Category: Infection

Introduction: Significance of Innovative Interventions for Controlling Nosocomial Infections

Preventing hospital-acquired infections is a crucial step toward facilitating high-quality healthcare services and increasing recovery rates among patients (Centers for Disease Control and Prevention, 2016). Typically defined as the infections that have been acquired in the course of staying in a healthcare or nursing facility, nosocomial infections pose a considerable threat to patients’ well-being since they delay the recovery process and may lead to a number of complications, thus, jeopardizing the patient’s chances to recover successfully. The design of a flexible prevention strategy that can be used to isolate the patients from the factors contributing to nosocomial infections development, as well as increasing awareness rates on the subject matter, is bound to lead to numerous improvements.

Considering the issue closer, one must admit that the current approaches toward enhancing the CLABSI management process, while being admittedly sensible, lack a deep insight about the external factors that contribute to the problem’s development. For instance, the fact that the current frameworks tend to embrace only one area at a time needs to be brought up as a primary stumbling block. Although addressing the issue on the level of inventory management is crucial for the control of the procedures and the facilitation of patients’ safety, the framework that will help prevent and handle the CLABSI issues, as well as raise awareness about the subject matter among nurses and patients alike, needs to focus on not only the central line implantation procedure but also the management of the information available to the nursing staff and the patients, the supervision of the latter, the process of collecting feedback from the customers and addressing the emerging problems in a timely manner, etc.

Innovative Interventions for Managing Central-line Associated Bloodstream Infections: Description

Supporting the National Initiative as the Primary Measure to Be Taken

Much to its credit, the Agency for Healthcare Research and Quality (AHRQ) has suggested the national initiative that is bound to reinvent the very concept of CLABSI-related issues management. The tools designed by the organization are bound to serve as the premises for reducing the rates of CLABSI development dramatically. Designed as the measures to address the problem on a national level, the toolkit created by AHRQ can be applied easily to the target nursing setting.

The fact sheets, the inventory, and the checklists designed by the organization serve a rather simple purpose; they can be used to raise awareness among the nursing personnel, as well as make sure that the specific guidelines designed for CLABSI prevention are followed to a T. Apart from providing basic guidelines about hygiene and the ways of maintaining it, the initiative strives to reduce the threats associated with the mismanagement of the available nursing resources. Furthermore, the time used to carry out the necessary procedures can be shrunk to a considerable extent, therefore, reducing the patients’ exposure to the threat of CLABSI contraction (Agency for Healthcare Research and Quality, 2014). By arranging the inventory located in the central line cart, a nurse will be able to manage their time and resources in a more sensible way (Lin et al., 2012).

Once the National Initiative receives enough support, it can become the foundation for reinventing the current concept of CLABSI management, as well as handling the CLABSI-associated issues. For instance, the program will help build awareness among not only nurses but also patients, which is critical for the further improvements. Indeed, because of the target audience’s inability to detect the issues that they develop shortly after CLABSI is implanted into their system, the problems associated with the central line are attended to at a very late stage. Thus, the chances of success are very few. Raising awareness among patients, therefore, will help improve the outcomes and increase the chances for recovery.

Using a Multifaceted Intervention Involving Enhancement of Safety, Cooperation, and Communication among Nurses

It should also be borne in mind that whether the patient develops a CLABSI problem in the ICU issue hinges on the quality of communication and congruence in the actions of the nurses (Marsteller et al., 2012). Therefore, the promotion of efficient information management practices, as well as a heavier emphasis on communication quality, must be brought up as a possible framework for building a nursing initiative. As a recent study indicates, the promotion of the associated principles in the environment of the ICU causes an immediate drop in the frequency of the CLABSI issues development (Marsteller et al., 2012). The multifaceted intervention in question implied creating a set of very rigid hygiene rules in the nursing setting.

For instance, the members of the facility were instructed to wash hands before placing the line, follow the full-barrier principles (e.g., wearing a gown, a mask, etc.), never place the line at the femoral cite, including chlorhexidine into the list of cleaning tools, and remove any lines that are not necessary for maintaining the patient’s well-being (Marsteller et al., 2012, p. 2936). In fact, the idea of incorporating the data retrieved from several units to cater to the needs of the patients has proven to be rather successful in some of the recent studies – according to AHRQ, the average CLABSI per unit changed from 3.12% to 0.93% to 0.72% to 0.65% to 0.64% after the introduction of the framework into the target setting (Agency for Healthcare Research and Quality, 2011).

Information management, in its turn, may be improved by incorporating IT technologies to improve the hand-off communication. Seeing that the study showed an unbelievable 81% reduction in the number of CLABSI issues among the patients, it must be considered a crucial addition to the intervention framework, even though the principles on which it lies are rather basic (Marsteller et al., 2012).

Promoting a Patient-Centered Approach by Using Simulations to Shed Light on the Related Issues

Sadly enough, the tools listed above are unlikely to have any effect on the current situation unless nurses have an opportunity to develop empathy toward the target audience. Once the members of the ICU services realize what patients are forced to experience, they will learn to empathize with the people that are subjected to the threats of CLABSI development. For these purposes, the development of Emotional-Intelligence-related (EI) skills among nurses should be considered (Kaur, Sambasivan, & Kumar, 2015). According to the Centers for Disease Control and Prevention (2016), the focus on the patient-centered strategies allowed for a 50% drop in the CLABSI rates among the U.S. population. Furthermore, between 2013 and 2014, a 9% drop in CLABSI was documented (Centers for Disease Control and Prevention, 2016).

Along with the enhancement of EI strategies in the identified environment, simulations must be viewed as the primary tool for helping nurses train the required skills and become proficient in managing the process of catheter placement, as well as the further observation of the patient. A recent study pointed to the fact that the use of simulations had contributed to a rapid drop in the number of readmissions in a local hospital (Liebrecht & Lieb, 2016). Furthermore, the application of simulations can be considered a foot forward in developing the appropriate risk management strategies.

Indeed, the framework of simulations allows taking an array of possible scenarios into consideration, therefore, providing nurses with the essential information about the actions that they need to take in case of specific emergencies. Furthermore, the adoption of simulations as the primary means of training the staff’s abilities to cater to the needs of patients will permit designing the strategy that can be used as a general guidance for addressing emergency issues. Thus, even if the measures to be taken in a specific scenario have not been identified in the course of training, a nurse will be able to determine them on their own by relying on the values and the code of the nursing facility.

Conclusion: Addressing the Issue of Central-line Associated Bloodstream Infections as the First Step Toward Quality Improvement

Preventing the development of nosocomial infections, in general, and the ones that are linked to the CLABSI-associated processes, in particular, requires that not only the actual procedure but also the management of the available information should be improved significantly. Apart from the program that will help instruct nurses on the means of implanting the central line and provide direct instructions about increasing efficiency in the workplace, i.e., reducing the time taken and carrying out the crucial steps, the tools for efficient information transfer and processing will have to be included as well. Although seemingly insignificant, the reception of the necessary data and its further usage in carrying out the CLABSI process defines the success thereof to a considerable extent.

The use of the multifaceted framework as the means of addressing the subject matter should also be deemed as one of the most successful ideas. As stressed above, it is imperative to make sure that the external and the internal factors that affect patients’ well-being should be taken into account, which is only possible once the multifaceted approach is used. Pointing to the way in which different elements of the nursing environment interact, the framework serves as the foundation for determining every possible factor that may pose a threat to the patient’s well-being in the course of carrying out the CLABSI-related procedures.

Finally, the incorporation of EI-based strategies, as well as the active use of simulations for training purposes must not be overlooked as a crucial step in the progress of a nurse. Seeing that not all patients are capable of determining the actual source of their health concern and put it into the terms that will help a nurse diagnose the problem, it is crucial to be able to read the patients’ emotions and identify the on-coming issue within the smallest amount of time possible. As a result, the infection can be attended as fast as possible until it grows out of proportions and becomes a significant threat to the patient’s health. Furthermore, the approach also sheds light on the importance of developing an emotional connection between the patient and the nurse, thus, creating prerequisites for the latter to develop empathy toward the customer.

References

Agency for Healthcare Research and Quality. (2011). Eliminating CLABSI: A national patient safety imperative. A progress report on the national “On the CUSP: Stop BSI Project.” Web.

Agency for Healthcare Research and Quality. (2014).Appendix 4: Central line cart inventory. Web.

Centers for Disease Control and Prevention. (2016). Healthcare-associated Infections (HAI) progress report. Web.

Kaur, K., Sambasivan, M., & Kumar, N. (2015). Significance of Spiritual (SI) and Emotional Intelligence (EI) on the caring behavior of nurses. Journal of Community & Public Health Nursing, 1(101), 1-3. Web.

Liebrecht, C. M., & Lieb, M. C. (2016). Incorporating quality and safety values into a CLABSI simulation experience. Nursing Forum: An Independent Voice for Nursing, 1(1), 1-6. Web.

Lin, D. M., Weeks, K., Bauer, L., Combes, J. R., George, C. T., Goeschel, C. A.,… & Pham, J. C. (2012). Eradicating central line-associated bloodstream infections statewide: the Hawaii experience. American Journal of Medical Quality, 27(2), 124-129. Web.

Marsteller, J. A., Sexton, J. B., Hsu, Y. J., Hsiao, C. J., Holzmueller, C. G., Pronovost, P. J., & Thompson, D. A. (2012). A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Critical Care Medicine, 40(11), 2933-2939. Web.

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

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

Description of the Outbreak

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

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

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

Epidemiological Determinant

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

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

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

Effects of the Outbreak at Systems Level

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

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

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

The Reporting Protocol

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

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

Education Strategies

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

Conclusion

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

References

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

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

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

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

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

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

Introduction

Recently, the spread of Clostridium difficile infection among hospitalized patients in the United States has increased significantly. As a result, patients and other populations are at risk of developing diseases caused by C. difficile, including diarrhea and colitis. The problem is exacerbated by the fact that the current strains of C. difficile can be resistant to treatment in many cases, an aspect that negatively affects the management of diseases caused by this infection (Ofosu, 2016). This situation has led to worsening epidemic levels in the United States related to the spread of C. difficile and to increased mortality rates. The purpose of this paper is to describe the problem in detail while focusing on symptoms and appropriate measures; identify the population at risk, laboratory tests, and treatment options; and discuss nursing interventions, medications, and outside impacts.

Description of the Problem

C. difficile is a Gram-positive, anaerobic, spore-forming bacterium. American scientists first identified it in healthy infants’ fecal material in 1935. They found that the bacterium is typical of the gut flora of some people; it became known as Bacillus difficilis because this particular bacterial organism was difficult to isolate. In 1978, researchers found that the bacterium is ­pathogenic, producing toxins that caused antibiotic-associated diarrhea in some patients in the 1970s (Kenneley, 2014). The name of the bacterium was changed to Clostridium difficile, and today, it is viewed as the cause of C. difficile infection or C. difficile-associated diarrhea.

C. difficile causes diarrhea in more than 25% of hospital cases that are associated with surgery and prolonged hospitalization, and today, it is a factor in more complications than previously. The population at risk includes hospitalized male patients older than 65 years who take antibiotics. Mortality rates among these patients are high (Goudarzi, Seyedjavadi, Goudarzi, Mehdizadeh Aghdam, & Nazeri, 2014). However, women and children are also considered to be at risk since C. difficile has become more resistant, and it causes more fatality cases nowadays.

Signs and Symptoms

The first signs of C. difficile infection can be observed during or following antibiotic therapy. Signs and symptoms include watery diarrhea and nau­sea. The spores of this bacterium are transmitted using the oral-fecal route and are resistant to antibiotics. These spores cannot live in an open environment, but they are able to grow in the stomach. Symptoms occur when bacterial growth causes the production of such toxins as an enterotoxin and a cytotoxin, among others, that damage the intestinal crypts (Leffler & Lamont, 2015). The active production of these toxins leads to inflammation and diarrhea symptoms. As the disease progresses, the symptoms worsen, and it is possible to observe an increased white blood cell count and the development of pseudomembranous colitis, which is characterized by watery diarrhea observed about 10–15 times a day, nau­sea, blood in the stool, abdominal tenderness, and fever (Goudarzi et al., 2014). Increasing inflammation can also lead to sepsis and shock. Surgery can be required to manage bowel perforation in this case.

Measures

In order to effectively manage C. difficile infection, it is important to isolate a patient who is showing the first symptoms of diar­rhea if this infection is suspected. Additional laboratory tests are required to prove the diagnosis. Spores of C. difficile can be found on equipment in hospitals, on the hands of staff members, and in bathrooms. Therefore, it is necessary to use soap and sanitizers to reduce the number of spores on different objects. Precautionary measures also include the use of gloves and gowns by healthcare providers who work with patients in isolation from other individuals (Kenneley, 2014). It is also possible to use probiotics to decrease the risk of spreading the infection and to address the risks associated with using antibiotics.

Laboratory Tests

Fecal samples are used to diagnose C. difficile infection. In order to isolate the bacterium, it is necessary to use cycloserine cefoxitin-fructose agar. The results of this test are known in 48–96 hours. The next step is a toxin assay, conducted with the help of the cell culture neutralization assay and immunoassay tests (EIA and GDH). These tests are highly sensitive and specific; while they demonstrate the presence and growth of C. difficile, they require some time and resources to be performed. It is also possible to use nucleic acid amplification tests effective in determining specific toxin genes (Smits, Lyras, Lacy, Wilcox, & Kuijper, 2016). Blood tests are important to demonstrate the severity of the disease. When WBC < 15,000 cells/mm³ and SCr < 1.5, mild diarrhea is diagnosed. Severe diarrhea is diagnosed with WBC > 15,000 cells/mm³ and SCr > 1.5 in relation to the baseline (Leffler & Lamont, 2015). An additional step includes endoscopy when laboratory tests do not support the assumed diagnosis.

Population at Risk

Hospitalized patients are at the highest risk of developing C. difficile infection. This population specifically includes persons who are older than 65 years, predominately males, and individuals who stay in a hospital for a long period of time. A more important factor is that persons at risk of developing the disease use antibiotics. These patients can also be diagnosed with bowel disease, kidney disease, or immunodeficiency, or they can be receiving chemotherapy (Kenneley, 2014). The reason for identifying this population is that antibiotic treatment provokes the growth of C. difficile along with the related production of toxins. The use of cephalosporins and clinda­mycin is most challenging in this case. In addition, hospitalizations and contact with patients and healthcare providers in hospitals are also risk factors for the progress of C. difficile infection when hygiene principles are neglected since the disease is spread through the oral-fecal route (Goudarzi et al., 2014). Additionally, as already mentioned, children and women have been recently added to the category of patients who are at risk of C. difficile infection.

Treatment

In order to manage C. difficile infection, healthcare providers will first stop any current antibiotic treatment. When mild‑to‑moderate or severe C. difficile infection is observed, treatment includes medicines as well as hospitalized patients. The use of metronidazole, vancomycin, or fidaxomicin is prescribed, depending on disease severity (Kenneley, 2014). It is important to guarantee hydration and regular monitoring of a patient’s state (Leffler & Lamont, 2015). Risks of reinfection are high, and in such cases, vancomycin and fidaxomicin are mainly used. Complicated cases can require surgery, and it is used when fulminant colitis is diagnosed, or when a patient does not respond to antibiotic treatment.

Nursing Interventions

In order to prevent the development of the disease and help patients cope with C. difficile infection, nurses should teach those patients who are at risk of infection how to focus on hygiene and to report any changes in their stool. Nurses are also responsible for the availability of clean hygiene tools and products. Patients who show the first symptoms and signs of C. difficile infection should be educated by nurses not to leave their rooms. Nurses are also responsible for organizing a private room for a patient with C. difficile infection or one suspected to have this infection (Kenneley, 2014). It is also important to monitor changes in a patient’s state and educate the individual regarding the necessity of reporting abdominal tenderness, skin irritation, reactions to medicines, and other signs.

Medications

To prevent the growth of C. difficile, medical organizations recommend using metronidazole and vancomycin as well as fidaxomicin. Oral metro­nidazole (500 mg three times per day) is used to address mild‑to‑moderate C. difficile infection because of minimal adverse effects and appropriate levels of absorption. In severe cases, it is appropriate to use oral vancomycin (500 mg four times per day; Goudarzi et al., 2014). Fidaxomicin (200 mg twice per day) is a more advanced type of antibiotic that was developed to address this infection. Adverse effects usually include headaches, nausea, taste disturbance, and peripheral neuropathy as a severe effect (Ofosu, 2016). When these symptoms are observed, nurses should inform physicians and choose another antibiotic.

Outside Influences

The transmission of C. difficile infection is possible because of certain outside factors. These include the uncontrolled overuse of antibiotics, such as ampicillin, clindamycin, amoxicillin, and fluoroquinolones, among others. External factors also include ignoring hygienic principles while using proton pump inhibitors and other equipment in healthcare facilities that have many patients who have had gastrointestinal surgery or patients who need to stay in a hospital over a long period of time (Smits et al., 2016). Longer stays in hospitals and nursing homes are directly associated with the risk of developing C. difficile infection. If norms of hygiene and sanitation are not followed in a facility, and healthcare providers do not use gloves, the risk of spreading C. difficile infection increases.

Importance of the Problem

The current spread of C. difficile infection in hospitals in the United States and other countries is a problem that requires an effective solution because the resistance of C. difficile to antibiotics is increasing, and more cases are being classified as severe and leading to complications or patients’ deaths. Therefore, this problem needs to be addressed. However, it is also important to note that an epidemic of C. difficile infection in hospitals can be prevented by following certain precautionary measures and focusing on hygiene standards (Kenneley, 2014). The spread of C. difficile infection demonstrates the necessity of prescribing adequate antibiotic therapies with probiotics and following hygiene standards in hospitals as simple steps to prevent the rise of C. difficile infection in healthcare facilities.

Conclusion

The paper has presented an analysis of C. difficile infection, providing a description of the disease and a discussion of preventive measures, treatment, and appropriate medications. It is important to note that C. difficile infection is a common problem for healthcare facilities. Thus, the possible complications of the resulting diarrhea are causing researchers and practitioners to pay more attention to identifying effective measures to prevent any outbreak of an epidemic. It is possible to decrease the mortality rates associated with C. difficile infection with the help of providing nurses more information about signs of the disease and effective precautionary procedures, as well as interventions to apply in hospitals.

References

Goudarzi, M., Seyedjavadi, S. S., Goudarzi, H., Mehdizadeh Aghdam, E., & Nazeri, S. (2014). Clostridium difficile infection: Epidemiology, pathogenesis, risk factors, and therapeutic options. Scientifica, 2014, 1-9.

Kenneley, I. L. (2014). Clostridium difficile infection is on the rise. The American Journal of Nursing, 114(3), 62-67.

Leffler, D. A., & Lamont, J. T. (2015). Clostridium difficile infection. New England Journal of Medicine, 372(16), 1539-1548.

Ofosu, A. (2016). Clostridium difficile infection: A review of current and emerging therapies. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology, 29(2), 147-154.

Smits, W. K., Lyras, D., Lacy, D. B., Wilcox, M. H., & Kuijper, E. J. (2016). Clostridium difficile infection. Nature Reviews Disease Primers, 2, 1-20.

Abundant diarrhea mixed with blood can be triggered by an infectious disease, such as dysentery. When provoked by infection, twenty or more bowel movements during a day may occur. The overall patient’s condition can be aggravated by fever, abdominal pain, nausea, and vomiting (“Deadly Diseases” 21).

Investigation

The first step of the diagnostics process should include a thorough investigation of subjective symptoms. The identification of pain characteristics (its correlation with food intake, frequency, localization and irradiation of pain), evaluation of other symptoms (nausea, vomiting, heartburn, appetite, etc.) in combination with the results of collected by objective research, such as clinical analysis, in most cases, helps to achieve a high level of preliminary diagnosis’ accuracy.

Examination of feces has great diagnostic importance and helps to find the presence of mucus streaked with blood in the fecal matter. Clinical confirmation of dysentery is conducted by using bacteriological and serological methods. For example, repeated isolation of Shigella organisms from the feces provides confirmation of the diagnosis in 40-60% of patients (Prince et al. 8).

Rapid diagnosis of acute intestinal diarrheal infections may be administered to detect pathogenic antigens and their toxins in saliva, urine, feces, or blood. For this purpose, the immunological methods, such as enzyme-linked immunosorbent assay (ELISA), with high sensitivity and specificity are commonly implemented (Meza-Lucas 379).

Preliminary Diagnosis

Ulcer disease is regarded as one of the common causes of diarrhea with blood. However, the high frequency of bowel movements indicated the infectious origins of the health problem.

Dysentery is a very dangerous infectious disease casually transmitted from a person to person. The causative agent of dysentery is the bacteria of the Shigella genus which have a high survival rate in the external environment (Phalipon and Sansonetti 119).

The disease develops quickly. At the beginning of progression the general intoxication syndrome characterized by fever, chills, hot flashes, fatigue, decreased appetite, headache, decreased blood pressure occur.

The repeated cramping pain in the lower abdomen, frequent false urges to defecation, feeling of incomplete defecation, as well as high stool frequency (up to 10-20 times a day) indicates at the moderate form of dysentery (Prince et al. 8).

The beginning of this infection form is rapid. Body temperature rises to 38-39°C and may remain at this level for a significant period starting from several hours to two-four days. Usually, intoxication and diarrhea last for 4-5 days while the complete recovering of the intestinal mucosa and the normalization of all body functions occurs merely after a month of treatment (Gairola et al. 1000).

Treatment

An important component of treatment is diet. It is recommended to follow the therapeutic diet characterized by a reduced content of fat and carbohydrate and normal protein content. It is suggested to exclude the products that can cause flatulence or any form of gastrointestinal irritation.

In severe cases, when the diarrhea is accompanied by diarrhea with blood, the uptake of antibiotics is suggested. Ciprofloxacin 500 mg 2 times a day is a commonly used medicine (Prince 6). The duration of the treatment course should be aligned with the individual needs of the patient and determined by a physician. The treatment of standard dysentery cases can last up to five days.

Prevention

The mechanism of infection with dysentery is based on direct contact with an infected person, infected food, or contaminated water (Feil 964). Thus, the major methods of Shigella infection prevention can be reduced to compliance with the rules of personal hygiene. It is important to wash hands before eating and after using the toilet and follow the rules of food storage and preparation.

Works Cited

“Deadly Diseases.” America’s Civil War 21.5 (2008): 21. Academic Search Complete. Web.

Feil, Edward J. “The Emergence And Spread Of Dysentery.” Nature Genetics 44.9 (2012): 964-965. Academic Search Complete. Web.

Gairola, Sumeet, et al. “Plants Used For Treatment Of Dysentery And Diarrhoea By The Bhoxa Community Of District Dehradun, Uttarakhand, India.” Journal Of Ethnopharmacology 150.3 (2013): 989-1006. Academic Search Complete. Web.

Meza-Lucas, Antonio, et al. “Comparison of DOT-ELISA and Standard-ELISA for Detection of the Vibrio Cholerae Toxin in Culture Supernatants of Bacteria Isolated from Human and Environmental Samples.” Indian Journal of Microbiology 56.3 (2016): 379-382. Web.

Phalipon, Armelle, and Philippe J. Sansonetti. “Shigella’S Ways Of Manipulating The Host Intestinal Innate And Adaptive Immune System: A Tool Box For Survival?.” Immunology & Cell Biology 85.2 (2007): 119-129. Academic Search Complete. Web.

Prince, Christopher, , David Kirubah, John Sushil and Venkatesan Sankarapandian. “Antibiotic Therapy for Shigella Dysentery.” Cochrane Database of Systematic Reviews Reviews (2009): 1-102. Web.

Preventing the development of nosocomial infections is crucial to maintaining the well-being of not only patients but also nurses, as well as creating the environment for faster recovery and reducing the length of the hospital stay. The specified issue is especially significant for meeting the needs of patients in the intensive care unit (ICU), where the opportunities for nurse-patient communication are limited, and where nurses are especially vulnerable to external threats, including infections and similar health risks (Kong, Park, & Park, 2016). Therefore, designing the tools that will allow minimising the risk should be viewed as the priority. The scope of the essay is limited to the discussion of the risks of contract in infectious diseases, which nurses may face in the context of the ICU environment in a hospital. Furthermore, the impact of the specified risks on the target population will be explored. As a result, the foundation for building a sustainable approach to managing the problem can be identified.

Because of the consistent exposure to infections during regular procedures performed in the realm of an ICU, nurses face the threat of contracting a bloodstream infection (BSI) on a regular basis. The fact that bacteria gradually develop resistance toward antibiotics makes the issue even more difficult to handle (Hasman et al., 2015). According to a recent study, multidrug-resistant infections (MDRs) account for 50.7% of instances of health complications in the ICU environment (Russotto et al., 2015, p. 288). The lack of efficient control procedures, which could have prevented the instances of developing BSIs among nurses, also affects the well-being of the target population, therefore, making nurses as vulnerable as patients once they are introduced to the ICU setting (Shang, Stone, & Larson, 2016).

Furthermore, the propensity toward making a mistake when carrying out ICU-specific procedures, such as the process of inserting a central line venous catheter in a patient’s body, also increases the threat of exposing not only a patient but also a nurse to the contraction of a BSI, which, in this case, is defined as the Central Line-associated Bloodstream Infection (CLABSI) (Sahni et al., 2017). Therefore, a closer focus on the promotion of safety among nurses operating in the ICU environment, as well as vaccination and the enhancement of the current standards for conducting ICU-related procedures (e.g., the provision of detailed guidelines for preventing the instances of BSIs during the central line catheter implanting), must be viewed as a necessity (Quddus, Jehan, & Ali, 2015).

The impact of BSIs on the well-being of nurses working in the ICU environment is deleterious; particularly, it includes a rapid drop in their physical and emotional health. Specifically, the variety of effects that BSIs may have on nurses ranges from the rise in the workplace burnout levels in the ICU environment to the sharp increase in morbidity rates among the target population (Garrouste-Orgeas et al., 2015). Indeed, when introduced to a combined effect of BSIs and the pressure of controlling the ICU environment to reduce the effects of life-threatening factors on patients, a nurse is likely to deal with psychological issues such as workplace burnout and depression and physiological concerns linked to the management of BSIs in question. As a result, the opportunities for a successful recovery are reduced to a considerable extent (Guntupalli, Wachtel, Mallampalli, & Surani, 2014).

Furthermore, the specified issue is bound to lead to a gradual drop in the quality of the staff’s performance due to the array of physiological and psychological negative consequences mentioned above. As a recent study points out, nurses that are experiencing workplace burnouts, depression, and the associated complications, deliver poorer performance than their healthy co-workers due to the loss of attention and motivation (Khamisa, Oldenburg, Peltzer, & Ilic, 2015). Finally, the change in the reputation of the nurses that develop the identified problems should be mentioned. Because of the drop in their performance levels, they are likely to experience harsh criticism from the hospital managers and be viewed as less competent and, thus, less valued staff members (Galletta et al., 2016).

The resulting drop in the nurses’ motivation and engagement levels will inevitably affect the quality of their work to an even greater degree, leading to a consistent deterioration of their relationships with the managers and, thus, their further dismissal. It should be noted that the hospital will also suffer significantly in the scenario described above since the reduction in the number of nurses will trigger an inescapable increase in workload and, thus, an even sharper decline in the quality of the services delivered by the rest of the nurses. Therefore, presenting the tools that will allow reducing the threat of nosocomial infections and especially BSIs development among nurses is crucial to both the well-being of the staff and the performance of the organisation. The introduction of revised and improved strategies for workplace safety in the ICU environment should be deemed as the crucial step toward the prevention of BSIs among nurses (Lo et al., 2014).

Seeing that the problem under analysis involves an immediate change in the levels of performance delivered by nurses, the consequences are bound to be drastic for all stakeholder involved, including patients, nurses, and healthcare institutions. The creation of obstacles for the further improvement in the quality of care and the communication between patients and nurses must be deemed as the primary area of concern. Indeed, a closer look at the subject matter will show that the rise in the BSIs contraction levels among the staff will trigger a gradual deterioration in the degree of investment and, therefore, the levels of care provided by the nursing staff.

Particularly, nurses are likely to pay less attention to the needs of the target population, which is paramount in the contemporary multicultural community (Bassuni & Bayoumi, 2015). Indeed, because of the increasingly high rates of globalisation, the population to the needs of which nurses must cater is becoming increasingly more diverse, which means that the range of needs and unique factors that affect their well-being is becoming larger. Without motivation, which serves as a powerful impetus for acquiring the knowledge required for an enhanced communication process and a better understanding of patients’ needs, nurses will be unable to manage the target population’s health concerns properly, hence a drop in the number of positive patient outcomes (Ahn, 2017).

Because of the consistent exposure to BSIs in the ICU environment, nurses face a significant threat to their well-being, as well as the performance of the hospital and the overall quality of care. To avoid the specified issue, one should consider using vaccines combined with the creation of a set of rigid guideline for the staff to comply with, as well as mandatory blood investigation as part and parcel of the hospital policy. As a result, the foundation for increasing the levels of safety in the ICU environment will be created. Consequently, both the quality of care and the well-being of the stakeholders involved will remain at the required level.

References

Ahn, J. W. (2017). Structural equation modeling of cultural competence of nurses caring for foreign patients. Asian Nursing Research, 11(1), 65-73. Web.

Bassuni, E. M., & Bayoumi, M. M. (2015). Improvement critical care patient safety: Using nursing staff development strategies, at Saudi Arabia. Global Journal of Health Science, 7(2), 335-343. Web.

Galletta, M., Portoghese, I., D’Aloja, E., Mereu, A., Contu, P., Coppola, R. C.,… Campagna, M. (2016). Relationship between job burnout, psychosocial factors and health care-associated infections in critical care units. Intensive and Critical Care Nursing, 34, 59-66. Web.

Garrouste-Orgeas, M., Perrin, M., Soufir, L., Vesin, A., Blot, F., Maxime, V.,… Azoulay, E. (2015). The Iatroref study: Medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture. Intensive Care Medicine, 41(2), 273-284. Web.

Guntupalli, K. K., Wachtel, S., Mallampalli, A., & Surani, S. (2014). Burnout in the intensive care unit professionals. Indian Journal of Critical Care Medicine, 18(3), 139-143. doi:10.4103/0972-5229.128703

Hasman, H., Hammerum, A. M., Hansen, F., Hendriksen, R. S., Olesen, B., Agersø, Y.,… Cavaco, L. M. (2015). Detection of mcr-1 encoding plasmid-mediated colistin-resistant Escherichia coli isolates from human bloodstream infection and imported chicken meat, Denmark 2015. Eurosurveillance, 20(49), 1-5. Web.

Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. International Journal of Environmental Research and Public Health, 12(1), 652-666. Web.

Kong, H. K., Park, T. J., & Park, K. Y. (2016). Knowledge on blood-borne infection, awareness and compliance on blood-borne infection control, and factors influencing compliance among emergency nurses. Korean Journal of Healthcare-Associated Infection Control and Prevention, 21(2), 65-73. Web.

Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J.,… Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(5), 464-479. Web.

Quddus, M., Jehan, M., & Ali, N. H. (2015). Hepatitis–b vaccination status and knowledge, attitude and practice of high risk health care worker body substance isolation. Journal of Ayub Medical College Abbottabad, 27(3), 664-668.

Russotto, V., Cortegiani, A., Graziano, G., Saporito, L., Raineri, S. M., Mammina, C., & Giarratano, A. (2015). Bloodstream infections in intensive care unit patients: Distribution and antibiotic resistance of bacteria. Infection and Drug Resistance, 8, 287-296.

Sahni, N., Biswal, M., Gandhi, K., Kaur, K., Saini, V., & Yaddanapudi, L. N. (2017). Effect of intensive education and training of nurses on ventilator-associated pneumonia and central line-associated bloodstream infection incidence in intensive care unit at a tertiary care center in North India. Indian Journal of Critical Care Medicine, 21(11), 779-795. Web.

Shang, J., Stone, P., & Larson, E. (2016). Studies on nurse staffing and health care-associated infection: Methodologic challenges and potential solutions. American Journal of Infection Control, 43(6), 581-588. Web.

Introduction

Catheter-associated urinary tract infection (CAUTI) remains one of the most significant health problems in acute care facilities. According to the recent statistical estimations, the daily risk of developing CAUTIs is nearly 7 percent, and it increases depending on the length of catheterization (Amine, Helal, & Bakr, 2014). Researchers indicate that the given health issue poses a topical problem to health practitioners and the overall healthcare system as it is associated with a high level of mortality and morbidity in patients, and puts an extra financial burden on hospitals.

CAUTI can be regarded as both a barrier to the maintenance of patient safety and the outcome of an ineffective care environment. At the same time, the topicality of the given study is defined by the fact that the majority of CAUTI cases are preventable, and the reduced incidence rate can be achieved through the enforcement of prevention practices among health providers and the education of nurses regarding the problem of patient safety. According to the National Council of State Boards of Nursing (NCSBN, 2016), safety and infection control is one of the primary client needs and functions in the nursing profession. In accordance with the knowledge content noted in the NCLEX-RN subcategories, a nurse should be skillful in incident prevention and emergency response, aware of safety regulations related to the use of equipment, standards, and principles of problem management (NCSBN, 2016). Based on this, the main purpose of the paper is the investigation of the recent research findings related to the selected clinical issue and examination of the evidence which will be subsequently used for the design of a CAUTI prevention plan.

Importance

According to Nicolle (2014), CAUTI is “the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities” (p. 1). Catheterization significantly increases the risk of the transfer of bacteria to the urinary tract and the consequent development of symptomatic infection. Although the presence of bacteria transferred via catheters in the organism remains asymptomatic in the majority of the acute care cases, such adverse outcome of CAUTI as bacteremia, i.e., the secondary bloodstream infection, occurs in 3 percent of patients with the given health problem (Nicolle, 2014). The researcher also identifies a few other types of CAUTI-related morbidity. They include catheter obstruction, bladder urolithiasis, purulent urethritis, gland abscesses, prostatitis, mechanical traumas, nonbacterial inflammation, immobility, etc. (Nicolle, 2014). In case the clinical issue remains unresolved, CAUTI may contribute to the increase in the length of the patient stay at the hospital or death.

Patient Population

Since bacteriuria inevitably occurs after a few weeks of catheterization, any hospitalized patient who receives urinary catheters throughout the stay at the facility is prone to the development of CAUTI. However, Nicolle (2014) states that the rate of incidence is higher for females and people of advanced age.

When speaking of potential impacts of cultural values held by diverse patients in the selected group, they may likely only affect the course of CAUTI treatment, e.g., if a person refuses to intake antibiotics due to specific health care beliefs, and so on. Nevertheless, researchers suggest that the best solution for the given health problem is the avoidance of the unnecessary application of catheters (Meddings, Krein, Fakih, Olmsted, & Saint, 2013). Therefore, it is mainly related to nursing practice and the specialists’ compliance with monitoring and intervention protocols. Thus, the cultural values held by nurses, as well as the overall organizational culture, maybe attributive to the success of the prevention strategy to a greater extent than patients’ beliefs. If a nurse is not sufficiently aware of the safety protection techniques and does not follow the basic hygiene practices, her or his incompetence may negatively affect the patient outcome. Thus, the level of nurses’ knowledge and healthcare literacy may likely have a stronger influence on the course of the intervention.

Proposed Solution

According to Meddings et al. (2013), and Nicolle (2014), the aim of an effective CAUTI prevention strategy is the limitation of the unwanted use of invasive devices. Therefore, the researchers suggest implementing two primary types of intervention: the regulation of the unnecessary placement of catheters, and the timely removal of unnecessary catheters (Meddings et al., 2013).

A number of recent studies point out that the development of protocols for the management of urinary retention in hospitalized patients, regular reporting system and analysis of the use of indwelling urinary catheters, as well as its unfavorable effects on patients may be efficient in reducing CAUTIs (Dy, Major-Joynes, Pegues, & Bradway, 2016). Thus, hospitals should design organization-wide strategies to identify and remove catheters when they are not necessary. Moreover, Dy et al. (2016) state that nurse-directed interventions are essential to comprehensive prevention endeavors.

According to Fink et al. (2012), one of the most common practices aimed at the prevention of CAUTIs is the implementation of systems for catheters removal. The results of their extensive study carried out on the sample of 75 acute care hospitals reveal the given practice is performed in 56% of the surveyed settings. The evidence provided by Tenke, Mezei, Bőde, and Köves (2017) demonstrates that the removal of catheters as early as possible and the avoidance of catheterization are the most effective prevention methods. The researchers state that the consideration of the device material and surface properties is essential for intervention success, e.g., chlorhexidine/silver sulfadiazine-impregnated catheters may avert infections. Additionally, it is recommended to pay attention to hygiene regulations (Tenke et al., 2017).

Overall, the implementation of catheter removal protocols is correlated with the overall CAUTI rate decrease. For instance, Dy et al. (2016) found that CAUTI incidence per 1.000 days may be reduced by up to 28 percent. Moreover, the study demonstrates that the education of care providers on patient assessment, placement, management, and early removal of catheters increased nurses’ commitment to the administration of removal protocols and resulted in improved their decision-making skills.

Protecting patients and self from infections is one of the primary ethical obligations of every nurse. However, due to some organizational issues, e.g., staffing and heavy workloads, nurses may not always regard patient safety as a priority. Thus, an organization-wide enforcement strategy is required. The intervention plan must aim to provide the nursing team with an appropriate environment, knowledge, and support to implement hygiene practices and monitor catheterized patients in a regular manner. To achieve better results, it is important to remove the competing ethical and professional duties which may challenge nurses’ shift towards desirable behavior. Nicolle (2014) claims that the overall success of the intervention program largely depends on such organizational factors as the existence of relevant policies for catheter indications and infection control, staffing, the level of staff education and competence, access to necessary clinical supplies, information technology, etc. Therefore, before the realization of the actual intervention, the hospital should evaluate the organizational strengths and weaknesses and fill the identified gaps. In this way, it will be possible to eliminate potential ethical issues and improve patient protection capability.

Goals

The recommended intervention program includes the design of catheter removal decision support instrument, continual nurse supervision, and submission of catheterization documentation/reports. Consistently with the removal protocol guidelines, nurses will assess patients’ conditions, needs for catheterization, and the overall time of catheterization every day and remove the devices when required. Since education and awareness are essential to the adoption of protocols (Dy et al., 2016), prior to the plan implementation, nurses will be educated by the project leader and through self-learning both online and offline.

The short-term objective of this project is the reduction of catheter use, while the long-term goal is the decreased rate of CAUTIs in the hospital. The best way to measure the first objective is the direct observation of nurses’ performance. Other surveillance methods may include self-reports, automated monitoring systems, and so on. The data collected via self-reports, personal interviews, and group meetings will also allow the identification of factors that interfere with nurses’ adherence to protocols. The long-term outcomes of the intervention plan will be measured by using statistical analysis. The documents and reports on patient conditions, demographic backgrounds, time of catheterization, and removal, etc. composed by nurses during the intervention period will serve as the source of the necessary data.

Barriers

Staffing ratios, as well as other organizational problems, may affect the success of the plan implementation (Dy et al., 2016). High workloads and low levels of nurse staffing are the major proximal causes of patient neglect. Thus, inadequate work structure may be correlated with high CAUTI rates. To improve the intervention outcomes, hospital management should balance patient-to-nurse staffing ratios and decrease the risk for nurses’ burnout. In this way, a favorable environment for high-quality care will be created and, moreover, the level of staff motivation and commitment will be increased.

Another barrier is poorly developed nurses’ skills in aseptic techniques and inadequate hand hygiene. Although the suggested intervention program is mainly focused on the time of catheterization, health protection practices play a major role in the overall success of CAUTI prevention efforts. Proper hand hygiene, the use of sterile materials, compliance with the standardized contact guidelines, and environmental controls are associated with the decreased risk of transmission of pathogens. For this reason, it can be recommended to re-educate nurses on aseptic and clean techniques before the implementation of the intervention plan. Secondly, charge nurses and supervisors should continually observe how nurses keep up with hygiene regulations and standards.

Benefits

The CAUTI prevention strategy mainly benefits patients with chronic indwelling catheters because bacteriuria in these patients is unavoidable. According to Tenke et al. (2017), antibiotic treatment of asymptomatic bacteriuria does not result in the decrease of CAUTI but only increases the organisms’ resistance. Thus, by removing catheters when the condition of a patient allows it, it is possible to reduce the risk for CAUTI development, avoid unnecessary exposure to medicines, decrease morbidity and discomfort associated with CAUTIs.

When speaking of the benefits for the nursing profession, the suggested plan largely contributes to the development of nurses’ competence and awareness. It is possible to say that individual RN’s professional performance reflects the nursing profession as a whole and affects its public image. Thus, by improving the CAUTI prevention skills of staff members, hospitals and health providers may advance the whole of the profession and, in this way, enhance nurses’ self-efficacy and the overall quality of healthcare.

Participants and Interdisciplinary Approach

An inter-professional team comprised of physicians, nurses, nurse managers, clinical nurse specialists, etc. is needed to develop and implement the plan and required intervention protocols. Along with nurses, physicians may play one of the major roles in the intervention process because usually they are considered to be responsible for the decisions to maintain indwelling catheters, while nurses frequently remain unaware of why patients have them (Kolonoski, Stanley, & Anderson, 2012). Thus, by including physicians into the process of the protocol development, and combining their clinical expertise with nurses’ understanding of patients’ needs, it will be possible to identify the efficiency criteria and authority in decision making which each party will have in the CAUTI prevention program, e.g., nurses should provide medical justification for the catheter removal to physicians, the device insertion should require the physician’s order, and so on. Additionally, in the study by Dy et al. (2016), the representatives of the Clinical Information Systems and Center for Evidence-Based Practice (SCEBP) department were included in the interdisciplinary team. The SCEBP members may instruct the hospital personnel on the issues related to information technology use, electronic data collection, data management, and so on. Therefore, their participation may significantly reduce the administrative workload of the involved health providers and, in this way, resulting in greater time availability, confidence, and overall intervention success.

Conclusion

Urinary tract infections remain one of the most topical health issues and the most common type of care-associated infections. The condition is detrimental to patients’ health. It causes significant morbidity and, in some severe cases, leads to fatal outcomes. The fact that the majority of CAUTIs develop after the insertion of the convenient yet frequently unnecessary catheters, which are then become easily forgotten by the clinical staff members, indicates that a significant number of adverse cases are preventable. Therefore, the major purpose of the prevention plan is the limitation of unnecessary catheterization, as well as the early removal of catheters. It is suggested that since the factor of time is correlated with the risk for CAUTI occurrence, by controlling the length of the catheter use (or simply avoiding it), it will be possible to prevent infection and decrease CAUTI rates within the hospital.

The selected clinical issue negatively affects hospitals, clinical personnel, and patients. Over a million CAUTIs are reported per year, and each case is associated with an average additional cost of over $670 (Meddings et al. 2013). Nowadays, the enormous amounts of additional costs become a burden for many healthcare organizations because, since 2008, Medicaid and Medicare do not provide hospitals with reimbursements for catheter-related complications. Without public health insurance coverage, many patients suffering from CAUTIs fail to pay their medical bills and, as a result, the number of outstanding revenues grows. Therefore, the prevention plan may help to improve the financial performance of hospitals. Along with this, the suggested strategy will foster a greater level of nurses’ awareness and improved professional performance. Moreover, in the long run, not only the standardized approach to CAUTI prevention may cause a decrease in infection rates, but also the development of professional confidence in nurses and greater time efficiency. Lastly, the plan is beneficial for patients, especially those who are associated with the increased risk for CAUTI occurrence (i.e., women of advanced age and patients with chronic indwelling catheters). The avoidance and removal of catheters can lead to better patient outcomes, reduce discomfort, and eliminate the issue of catheter-related immobility.

References

Amine, A. E. K., Helal, M. O. M., & Bakr, W. M. K. (2014). Evaluation of an intervention program to prevent hospital-acquired catheter-associated urinary tract infections in an ICU in a rural Egypt hospital. GMS Hygiene and Infection Control, 9(2), Doc15. Web.

Dy, S., Major-Joynes, B., Pegues, D., & Bradway, C. (2016). A nurse-driven protocol for removal of indwelling urinary catheters across a multi-hospital academic healthcare system. Urologic Nursing, 36(5), 243-249. Web.

Fink, R., Gilmartin, H., Richard, A., Capezuti, E., Boltz, M., & Wald, H. (2012). Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals. American Journal of Infection Control, 40, 715-720. Web.

Kolonoski, P., Stanley, K., & Anderson, K. (2012). An interdisciplinary approach toward reducing the incidence of catheter-associated urinary tract infections in a post-acute facility. American Journal of Infection Control, 40(5). Web.

Meddings, J., Krein, S. L., Fakih, M., Olmsted, R., & Saint, S. (2013). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infections: Brief update review. In Making health care safer II: An updated critical analysis of the evidence for patient safety practices (pp. 67-73). Rockville, MD: Evidence Reports/Technology Assessments.

National Council of State Boards of Nursing. (2016). NCLEX-RN Examination: Test Plan for the National Council Licensure Examination for Registered Nurses. Web.

Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial Resistance and Infection Control, 3, 23. Web.

Tenke, P., Mezei, T., Bőde, I., & Köves, B. (2017). Catheter-associated Urinary Tract Infections. European Urology Supplements, 16(4), 138-143. Web.

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

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

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

Glomerulus

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

Function of the Urinary System

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

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

Urinary Tract Infection

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

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

Epidemiology

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

Causes of UTIs

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

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

UTI Symptoms/signs

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

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

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

How STIs are Diagnosed

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

UTIs Diagnosis

Classification

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

In children

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

Differential diagnosis

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

UTI risk factors

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

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

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

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

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

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

Possible Complications UTIs

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

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

UTI Treatment

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

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

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

Prevention of UTIs

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

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

UTI prognosis

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

Works Cited

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

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

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

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

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

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

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

Pathophysiology of Urinary Tract Infections

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

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

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

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

Gender and Behavior as Factors Influencing the Pathophysiology of UTI

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

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

Conclusions

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

References

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

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

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

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

Introduction

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

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

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

Public health management of hepatitis B virus infection

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommendations

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

Conclusion

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

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

References

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

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

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

The school nurse could advise Megan to visit a nurse practitioner or a gynecologist, to drink a lot of water as suggested by some practitioners, and to urinate as often as possible. She could also advise her not to have sexual intercourse until her symptoms are gone, or the illness is cured.

The information that the nurse practitioner should consider is the possible non-sexually transmitted infections that can cause the change in the vaginal discharge and the urge to urinate frequently. For example, bacterial vaginosis and candidal infections might be considered. Full clinical history of the patient should be obtained together with the information about medications that Megan takes (e.g., antibiotics). Potential allergic reactions are also possible and need to be discussed with the patient. The recommended treatment for C.trachomatis is azithromycin (1 g in a single dose) or doxycycline (100 mg, twice a day x 7 days) (CDC, 2015).

Erythromycin (500 mg, four times per day x 7 days) or levofloxacin (500 mg, 1 x 7 days orally) are also possible regimens. Additional recommendations include prescribing a single-dose therapy with azithromycin onsite if there is a concern about the adherence to multi-day dosing (CDC, 2015). Furthermore, to exclude the transmission of the disease to sex partners, Megan needs to abstain from sexual intercourse for seven days after a single dose treatment or during the multi-day treatment (CDC, 2015). It is also advisable to wait for the resolution of symptoms. Her partner(s) should also be treated to ensure that the risk of a reinfection is minimal.

As stated in the case study, Megan was tested for HIV and GC (Harkness & DeMarco, 2015). A testing for syphilis is also necessary (CDC, 2015). As patients with C.trachomatis are often coinfected with N.Gonorrhoeae, it is advisable to follow the same prescriptions related to the abstinence from sexual intercourse during treatment and to ensure that other sexual partners are treated as well. In this case, Megan needs to notify her recent sex partners about the illnesses so that they can seek treatment too (Harkness & DeMarco, 2015). N.Gonorrhoeae is treated with ceftriaxone (250mg x single dose) and azithromycin (1 g orally, single dose) or doxycycline (100 mg orally, twice a day x 7 days) (Harkness & DeMarco, 2015). Gonorrhea is a disease that needs to be reported to local health authorities (mandatory written reporting is required) (Medline, 2017). C.trachomatis does not need to be reported.

Primary prevention for HIV includes the use of condoms during sexual intercourses, testing for HIV, and undergoing behavior changes that will help decrease the risk of being infected with HIV (e.g., engage in protected sexual intercourse only and be aware of your partner’s HIV status). It is necessary to use a new condom every time a person has sex with a partner whose HIV-status is unknown to them (Megan, in this case).

Condoms need to be used during anal and vaginal sex to avoid being infected. If Megan takes any drugs by injecting, it is important for her to use clean needles that are not shared with others. In this case, it is also necessary for Megan to seek help if she acknowledges drug use (or abuse). If it is impossible for her to use new condoms every time she has sex with a partner with unknown HIV status, she needs to abstain from having sexual intercourse with this person. If she has oral sex, the use of a condom is necessary too (it can be cut-open). Female condoms are also an option.

References

CDC. (2015). Chlamydial infections. Web.

Harkness, G. A., & DeMarco, R. F. (2015). Community and public health nursing evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins.

Medline. (2017). Reportable diseases. Web.