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Infection Control In Secondary Care Setting - Shingles Add in library

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Question:

Describe about the Infection control in secondary care setting for Shingles?

 

Answer:

Introduction

Shingles is a viral disease and a secondary infection of varicella zoster virus (VZV) and causes painful blisters as well as rashes in one side of the body (Richter, K. 2014). This disease can be caused as the reactivation of previous disease with herpes zoster virus or chicken pox virus. There is much kind of risk factors present behind the occurrence of disease. The risk factors are like if anyone has had chicken pox infection or the chicken pox vaccine then there is possibility that he may carry the herpes zoster virus. This virus in turn can cause shingles. The people who have immunodeficiency have the chance of the occurrence of the disease. It has been seen that people with the risk factors for shingles are found to be healthy as their immune system is strong. In this assignment the infection control for the varicella zoster virus within a health sector has been described. The only known host for the VZV infection is human. The mode of transmission of the varicella zoster virus is from person-to-person and by the droplets and air. The infection must occur when in close contact. Although the virus is very much labile so that it cannot be transmitted via inanimate objects like hospital instruments. There is report for nosocomial infection of this virus. For that reason the virus can be transmitted via air route or by droplets. In contrast, there is no report of the transmission of the virus to the term infants as there is a protection of the maternal transplacental antibodies.  To avoid this kind of spreading there is a guideline of CDC that tells that after vaccination who produce rashes should avoid the contact with other persons. EPIC3 and UK based NICE guidelines have to be followed by the hospitals to prevent the spreading of the varicella zoster virus.

Signs, symptoms and difficulties of shingles

Shingles cause pain instead of itching that occurs mainly during chicken pox. The common symptoms and signs include a caution period, outburst of blisters and rashes, and finally pain and flu like symptom.

The warning period: In this case, include skin irritation, itchiness, burns and tingling sensations that usually occur in only one portion of the body. These symptoms may be temporary or permanent. Symptoms may last for two to three days or for a longer time (Jones and Jones, 2013).

Rashes and Blisters: After the warning period of shingles, rashes appear all over the body or in that specific portion. Finally, those rashes turned into blisters that turn bloody before they scab and heal. This lasts for two to three weeks. This phase is so much painful that painkillers are wastage (Hosseini et.al. 2015).

Difficulties of shingles occur in any person with the situation, but are more probable in older adults and those with a destabilized immune structure (Pinninti and Kimberlin, 2013). In general, problems arise in about 12 percent of all persons with shingles. Post-herpetic neuralgia (PHN) is the most general problem of shingles. It causes gentle to harsh pain or horrible sensations and is frequently described as burning. PHN affects 10 to 15 percent of patients, that is a great number, and with about half of these cases in individuals older than 60 years (Gupta et.al. 2015).

Eye complications take place in regarding 2 percent of persons. These are severe cases of shingles. These are much more likely to happen when the shingles rash occurs roughly around the eye. These problems are severe and can lead to loss of visualization (Yawn et.al. 2013). Herpes zoster virus (HSV) of the eye can grounds irritation, injures retina, and termed as acute retinal necrosis. The retina is present in the rear of the eye, and senses beam and facilitates vision. Retinal irritation can develop quickly in persons with HIV virus. Retinal irritation generally initiate with fuzzy hallucination and pain in the one eye. In half of the persons, it afterward distresses the other eye. (Takhar et. al. 2015). These viruses can origin irritation of the ear known as Ramsay Hunt syndrome. Signs consist of the flaw of the facial strength on the exaggerated side. Groups with a weakened immune structure, which includes populace contaminated with HIV, are at considerable hazard for harsh varicella zoster virus linked difficulties.

 

Rationale for choosing the respective topic

Chicken pox virus (Varicella zoster) is a deadly virus that becomes an endemic in the United States in recent years. Shingles are the secondary infection that can occur after the chicken pox (Baveja, 2014). Shingles is becoming very much threatening to the population. It also hinders the quality of life of the community. Shingles outbreak in the United Kingdom is very much devastating in nature. This secondary immune infection leads to different kinds of diseases and symptoms later on. These are bacterial skin infections, the signs of Hutchinson, Ramsay Hunt Symptom, neuropathic syndromes linked to motor functional impairment, urinary meningitis infection. Children are mostly affected by the Shingles infection. The contemporary fact in this concern that the children affected by Shingles are not cured properly and the prevalence rate counted at 190,000 numbers of people (Baveja, 2014). The threatening virus VZV remain in the central nervous system of the affected individuals. The reactivation of the virus is the potential cause for respective disease outbreak. It is very much unexpected that in spite of having specific vaccines for chicken pox virus the secondary immune infection of the respective disease affection cannot be controlled within the acceptable limit. Because of developing the secondary immune cells (memory ‘B' cell), the infection is not inhibited and protested within the human immune (Bloomfield & Scott, 2013).

Critical Analysis of the topic

Controlling measures to prevent the disease spreading

Non-Immune Contacts and Susceptible Groups

The healthy individuals should not come into the contact with the affected person or in the person in remaining disease attenuating condition (Havill, Nucci, Sullivan & Dembry, 2014).

Patients having shingles

The infection prevention and control team should always be aware on the outbreak of new emergence of the shingles. If the case is informed properly, immediate action should be taken by the control and prevention team (Sciortino, 2013). The affected patients should be always nursed in a different and separate place or room in such a way the airborne transfusion of disease is minimized to a certain extent. Appropriate contact isolation can be needed to prevent the further spreading (Malik, 2013). Day to day monitoring is required to check the degree of affection in the affected patients. VZV antibody test should be performed to check the disease affection in the susceptible community. Consultation of a microbiologist is required to take advice and also the development of a protocol for disease prevention and control within the community (McFarlin, 2012).

Varicella Zoster Immunoglobulin (VZIG)

VZVIG cannot prevent the shingles. It can attenuate only. When the initial exposure (within 7 days in immune-compromised patients) is observed, the administration of VZIG should be needed. VZIG is supplied by the Clinical Virology Departments of all NHS trusts in the UK. But it is mandatory that the consultation with microbiologists or Health Protection agency should be needed before the administration of VZIG. According to the contemporary prevention and control care guidelines set by Department of Health (UK), the administration procedure must be implemented and conveyed. The information about the decision for VZIG administration must be properly conveyed to the occupational health department or public health department (Millar, 2008).       

Susceptible Cases (Antibody Negative) that should be considered for administration of VZIG

Patients underlying bone marrow transplantation should be considered as a susceptible individual for six months after the surgery. Neonates whose mothers are affected in chickenpox or shingles during pregnancy periods are also affected. Neonates get exposed to chickenpox within seven days after birth. VZ antibody-negative neonates of any age getting exposed to shingles or chicken pox virus pregnant women getting exposed to chicken pox virus at the early trimester of pregnancy (Perez, Mena, Watson, Prater McIntyre, 2015)

Considerable Exposure – Warranting VZIG

It is very much beneficial to the practitioners when the administration of VZIG should be needed with rapid action. These indications are- Constant contact in household, Hospital contact, patients within the similar six bedded/4 bedded inlet, Continuous face to face exposure, e.g. during nursing or consultation (Skillman, 2012)

Responsibilities and Roles

The respective microbiologists or GP should follow the disease control and preventive measure guidelines set by Department of Health in UK.

Control of infection- The respective ancillary community health care professionals (Sciortino, 2013)

Infection control practices to promote and maintain quality of care

Appearance of different severe infectious diseases like shingles, HIV etc have painted the requirement of a well-organized infection control program for every aspect and capacity for different health care workers. These are various practices that upon application restrict the increased infection. One branch of this health care practice also helps to restrict the spread of disease from the patient to health care worker, other patients, and attendants as well. Therefore it is important for each and every worker, friends, and family members of the patients to follow the guidelines strictly (Stevens's et. al. 2014). It is also essential for the supervisor to guarantee the accomplishment of this program with all those health care skills.

Different infection control skills are there that can be grouped in two kinds of categories standard protection and transmission-based protection.

Standard protection

 According to EPIC3 guidelines, treatment of every patient having shingles in this health care ability with an equal level of proper precautions contains work practices that are needed to offer a much higher level of defense to patients, health worker as well as visitors. This protocol includes: antisepsis and hygiene maintenance, Hand washing practices as well as to utilize private defensive equipment when managing blood, body substances, secretions and excretions and finally the proper treatment of patient care tools and grubby linens etc.

Transmission-based protection

Additional or transmission-based safety measures are taken whereas ensuring typical safety measures are maintained. Additional safety measures comprise: Airborne protection that includes, application of typical defense mechanisms and the patient should be placed in a single room, and that room should have a properly scrutinized airflow pressure (negative), and is frequently referred to as a negative pressure room. Droplet nuclei protection which includes, Standard terms need to be implemented, and the patient should be placed in a single room or with another patient having the same kind of disease. Contact protection that includes, application of standard protocol and the disease epidemiology should be considered. The patient should be placed in an isolated room or with another patient having shingles.

 

Factors affecting the control over contagious Shingles

Biggest factors effecting the control and prevention on this disease is less knowledge of dos and don'ts of this disease. People know very less about shingles, and therefore they cannot understand the triggering factors leading to severe pains and itchiness. Unavailability of proper medication can be another reason. Less availability of vaccines as well as medicines leads to spread of this disease (Russell et. al. 2014). Improper sanitation and handling of the patient also prevents them to recover from this disease as it can persist for long time. Inadequate hospital management and patient care is one of the prime factors effecting people's health due to shingles. Staff working in the sterilization department handles this case.

Role of the practitioner in monitoring infection control policies within secondary care settings

A polluted scientific surrounding is one of the biggest features that may add towards infectivity rates. On the other hand, high values of sanitation will help to lessen the danger of cross-infection. Good plan in buildings, furniture and equipment is also significant to permit well-organized cleanout. According to regulation available by NHS and NICE guideline states – an organization of the Department of Health – healthcare amenities should be patient-friendly and recommend safe surroundings for care (NHS Estates, 2014).

Proper checking of sanitation aspects

Sufficient hand washing amenities should be accessible and effortlessly available in every shingles, wards of patients, healing quarters, washrooms and kitchens. Basins, wash-basins in medical areas should have nudge lever functioned mixer taps or should possess automatic controls and should be provided by way of liquid soap distributors, paper, hand towels, leg-driven dustbins. Alcohol containing hand gel should also be obtainable at all prime and inferior care settings All healthcare staff should note any lack of these equipments or practices to inform their managers while properly performing their duties  to patients and to themselves as well to stop the process of cross-infection (Loveday et. al. 2014).

Monitoring the availability of personal care equipment 

Hand cleanliness is extensively recognized to be the sole most significant commotion for reducing the spread of disease, yet facts recommend that a lot of healthcare experts do not clean up their hands as frequently as they require to or use the proper method which means that hands are not properly washed. The key areas that are of main concern of management include: Nails of the hospital staff should be clean, short and polish-free, artificial nails also are avoided. Nurses, Ward boys should not wear any jewelry or wrist watches, stoned rings, etc. during treatment procedures and Cuts, wounds and exposed abrasions should be covered properly with waterproof dressing (Swayne et. al. 2012). Staff should wear masks, visor, and eye protection gears while dealing with the patients. Wherever there is a chance of splash of blood, mucous, or other bodily contaminating fluids. Usage of mouth masks is also should be mandatory in the hospitals to limit the spread of multi-drug resistant diseases and severe contagious viral diseases like varicella zoster shingles.

Current research findings that can be applied to prevent and control contagious disease - shingles

The prevalence of shingles infection in United Kingdom is around 190,000 people every year and excess of them belongs to the old age group. In a particular study with 183 patients driven by a group of physicians in six countries, it was found that a new drug EMA401 is a new formulated drug which helps to reduce the pain related to the shingles and it did not cause any kind of serious side effects. These findings were published in the Lancet (Wong, 2014).

Usage of different antidepressants can also lead to relief some of the anxieties during the outbreak of this disease. Current researchers are also aiming to find some improved vaccination program to deal with the condition. Incorporation of VSV vaccine during childhood can limit this infection to some extent. Approval of zoster vaccine can also prevent the spread of this disease in the whole UK (Choi et. al. 2015).

One combined drug is tramadol. Oxycodone in combination with acetaminophen or morphine can be another choice of drug (koelle and Corey 2013).

 

Recommendations for risk assessments, isolation policies, and guidelines

Placement and transportation of patients

In hospitals, appropriate placement of patients is so much of importance as it determines the rate of transmission of the disease. There should be some general principles related to the placement of patients: There should be proper spacing ( nearly 1-2 meters) between beds to reduce the risk associated with shingles as there is a high chance of cross reaction due to direct or indirect contact ( droplet nuclei, air flow, etc.). Cohorting i.e. people with shingles are sharing a single room can be another option to deal with spreading of this disease (Gould 2014). Availability of single beds is one of the main issues in hospitals so the use of cohort can be an easy way to deal with this situation. Shingles being a highly contagious one needs a proper isolation technique. Therefore, a specific area of the hospital should be courted with shingles patients.

Environment management

Environment management should be handled with proper dedication and expertise as it can be one of the biggest sources of contamination leading to this contagious disease. The Immunosupressed condition of shingles patient requires adequate care and monitoring. Usage of unidirectional ultra clean air in these wards can minimize the risk. HEPA filers should be used in such rooms. Frequent management and validation of these filters, as well as the temperature, should be maintained. Humidity, pressure gradient, etc. should also be maintained.

Waste management

There should be a separate department in the hospitals to manage the wastes originated from the hospitals as the wastes are reservoirs of microorganisms and can lead to diseases as well. These require proper, adequate, and reliable handling to store, collect and dispose the originated waste. It should be conducted with the help of infection control squad of the hospital and should include health measures as per guidelines.

Treatment of hazardous wastes

The clinical/ hazardous substances should be disposed separately with proper monitoring and under expert supervision. Hazards should be transported to a specific chamber where experts can dispose that to simpler substances. Sharp objects should be sterilized using autoclaves, microwave, whereas plastic objects should be incinerated. Radioactive wastes, on the other hand, should be deal with expertise chemical reactions.

 

Conclusion

From the above assignment it can be concluded that varicella zoster virus is a very infectious virus and causes a painful disease named shingles. From the EPIC3 and UK based NICE guideline it has been known that the hygiene of the hospital should be maintained to prevent the spreading of the virus. This can be achieved by keeping the hospitals visibly clean by using some effective disinfectants. The hand hygiene must be a matter of concern. If any patient with the infection of varicella zoster virus is admitted then the patient should be given the personal protective equipments to reduce the transmission of the virus from person-to-person contact. The health care workers should be well educated about the infection and its protection. Hospitals should use the disposal gloves and aprons to reduce the chance of the infection. From this assignment this is clear that hospital staffs should maintain their hand hygiene when they attend the patients with the infection with varicella zoster. The patients are immunocompromised in that time and any kind of secondary infection can take place. The patients as well as the health care providers should wear the face mask when staying within the hospital to reduce the chance of transmission of the virus. As the virus cannot live on the inanimate objects, for this reason there is no fear for the transmission of the virus from the hospital instruments. However to reduce the chances of secondary infection the hospital should maintain its sanitary condition as well as the hygiene. It is also recommended that the hospital staffs should be vaccinated against the varicella zoster virus.  This assignment also concludes that those health workers who have previously vaccinated should be monitored regularly for the occurrence of any skin symptoms of the disease.

 

Reference list

Choi, E. J., Lee, C. H., Kim, Y. C.,  Shin, O. S., 2015. Wogonin inhibits Varicella-Zoster (shingles) virus replication via modulation of type I interferon signaling and adenosine monophosphate-activated protein kinase activity.Journal of Functional Foods, 17, 399-409.

Russell, M. L., Dover, D. C., Simmonds, K. A., Svenson, L. W. 2014. Shingles in Alberta: before and after publicly funded varicella vaccination. Vaccine, 32(47), 6319-6324.

Richter, K. 2014. Feared shingles is now a preventable disease: health and fitness. Plus 50, 9(4), 50-51.

Yawn, B. P., Wollan, P. C., Sauver, J. L. S., Butterfield, L. C. 2013, June. Herpes zoster eye complications: rates and trends. In Mayo Clinic Proceedings(Vol. 88, No. 6, pp. 562-570). Elsevier.

Wilson, D. D. 2014. Herpes zoster (shingles). The Nurse Practitioner, 39(5), 15-16.

Kawai, K., Gebremeskel, B. G., Acosta, C. J. 2014. Systematic review of incidence and complications of herpes zoster: towards a global perspective.BMJ open, 4(6), e004833.

Gupta, R., Gupta, P., Gupta, S. 2015. Complications of Herpes Zoster: A review. IJAR, 1(7), 175-178.

Hosseini, S., Zawawi, F., Young, J. 2015. Atypical Presentation of a Common Disease: Shingles of the Larynx. Journal of Voice.

Juel-Jensen, B. E., MacCallum, F. O. 2013. Herpes Simplex Varicella and Zoster: Clinical Manifestations and Treatment. Butterworth-Heinemann.

Koelle, D. M., Corey, L. 2013. Recent Progress in Herpes Simplex Virus Immunobiology and Vaccine Research. Clinical Microbiology Reviews, 16(1), 96–113. doi:10.1128/CMR.16.1.96-113.2003

Takhar, S. S., Moran, G. J. 2015. Disseminated Viral Infections: Introduction. Pathophysiology, 2, 16.

Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J., Gorbach, S. L., ...  Wade, J. C. 2014. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), e10-e52.

Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A.,  Wilcox, M. 2014. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.

Swayne, L. E., Duncan, W. J., Ginter, P. M. 2012. Strategic management of health care organizations. John Wiley & Sons.

Jones, C. and Jones, C. 2013. Bovine Herpes Virus 1 (BHV-1) and Herpes Simplex Virus Type 1 (HSV-1) Promote Survival of Latently Infected Sensory Neurons, in Part by Inhibiting Apoptosis. JCD, p.1.

Kasetsuwan, N. Tangmonkongvoragul, C. 2013. Concomitant herpes simplex virus and cytomegalovirus endotheliitis in immunocompetent patient. Case Reports, 2013(may09 1), pp.bcr2012007942-bcr2012007942.

Ogle, K. 2012. Shingles. Nursing Made Incredibly Easy!, 10(4), pp.28-34.

Pinninti, S. Kimberlin, D. 2013. Neonatal Herpes Simplex Virus Infections. Pediatric Clinics of North America, 60(2), pp.351-365.

wong, s. 2014. [online] Available at: https://dx.doi.org/10.1016/%20S0140-6736(13)62337-5 [Accessed 5 Feb. 2014].

Baveja, U. 2014. Risk assessment tools: Prevention and control of healthcare associated infections.Journal Of Patient Safety & Infection Control, 2(1), 9. doi:10.1016/j.jpsic.2014.05.015

Baveja, U. 2014. Risk assessment tools: Prevention and control of healthcare associated infections.Journal Of Patient Safety & Infection Control, 2(1), 9. doi:10.1016/j.jpsic.2014.05.015

Bloomfield, S., Scott, E. 2013. A risk assessment approach to use of antimicrobials in the home to prevent spread of infection. American Journal Of Infection Control, 41(5), S87-S93. doi:10.1016/j.ajic.2013.01.001

Havill, N., Nucci, D., Sullivan, L., Dembry, L. 2014. Ambulatory Infection Prevention Risk Assessment: Not All Ambulatory Sites Are Created Equal. American Journal Of Infection Control,42(6), S87-S88. doi:10.1016/j.ajic.2014.03.200

Malik, D. 2013. Assessment of infection risk from environmental contamination using rapid ATP surface measurements. American Journal Of Infection Control, 41(5), 477-478. doi:10.1016/j.ajic.2012.12.017

McFarlin, J. 2012. Taxonomical Risk Assessment. American Journal Of Infection Control, 40(5), e89. doi:10.1016/j.ajic.2012.04.157

Millar, M. 2008. Risk Assessment in Infection Control: Which Risks?. Infection Control And Hospital Epidemiology, 29(4), 381-382. doi:10.1086/529122

Perez, V., Mena, K., Watson, H., Prater, R., & McIntyre, J. 2015. Evaluation and quantitative microbial risk assessment of a unique antimicrobial agent for hospital surface treatment. American Journal Of Infection Control. doi:10.1016/j.ajic.2015.06.013

Sciortino, C. 2013. Response to “Assessment of infection risk from environmental contamination using rapid ATP surface measurements”. American Journal Of Infection Control, 41(5), 478-479. doi:10.1016/j.ajic.2013.01.011

Skillman, J. 2012. Shingles. JAMA, 308(15), 1507. doi:10.1001/2012.jama.11594

Gould, D. 2014. Varicella zoster virus: chickenpox and shingles. Nursing Standard, 28(33), 52-58.

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