Infection Control Measures of Some Infectious Diseases - Assignment Example

Infection Control Measures of Some Infectious Diseases Control measures applied Virus Parasite Bacteria Fungus To the host Measles immunizartion to children 12-15 months and older and to adults born in or after 1957 (Layne, 2005). Vaccination to all susceptible household contacts who have not been immunized or who are unaware of their immunization status (Layne, 2005). Health care worker handling infected individuals should use a gown and protective mask (HEPA). Protection from biting mosquitoes is the first line of defense against malaria in endemic areas ((Phillips, 2001). Malaria prophylaxis in the first 3 months of pregnancy Chloroquine/Proguanil is safe for use in the first trimester (2004). Travelers to countries where malaria is prevalent, such as the Dominican Republic and Gambia, take the appropriate preventative medication prior to traveling, during their stay abroad and for a period after returning (2004) Protect mucous membrane of eyes mouth and nose from blood splashes (Wong). Prevent puncture wounds, cuts and abrasions in the presence of blood (Wong) Primary immunization of tetanus toxoid at two months of age, and two more doses of tetanus toxoid-containing vaccine at two-monthly intervals (Alagappan, 2001). Booster at four years of age, plus a further booster dose prior to leaving school (15–17 years of age) and again at 50 years of age (2006c). Passive immunization with tetanus immunnoglobulin, if the patient has not been previously immunized with a series of at least three doses of toxoid (Alagappan, 2001). Tetanus immunization every ten years, especially the elderly (over 60 years old) who are at an increased risk for acquiring tetanus (Alagappan, 2001) Screening close contacts and treating if positive by using topical anti-fungal shampoo 2x a week (2006a). Siblings and playmates of patients should avoid close physical contact and sharing of toys or other personal objects, such as combs and hairbrushes (Kao, 2006). To the vectors Chemical control of mosquitoes using petroleum oils and derivatives sprayed onto water, forming a film thus preventing larvae and pupae from breathing through the surface of the water (Phillips, 2001). Biological Contol: The use of mosquito damaging fish, bacteria, protozoa, nematodes or fungi in domestic ponds or standing water (Phillips, 2001). Residual spraying with DEET and DDT for killing adult mosquitoes living indoors. (2004). Use of screens over doors and windows (Phillips, 2001, Rietveld, 2004). Use of anti-mosquito sprays or insecticide dispensers that contain tablets impregnated with pyrethroids, or burn pyrethroid mosquito coils in bedroom at night (Rietveld, 2004). To the environment A ventilation system (consisting of at least an extractor fan) (Wong). Hand washing with either a non-medicated soap or a detergent antiseptic preparation before and after contact with the patient (Wong) All surfaces and walls must be washed thoroughly with warm water and detergent and dried (wipe over with a disinfectant) (Wong). All bed linens, curtains etc. that is sent to the laundry should be clearly marked "infected" The bed mattress and pillow should be wiped with warm water and detergent and dried thoroughly (Wong). All equipment and supplies should be thoroughly disinfected Drainage and water management (Phillips, 2001). Land reclamation by filling in ditches, covering water containers and flushing irrigation channels to prevent continued infestation; clearing ponds of weed growth, which allows the introduction into ponds of fish which eat mosquito eggs and larvae (Phillips, 2001) Although the bacteria found in dirt, soil and manure causes a potentially fatal tetanus, control of the environment is not required (2006c). Cleansing of fomites Cleaning brushes and combs in a bleach solution or disinfectant (Kao, 2006). Restricting the sharing of hair brushes, combs and hats (Kao, 2006). The organism remains viable on couches and sheets for long periods, wash sheets and nightclothes every day while infected (Kao, 2006). Barber tools should be cleaned and sterilized (Kao, 2006). Treatment household pets with lesions on skin and scalp (Kao, 2006) To infected individuals Patients must be kept in isolation until 4 days after the appearance of the rash (2006b). Patient is placed under airborne infection isolation (Wong). Provide masks for all patients presenting with respiratory symptoms (especially cough) (2003). Proper use and disposal of tissues when coughing, sneezing or controlling nasal secretions (Plough, 2004). Hand hygiene after handling secretions (Plough, 2004). Reporting of malaria cases (Rietveld, 2004). Should not donate blood for at least 3 years, and proper blood screening done prior to blood donation (Wong). Cover existing wounds or skin lesions with waterproof dressings (Wong) No isolation is required for patients (Rietveld, 2004). Control of case by referring the patient immediately to a specialised centre with intensive care facilities (Alagappan, 2001). Once a patient recovers, tetanus toxoid must be given, because the very small quantity of tetanospasmin required to produce the disease is insufficient to induce adequate antibody titers (Alagappan, 2001). Tetanus immunoprophylaxis of wounds (Alagappan, 2001). Proper and adequate wound debridement to discourage growth of anerobic Clostridium tetani. Spores become vegetative only if the oxygen tension is low as in necrotic tissue and poorly vascularized areas (Alagappan, 2001). Control of contacts is not required (Alagappan, 2001). Exclusion from school until appropriate treatment has commenced (Guilliams, 2006). Control of case For tinea capitis oral griseofulvin is the treatment of choice. Topical anti-fungal medication selenium sulphide or ketoconazole shampoos may be used concurrently to reduce infectivity by reducing the carriage of viable spores (Kao, 2006). Reporting of cases to the local health department (Kao, 2006). Infection Control Measures of Some Infectious Diseases Infection is the entry, development and reproduction of disease-causing microorganisms, i.e., bacteria, viruses, viroids, fungi, rickettsias, and protozoans in the body of a host resulting to a disease process due to tissue injury and altered cellular metabolism. A communicable or infectious infection is easily passed from one person to another transmitted in several ways (contact, droplet, airborne, common vehicle, or vector) through a “chain of infection”. Eliminating or breaking any link in the chain will halt the spread of the infection (Stanwell-Smith, 2006). Measles is a viral disease caused by morbillivirus in the paramyxovirus family. The virus usually enters the respiratory tract via airborne droplet nuclei. It is a human disease with no known animal host (2006b). On the other hand, Tetanus is caused by Clostridium tetani, a gram-positive anaerobic bacterium found mostly in warm climates regions that are rich in organic soil. Tetanus spores are omnipresent, highly resistant to destruction, and can live on almost any surface for long periods of time. Any break in the skin can allow spores to go into the body, where they can become vegetative and consequently produce tetanospasmin, a very potent neurotoxin (Alagappan, 2001). Additionally, malaria is a protozoan disease caused in humans by four species of the genus Plasmocium (P. falciparum, P. vivax, P. ovale, and P. malariae). It is carried from person-to-person by the bite of an infected female Anopheles mosquitoes biting mainly between sunset and sunrise. It is typified by extreme exhaustion combined with outbursts of high fever, sweating, shaking chills, and anemia (Rietveld, 2004). Moreover, tinea capitis is superficial fungal infection that invades the skin of the scalp, eyebrows and eyelashes, with a tendency to attack hair shafts and follicles. It is caused by fungi of genera Trichophyton and Microsporum (Kao, 2006).Young children are particularly at risk to tinea capitis, also known as ringworm of the scalp. It is the most common pediatric dermatophyte infection worldwide (2006a). It is transmitted by direct contact with an infected person or animal, or indirectly via objects contaminated with the infective organism (Kao, 2006). The most important public health intervention for containing the spread of infectious diseases is infection control. Among the key concepts to consider in infection control is that infectious diseases can be efficiently transmitted if patients are not immediately recognized and infection control precautions are not applied (Guilliams, 2006). Therefore, the basic infection control measures are a critical component of infectious diseases prevention strategies. In this light, the keys in thwarting the spread of infectious diseases are implementation and adherence to infection control practices (2002) .In measles and tetanus infection control, the single most important preventive measure is to keep a high level of immunization (2003). Vaccination remains to be the chief measure to avert infection or progress of illness and in this manner limits spread of the illness and prevents complications. But since measles remain to be a highly contagious infectious disease that causes death among young children, a strong routine immunization of measles is recommended. Measles vaccine which is live and attenuated is often included with mumps and rubella (MMR vaccine) is given to children at nine months of age and shortly thereafter (2003). In addition too this, adults born in or after 1957 should be given a vaccination against measles (Layne, 2005). And to assure measles immunity n children who failed to obtain a previous dose of measles vaccine, as well as in those who failed to develop immunity following vaccination, a ‘second opportunity’ for measles immunity is provided to all children (2003). An immediate search for susceptible contacts who have not been immunized or unaware of their immunization status so that they too will be immunized with live vaccine within 7 hours of exposure to limit the spread of the disease (Wong). Similarly, in tetanus infection control, the optimal use of vaccines can prevent the spread of vaccine-preventable diseases and eliminate unnecessary development of complications. The protection of children can lead to a lower incidence of natural resistance, which is often the only form of protection later in life. Children as young as two months old receive primary immunization of tetanus toxoid. It is followed by two more doses at two-monthly intervals (Alagappan, 2001). To ensure immunity, booster shots are administered at four years of age and at 15-17 years of age and again at 50 years of age (2006c). The elderly (over 60 years old) are at an increased risk of acquiring tetanus should be immunized against tetanus ever ten years (Alagappan, 2001). If the patient has not been previously immunized with a series of at least three doses of toxoid, passive immunization with tetanus immunoglobulin is given (Alagappan, 2001). Tinea capitis generally affects children and requires minimum control measures. There is no vaccine against ringworm of the scalp but one effective measure is education f children and parents regarding the modes of spread from infected children and animals, prevention and the need to keep up a high standard of personal hygiene (2006a). Malaria is preventable and treatable, but unlike in measles and tetanus, there is no available vaccine against malaria (2006a). There are two major approaches to reduce the chance of infection: 1) personal protective measures and 2) public health measures to lessen the mosquito population (Rietveld, 2004).The first line of defense against malaria therefore is personal protection from biting mosquitoes (Rietveld, 2004). Measures suggested include avoiding going out between dusk and dawn when mosquitoes normally bite, wearing long-sleeved clothing and long trousers when going out at night, avoiding dark colors clothing which attract mosquitoes, avoiding perfumes and colognes, application of insect repellent with DEET or dimethylphthalate on exposed skin, using of insect screens and using of bednets and curtains impregnated with insecticides (Phillips, 2001). Among the infectious diseases discussed earlier, malaria is the only disease that is vectorborne. The female Anopheles mosquito carry the pathogen Plasmodium and pass them on when they bite an unwary host (Guilliams, 2006). The World Health Organization advocates that there are three elements that are crucial in malaria control. One of the elements of the malaria control strategy is sustainable and selective application of vector control (Rietveld, 2004). This includes decreasing the numbers of vector mosquitoes by eradication, destruction of mosquito breeding sites, destroying larval, pupal and adult mosquitoes, and lessening human-mosquito contact (Phillips, 2001). Chemicals continue as the mainstay of mosquito control to curtail the mosquito s life span so that itcannot transmit malaria infection. (Rietveld, 2004). DDT and DEET are the two main insecticides used to combat the anopheles mosquitoes (2004). In addition to these, knock-down sprays, mosquito coils, or plug-in vaporizing devices are used indoors to control residual adult mosquitoes (2006a). Apparently, one of the best means to control the spread of the malaria vector, is to attack it at its source which is the breeding and egg stage (Rietveld, 2004).Petroleum oils and derivatives sprayed onto water are also being utilized to forming a film on the surface of the water thereby preventing larvae and pupae from breathing through the surface of the water (Phillips, 2001). The malaria situation worldwide is weakening. There is rising level of spread associated with vector resistance to insecticides. Worldwide, an estimate of 220 million new cases a year has been reported in areas of Asia, Africa, Central and South America (WHO). Researches have been launched in genetic control following the breakthrough of the genome of A. gambiae and P. falciparum, in developing genetically-engineered mosquitoes that could no longer harbor the Plasmodium parasite (Phillips, 2001). The highly communicable measles virus is spread by large droplets during close contact, or indirectly by coming in contact with respiratory secretions and by airborne virus-laden droplets. These large droplets, released when an infected person coughs or sneeze can come in contact with the nose, mouth or eyes of susceptible persons who are within 3 feet from the infected individual (Stanwell-Smith, 2006). Indirect contact with the respiratory secretions of the infected person can occur from touching surfaces contaminated with measles virus and then touching the eyes, mouth or nose. Droplets circulating in the air as a result of coughing and sneezing remain active and contagious for a couple of hours (Plough, 2004). To reduce the transmission of infectious agents through the air, Airborne Infection Isolation is applied to the patient. This requires a private room with special air handling (extractor fan) and negative pressure. Cohorting is done if no private room is available. It is placing the patient in a room with a patient with the same infection (Guilliams, 2006). Airing the room by opening the windows daily helps reduce the numbers of airborne microbes in the room. Also, any room where the infected patient stayed should be left unoccupied for at least a couple of hours after the patient have left (2003). Respiratory protection for both visitors and staffs handling the patient is necessary when entering the patient’s room. Surgical or procedure masks (HEPA) should be worn when entering the patient’s room and discarded in waste containers when leaving the room. In addition to this gloves and aprons should be worn when handling the infected materials and sites of the patient (Guilliams, 2006). Vigorous bed-making should be avoided in Airborne Isolation. Used linens should be properly marked and labeled for laundry for they may pose a hazard to the laundry staff (Plough, 2004). Strict adherence to Airborne Isolation of patients for four days after the onset of the rash. Visitation restrictions should be observed because there is a high proportion that susceptible close contacts will also become infected with the measles virus (2003). Respiratory hygiene/cough etiquette should be executed at the first contact with an infected person to prevent the transmission of all respiratory tract infections. It includes: 1) visual alerts requesting patients and visitors to inform healthcare personnel of respiratory symptoms, 2) providing tissues or masks with presenting repiratory symptoms to cover their nose and mouth, 3) provide instructions to proper disposal of used masks and tissues contaminated with nasal and throat discharges, 4) ensuring hand hygiene materials (alcohol-based hand rubs) are available at the sink area, and 5) encouraging infected persons to keep a distance of 3 feet away from others (Plough, 2004). In malaria, environmental control consists of flushing irrigation channels, clearing pond of weeds, filling in ditches and covering water containers. These actions promotes the growth and multiplication of fish into ponds which feast on mosquito eggs and larvae reducing breeding sites (Phillips, 2001). People traveling to malaria endemic areas are at risk. Prophylactic drugs should be taken regularly for the duration of the stay in the malaria risk area. Medications should be maintained for a month after the last possible exposure to infection because parasites may still emerge from the liver and cause disease during this period (Rietveld, 2004). Chloroquine and mefloquine are antimalarial drugs given to cure malaria infections. They do not totally eradicate mature Plasmodium falciparum gametocytes from the bloodstream. Thus, a person who has been treated with antimalarial drugs may be healthy but infective for on average 2 months until the gametocytes die off naturally, or until another drug such as primaquine is given that eliminate the gametocytes. If untreated or inadequately treated, infected cases remain infectious for years because gametocytes persist (Phillips, 2001). But present studies reveal that There is no drug that is absolutely risk-free and completely effective for prophylaxis against malaria. Over-reliance on chemoprophylaxis is risky as the malaria parasite continues to change and develop drug resistance (2004). Isolation and exclusion of infected individuals is not required unlike in measles infection (Rietveld, 2004). But aarly diagnosis with prompt proper treatment is necessary because malaria can be a fatal disease If adequately and promptly treated, malaria is a curable disease (Rietveld, 2004). Priority measure is prevention of mosquito contact with the patient. The country or area of acquisition should be determined so that sources of e.g. blood transfusion can be further investigated, because malaria can also be transmitted by blood transfusion, and by contaminated needles and syringes (Phillips, 2001). C. tetani is widely distributed in cultivated soil and in the gut of humans and animals. Spores of C. tetani can usually be found in contaminated soil with animal excreta. Spores may possibly linger viable for many years in the environment that may be introduced into the body through puncture wounds, burns or lacerations (Alagappan, 2001) . Control measure of tetanus infected individuals is equally the same to those with malaria and ringworm. Exclusion or isolation is not necessary. Worldwide, tetanus occurrence is now rare due to high immunization rates in developed countries which is comparable to measles. In the case of tetanus, control of the environment and contacts are not required (2006a). In Tinea capitis infection, school exclusion is only until treatment has commenced and the child with ringworm may attend school even if under treatment. In the control of its spread, no special measures are needed. With Tinea capitis, although not particularly dangerous, early treatment of infected persons is crucial (Kao, 2006). Treatment of infected individual is usually a combination of topical and oral antifungal preparations. Examination and treatment of siblings, playmates and household pets are indicated. Health education on preventive measures that includes not sharing personal items such as hair care articles, bed linens and clothing to prevent transmission should be implemented (2006a). Generally, the purpose of infection control is to thwart new infections and arrest their spread whenever prevention is not likely. Infection control is unending as pathogens freely thrive (Stanwell-Smith, 2006). Actions that can prevent infections vary in every pathogen. But in general, the common infection control actions include: prompt identification of the infectious illness through surveillance, protection of individuals through immunization or chemoprophylaxis, treating affected individuals to stop colonization or infection and breaking off transmission and spread through aseptic measures such as periodic handwashing, environmental sanitation and decontamination, proper disposal of contaminated objects, and ventilation control (Guilliams, 2006). Morbidity and mortality rates can be significantly reduced through immunization which is by at large is safe, effective and economical. In any infection, the affected individual should be referred to a local health department so that prompt diagnosis and proper treatment can be instituted (Stanwell-Smith, 2006). Control of a spread of infectious diseases involves alleviating the immediate clinical outcomes, averting the progress of the epidemic, and avoiding future recurrences of the epidemic. This indicates improving disease management and transmission control (Guilliams, 2006). Bibiliography (2002) General Infection Control Measures Boston, MA The Massachusetts Department of Public Health (2003) Communicable Diseases and Epidemiology Measles (Rubeola) Prevention and Control Seattle, WA Public Health - Seattle & King County. (2004) Health Protection Agency Warns of Malaria Risk to Travellers. Infection Control Today. Virgo Publishing. (2006a) Infectious Diseases: Epidemiology and Surveillance. Victorian State Government, Department of Human Services, Australia. (2006b) Measles. WHO Health Topics. Geneva, World Health Organization. (2006c) Tetanus. Infectious Diseases: Epidemiology and Surveillance Victorian State Government. ALAGAPPAN, K. (2001) Tetanus: An Overview. Hospital Physician. GUILLIAMS, J. (2006) Principles of Infection Control. Roanoke, VA, William Fleming High School KAO, G. F. (2006) Tinea capitis. IN EMEDICINE (Ed.), WebMD. LAYNE, S. P. (2005) Measles. Principles of Infectious Disease Epidemiology. UCLA School of Public Health. PHILLIPS, R. S. (2001) Current Status of Malaria and Potential for Control Clinical Microbiology Reviews, 14, 208-226. PLOUGH, A. L. (2004) Measles (Rubeola) Prevention and Control Recommendations for Health Care Providers and Facilities Healthy People Healthy Communities. Public Health-Seattle & King County. RIETVELD, A. (2004) Frequently-Asked-Questions about Malaria WHO. STANWELL-SMITH, R. (2006) Infection Challenges and Their Control. RedOrbit. WONG, D. Infection Control Measures Against Viral Infections Hong Kong.  Read More