NSG 604 Module III: Discussion 2 Wilkes University

Choose an infectious disease from your practice area. Identify common sources and modes of transmission. How does knowing this information impact how you care for someone with an infectious disease? How does this impact developing and implementing a plan to mitigate community spread?

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59 PM EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resources module. 

Clostridium Difficile infection

The latter, a nurse nightmare in the hospital setting. Any experienced would know if a patient with C-diff is on the unit just by the smell of the diarrhea. A very distinct and very strong smell. 

The infection is due to a bacterium. It is a side effect of antibiotics.

People over 65 taking antibiotics, people residing on long term facilities, people in hospitals and people with weakened immune systems are the most susceptible. (CDC, 2019)

Symptoms start a few days to weeks after the infection. These include watery diarrhea, loss of appetite, fever and stomach tenderness.

This infection can be deadly. For instance, 12800 people in the US died of the infection in 2017 (CDC, 2019)

C diff is found in the gut of 1-3% of the population. These people chronically carry the disease moreover they don’t show signs of the disease. Hence when Abx is taken the latter kills the infection as well as disturbing the flora of the gut, killing symbiotic bacteria and allowing to Cdiff to grow disproportionally. This is also the case in people with weakened immunity as normally, the immune system controls any abnormal growth of the bacteria. Moreover, when the immune system is weakened as in the case of HIV, the normally weak bacteria grow and creates an infection (Public, 2008). C diff pores and bacteria also found the stool of an infected person and hence in the immediate vicinity. In the hospital this consist of all surfaces in the room of an infected person including the floor.

Transmission consists by touching infected surfaces in the vicinity of a person with active infection and later on touching food that is consumed. Infected people post treatment could also carry the disease and despite not showing signs of infection could still spread it. (THE PROGRESSION of A, n.d.).

Hence while caring for a patient with an active infection in the hospital setting, the patient is placed in an isolation room. Gown and gloves are always worn in the room, 

Furthermore, hand hygiene is primordial post care for a patient with an active infection. Also, the need to adequately clean any utensils used during care of the patient.

Also, people who had previous infection should adhere to strict hand hygiene and communicating with healthcare workers about the presence of previous active infection. (THE PROGRESSION of A, n.d.)

This communication of information will help healthcare workers to take preventive action in preventing further progression in the community.

In case where infection is repetitive, fecal microbiota transplant may be warranted. This further mitigates the risk in the community as the latter is a venue where control of the infection and propagation will be challenging (CDC,2019)

 References

1-CDC. (2019, November 13). Clostridioides difficile Infection. Centers for Disease Control and Prevention. https://www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html

2-Public. (2008). Fact Sheet – Clostridium difficile (C. difficile) – Canada.ca. Canada.ca. https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

3-THE PROGRESSION OF A. (n.d.). https://www.cdc.gov/cdiff/pdf/Cdiff-progression-H.pdf

‌

In my clinical practice as an instructor, I have seen many cases of Clostridiodes difficle, most commonly referred to as C-difficile.  According to Czepiel et al. (2019), clostridium difficle is defined as a gram-positive anaerobic bacillus that is found in the intestinal tracts of both animals and humans and is spread by transmission by the fecal-oral route.  In addition, the transmission also occurs with exposure to a contaminated environmental surface and contact with spores from a colonized hand of a healthcare worker (Guh & Kutty, 2018).  Since my students and I are assigned to a long-term care facility, the patient population is identified as a significant risk factor; as Czepiel et al. (2019) point out, one risk factor for this illness is if the patients are in a hospital or nursing home.

            In applying the epidemiological concepts, asymptomatic carrier patients are also identified as a reservoir for the illness (Czepiel et al.,2019).  In addition, other reservoirs include dogs and cats as well (Czepiel et al., 2019).  One thing we need to keep in mind is that this pathogen does not only affect those with risk factors; children can be reservoirs as well.  Czepiel et al. (2019) pointed out that approximately 5% of adults and between 15-70% of children have been colonized with c-diff.

            Since this pathogen is spread by the fecal-oral route and contamination of surfaces, first and foremost, hand hygiene should always be a priority.  Guh and Kutty (2018) report that conventional handwashing with soap and water is the best method as opposed to alcohol hand rub to remove spores from the hand.  In addition, proper PPE should be worn; likewise, according to Guh and Kutty (2018), infected patients should have disposable equipment in the room, for example, stethoscopes, gowns, and blood pressure cuffs. The patient’s room should be cleaned daily, focusing on touched or high-touch surfaces (Guh &  Kutty, 2018).

            Treatment modalities for c-diff include vancomycin and metronidazole.  However, caution must be advised, as patients who receive antimicrobial therapy are at risk for developing a CDI and are at “8 to 10-fold higher during antimicrobial therapy and four weeks after that (Czepiel et al., 2019).”

            Lastly, in helping to mitigate the spread, it is essential to recognize the signs of c-diff.  Symptoms such as abdominal pain, watery diarrhea, potential fever, or loss of appetite should be noted (Czepiel et al., 2019).  If the patient is identified to show these signs and is found to have the diagnoses, proper isolation, with appropriate PPE, is instituted.  Thus, all healthcare providers and visitors must perform hand hygiene at all times, as well as wear gloves and disposable gowns.  In addition, patients will take the prescribed antibiotics to combat the pathogen, receive appropriate follow-up care to be monitored, and receive hydration therapy to replenish fluid and electrolyte imbalances (Guh &  Kutty, 2018).

                                                            References

Czepiel, J., Dróżdż, M., Pituch, H., Kuijper, E. J., Perucki, W., Mielimonka, A., Goldman, S., Wultańska, D., Garlicki, A., & Biesiada, G. (2018). Clostridium difficile infection: Review. European Journal of Clinical Microbiology & Infectious Diseases, 38(7), 1211-1221. https://doi.org/10.1007/s10096-019-03539-6

Guh, A. Y., & Kutty, P. K. (2018). Clostridioides difficile Infection. Annals of internal medicine, 169(7), ITC49. https://doi.org/10.7326/AITC201810020

Antimicrobial resistance is becoming more common in the hospital setting. Enterococcus species are a leading cause of hospital acquired infections, with vancomycin resistant enterococcus (VRE) emerging as a major concern. Ironically, these organisms are of low virulence and low pathogenicity, yet remain capable of causing severe infection in those who are susceptible (Puchter et al., 2018). Enterococci are anaerobic gram positive cocci in pairs and chains, normally found in the gastrointestinal (GI) tract as part of the normal intestinal microbiome. VRE can also colonize the GI tract and has the potential to cause infection, making treatment decisions a challenging dilemma.

     Sites for VRE infection are generally seen in urine, blood, and occasionally wounds. The greatest risk factor for development of VRE infection is previous antibiotic therapy, and those with chronic illnesses or who are immunocompromised are also at an increased risk. Catheter associated urinary tract infection (CAUTI) and central line associated blood stream infection (CLABSI) account for the majority of VRE infections. Correa-Martinez et al. (2022) conducted a population based prospective longitudinal study discussing the emerging new strains of VRE bloodstream infections and their greater antibiotic resistance, as well as enhanced capability for transmission. In turn, these patients will have lengthier hospital stays, require more expensive treatments, and have higher mortality rates, causing more stress to the health care delivery system. Thus, creating more economic burden.

     The primary mode of transmission is through contact with an infected person or infected object. Enterococcus can remain on hands for up to sixty minutes after inoculation, and as long as four months on inanimate surfaces (Levitus et al., 2022). Patients with VRE should be placed on contact precautions to include gown, gloves, and eye protection to be worn when caring for a patient or handling soiled linens from the patient. Hand washing is mandatory after care and personal protection equipment is removed. Multidisciplinary coordination of care is optimal for treatment. Infectious Disease staff can offer recommendations regarding antibiotic therapy based on sensitivity results. All health care providers must be practice good antibiotic stewardship in an effort to reduce antibiotic resistance. Surveillance cultures may be helpful in determining if the infection has cleared once treatment is completed.

     VRE, although more common in the hospital setting, is also seen in the community. Because transmission occurs through contact either from another person or contact with a contaminated object or surface, education is key in prevention. For example, infected people should always wash their hands with soap and water after bathroom use and when preparing food. Frequent cleaning of kitchen and bathroom areas will help prevent the spread of VRE. People with a known infection or a history of a VRE infection should make all health care providers aware to ensure proper measures are taken when seeking care.

References

Correa-Martinez, C., Jurke, A., Schmitz, J., Schaumburg, F., Kampmeier, S., & Mellmann, A. (2022). Molecular epidemiology of vancomycin-resistant enterococci bloodstream infections in Germany: a population-based prospective longitudinal study. Microorganisms, 10(130). https://doi.org/10.3390/microorganisms10010130

Levitus, M., Rewane, A., Perera, T.B. (2022). Vancomycin-resistent enterococci. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/30020605/

Puchter, L., Chaberny, I.F., Schwab, F., Vonberg, R., Bange, F., & Ebadi, E. (2018). Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrobial Resistance and Infection Control, 7(1). doi: 10.1186/s13756-017-0291-z