested, though, that the process of disclosing the essential data to the patient should be followed by more active support. Although the crucial information was explained to the patient, the options for the further treatment of the CLABSI issue were not outlined fully.
Another problem, which the approach used by the healthcare members incorporated, concerned addressing the issue caused by their negligence. Although the victim of the healthcare error was provided with a brief description of the prospects that he had, the hospital members offered a rather scanty range of options for full and free management of the issue. The quality of the free services that the personnel, including the surgeon, listed as the possible means of managing the CLABSI issue, included cheap antibiotics yet did not provide the medicine for antifungal therapy. Though the development of fungi will not necessarily appear as a result of the active use of antibiotics, there was a possibility that the patient could have developed the identified problem.
Granted that the course of actions taken by the healthcare staff was quite understandable in light of the direct medical costs that the facility would have suffered, but there was no justification for the low quality of the services suggested to the patient as the means of managing the issue. Therefore, the disclosure process did not follow the existing standards completely. The lack of care for the well-being of the patient, combined with the absence of empathy, created a rather hostile environment, in which the patient’s chances for a recovery dropped significantly. Close scrutiny of the way in which the CLABSI issue was addressed in the case showed that the facility needed a patient-centered approach as the means of addressing the threat of nosocomial infections and that the risk management framework that the organization utilized needed to be shaped. Particularly, the introduction of a patient-centered strategy would help alter the current risk management framework toward a more careful identification of the threats of nosocomial infections, as well as a better management thereof (Ross 2013).
Investigation
To analyze the nature of the problem and determine the faults in the current risk management strategy that have led to the incident, the Risk Manager applied the Root Cause Analysis (RCA) tool. One must admit, though, that the process of detecting factors that may have affected the situation was rather difficult since a considerable range of factors that could have caused the CLABSI development had to be reviewed.
The RCA analysis showed that the prolonged hospitalization prior to the insertion of the catheter must have played the greatest role in infecting the patient. Combined with the intrinsic factors, such as the patient’s age and gender (57, male), the long stay in the hospital environment must have played a drastic role in the change of the patient’s health status.
At this point, one must mention that the current risk management framework used in the target facility cannot be deemed as appropriate. Although identifying every factor that may inhibit a successful surgery and the process of recovery is barely possible, essential principles for maintaining high safety rates must be followed, which was not the case in the identified scenario. The patient was clearly supposed to undergo surgery much earlier than he eventually did; as a result, the CLABSI development became practically unavoidable. Therefore, the current risk management strategy needs to be redesigned, so that patient outcomes become more positive (Yokoe et al. 2014).
Remedy
When considering the tools that are likely to serve as preventive measures in managing the CLABSI issue, one should consider changes in the current leadership and ethical frameworks. As detailed in the case, the changes in the patient’s well-being were easily recognizable shortly after the surgery, yet little to no attention was paid to the problem. Therefore, it is necessary to promote a more patient-centered approach among therapists so that every change can be reviewed on a case-by-case basis. Thus, the individual responses of the patients toward treatment and surgery can be interpreted properly, and the emerging issues can be addressed adequately.
Furthermore, staff members must be provided with opportunities to increase their competencies and acquire new skills. As stressed above, the discomfort that the patient experienced could be identified at a comparatively early stage of the problem development. If enough attention was paid to the emotional connection between the patient and the healthcare experts, the issue could have been addressed much earlier. Therefore, there is a necessity to introduce new training opportunities for the staff.
When designing risk management (RM) strategy that will help prevent the instances of CLABSI in the future, as well as preventing other problems from occurring in the context of the specified healthcare facility, one must ascertain that the essential elements of the risk management framework have been included in the RM strategy. Particularly, the following items must be considered as the foundation of an efficient approach: risk identification, risk assessment, and risk treatment. In the target environment, the risk management processes must be launched once the patient is admitted to the facility. The procedure will include such stages as the identification of internal (i.e., patient-related, such as age, gender, etc.) and external (i.e., pertaining to the hospital environment) threats that may contribute to the development of CLABSI and similar issues after surgery (Agency for Healthcare Research and Quality 2016).
Resolution With the Patient
The patient declined to file a lawsuit against the hospital. However, he demanded better services with an improved focus on his personal needs. As a result, a settlement was arranged.
Conclusion
As far as the operation room risk management is concerned, the devices for patient monitoring must be maintained in perfect working condition. Furthermore, the instances of anesthesia malpractice must be prevented successfully. Studies show that the lack of proper care during the provision of anesthesia to the patient may result in the latter receiving a severe injury (Kozek-Langenecker et al. 2013). In order to make sure that anesthesia-related risks are prevented, one must follow the pre-use checklist, including the use of any necessary supporting equipment and medicine so listed.
The importance of physiologic and multiple medical gas monitors can hardly be overrated, either. It is crucial to maintain patient safety at the highest level possible and detect any changes in the patient’s well-being at the earliest stages of development. Therefore, it is crucial that the upgrade in the technology used in the course of surgery should be considered as an essential step in improving the current risk management system.
It should be borne in mind, though, that the changes listed above must be carried out in the context of an improved workplace environment. Put differently, the ethical principles and the quality standards by which the employees must be guided in the process of decision-making have to be revisited so that the risks could be addressed properly. Along with the change toward a patient-centered approach, the managers of the healthcare facility in question must consider the promotion of a more responsible attitude among the staff members. The principles of Corporate Social Responsibility (CSR) must be viewed as the foundation for further prevention of CLABSI-related outcomes in patients and more efficient management of the risks associated with the provision of the necessary healthcare services.
Anderson, JE, Kodate, N, Walters, R, & Dodds, A. (2013). ‘Can incident reporting improve safety? Healthcare practitioners’ views of the effectiveness of incident reporting’, International Journal for Quality in Health Care, vol. 1, no. 1, pp. 1–10. Web.
Kozek-Langenecker, SA, Afshari, A, Albaladejo, P, Santullano, CAA, Robertis, ED, Filipescu, DC, & Wyffels, P. 2013, ‘Management of severe perioperative bleeding. Guidelines from the European Society of Anaesthesiology’, European Journal of Anaesthesiology (EJA), vol. 30, pp. 267-382. Web.
Krein, SL, Kuhn, L, Ratz, D, & Choppa, V. 2015 ’Use of designated nurse PICC teams and CLABSI Prevention practices among U.S. hospitals: A survey-based study’, Journal of Patient Safety, vol. 9, no. 3, pp. 122-128. Web.
Loubon, CO, Hinojal, YC, Carreras, EF, Nuñez, GL, Peláez, PP, Sáez, MB, & Molina, MF. 2015. ‘Extracorporeal circulation in cardiac surgery inflammatory response, controversies and future directions’, International Archives of Medicine, vol. 8, no. 19, pp. 1-13. Web.
Ross, TK 2013, Health care quality management: Tools and applications, John Wiley & Sons, New York, NY.
Visser, M, Niessen, HWM, Kok, WEM, Cocchieri, R, Wisselink, W, van Leeuwen, PAM, & de Mol, BAJM. 2015, ‘Nutrition before and during surgery and the inflammatory response of the heart: A randomized controlled trial’, Journal of Nutrition and Metabolism, vol. 2015, no. 123158, pp. 1-8. Web.
Yokoe, D S, Anderson, DJ, Berenholtz, SM, Calfee, DP, Dubberke, ER, Ellingson, KD, & Maragakis, LL. 2014, ‘A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates’, Infection Control & Hospital Epidemiology, vol. 35, no. 8, pp. 967–977. Web.
The present database plan concentrates on infection control measures. Throughout their practice, health care professionals have to handle numerous infections and protect not only themselves but also other uninfected people while maintaining appropriate preventive services. This paper will discuss the main preventive measures. The present-day situation is far from being perfect. The World Health Organization (n.d.) informs that infections acquired in health care settings are “the most frequent adverse event in health-care delivery worldwide,” including the USA (para. 1). Apart from that, the annual hospital costs of healthcare-associated infections in the U.S. have been estimated to be up to $33 billion (Stone, Pogorzelska-Maziarz, Herzig, Weiner, Furuya, Dick, & Larson, 2014). This database plan explains the information-management problem and contains a guideline that prescribes the execution of specific rules, the entity-relationship correlation, and justification for all entities.
Information Management
Handwashing, donning gloves, and putting on gowns are standard precautions, particularly for the simplest level of infection control (Kacmarek, Stoller, & Heuer, 2016). However, one should not underestimate the importance of these measures. In the context of patient care, it is one of the major strategies for the prevention of healthcare-associated infections among health care consumers and hospital staff members. Presently, there are still some gaps concerning the implementation of infection control measures. This database aims at enhancing medical professionals’ knowledge, encouraging the quality improvement of services, and drawing attention to the preventive measures as the basis of the present-day patient care in the hospital setting. It is necessary to emphasize that the proper infection control might be complicated by the carefree attitude towards standard measures. Thus, it is necessary to recap the basic information and simultaneously follow the present-day trends in terms of infection control.
Specific Rules Execution
The execution of specific rules refers to the idea that the essence of the standard procedures should remain the same while some specific innovations are to be implemented. In this respect, three main measures should be reconsidered: handwashing, donning gloves and putting on gowns. Hand hygiene procedures should be performed as usual, but new agents, such as alcohol-based hand rubs, may be used as well (Caple, 2015). In some cases, for instance, when a person removes contaminated personal protective equipment, double-gloving may be useful because it reduces the risk of viral contamination of health care workers’ hands (Casanova, Rutala, Weber, & Sobsey, 2012). As for the usage of gowns, it is necessary to identify the common standard among those that already exist and share knowledge. It is sometimes believed that the scope of gowns application concerns bacteria, but the recent research proves that their primary task is to prevent or reduce exposure to bloodborne pathogens (Balci, 2016).
Entities Planned for Database
In the context of standard infection control, the entities will represent the measures that health care workers perform daily. Since they have many responsibilities, the database will include options concerning the concrete situation. The differences will be identified by the character of the work; in other words, one should understand in which circumstances they use a certain standard precaution.
Justification for Entities
Infection control incorporates a set of practices that may differ depending on the situation. Although they are called standard, they might deviate to some extent. Practically, the usage of the same model is not present, because of the different types of activities that health care workers perform. For example, direct communication with patients and treatment differ from work with documents and equipment. Consequently, the first case requires the exact accuracy of the infection control measures implementation, while the ideal cleanliness is less important for paper or computer work.
E-R Diagram
The entity-relationship diagram presents the protocol used to determine the necessary measures in different cases. Taking into account the type of work, one will identify the rigidity of the rules.
Identifier for Entities
In this database, nurses are the primary identifiers for the type of work. Further, the work object is the identifier for particular precautions.
Relationships Among Entities
Infection prevention and control programs assume innovations, including the changes in precaution issues (Stone et al., 2014). The entities complement each other. Each of them is equally significant because the absence of one preventive measure will result in infection even if other precautions are taken.
Questions for the Database
What measures should be taken in terms of direct patient care?
Which measures can be adopted to a certain situation, and which are invariable?
Can additional versions of the same preventive measure be added to the database?
Conclusion
To sum up, precautionary measures remain the most significant instrument in the context of infection control. This paper emphasized the key preventive services and shed light on the possibility of changes implementation. Apart from that, the idea about the concrete situation and corresponding measures was conveyed. The execution of specific rules was explained and represented using the entity-relationship diagram. One can use the database to learn about and teach the importance of infection control measures and decision-making about the standard precautions and their variables.
References
Balci, F. S. K. (2016). Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use. American Journal of Infection Control, 44(1), 104-111.
Caple, C. (2015). Hand hygiene: Hand and arm drying following surgical scrub. Web.
Casanova, L. M., Rutala, W. A., Weber, D. J., & Sobsey, M. D. (2012). Effect of single-versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment. American Journal of Infection Control, 40(4), 369-374.
Kacmarek, R. M., Stoller, J. K., & Heuer, A. (2016). Egan’s fundamentals of respiratory care. St. Louis, MO: Elsevier Health Sciences.
Stone, P. W., Pogorzelska-Maziarz, M., Herzig, C. T., Weiner, L. M., Furuya, E. Y., Dick, A., & Larson, E. (2014). State of infection prevention in US hospitals enrolled in the National Health and Safety Network. American Journal of Infection Control, 42(2), 94-99.
World Health Organization. (n.d.). Health care-associated infections. Web.