Pharmacology

Question One: Canada’s Hand Hygiene Challenge

Introduction

It is estimated that one in every nine patients that are admitted to Canadian hospitals end up contracting Healthcare-associated infections (HAI). Hand hygiene has been seen by many as simple and avaoidable, but according to the Canadian Patient Safety Institute, it is a complex multifaceted cultural change to establish (Hand hygiene.ca, n.d.). Hand hygiene as the first intervention to prevent disease transmission has the prospective to become the foundation stone of a secure, safe, reliable and sky-scraping quality healthcare system. According to the CPSI report of 2016, almost 22,000 individuals every year fall victims to infections that are associated with process of providing health care. Out of those affected by these health-care associated infections, 8000 to 12000 lose their lives every year just because enough care to protect them was not taken (Hand hygiene.ca, n.d.). Another study, according to the CSPI report, found out that closed to 80% of healthcare providers who are charged with the responsibility of dressing wounds that are infected by the deadly Methicillin resistant Staphylococcus aureus carried the bacteria for a period of up to three hours. Other organisms that have a high capacity to be transmitted by those who provide health care to patients courtesy of poor hand hygiene include Clostridium difficile and Klebsiella penumoniae. However, the most interesting thing about these nosocomial infections is that the mere act of washing hands properly with plenty of clean water and soap eradicates all the responsible microorganisms.

Guidelines

The Canada’s Hand Hygiene Challenge is a program or rather an initiative that was introduced by the Canadian Patient Safety Institute after observing that a lot of infections and deaths could be reduced if proper hand washing culture is encouraged. Hand hygiene is one of the most important components of an effective and reliable prevention of infections and control programs that can make a significantly huge difference. The Canada’s Hand Hygiene Challenge acknowledges that there are many occasions and instances that hand hygiene ought to be performed. However, the most important of all the instances is before and after coming into contact with a patient or the patients’ environment.

Resources

It is always a tall order to care for patients while ensuring that their safety is guaranteed. With the input of experts and specialists, the CSPI has developed tools and resources aimed at protecting patients from safety incidents (Hand hygiene.ca, n.d.). These tools can help its users to learn from different incidents, which are important in the improvement of existing prevention strategies.  Canada Patient Safety Institute provides various Hand Hygiene Toolkits with numerous tools and templates that are aimed at supporting and encouraging a wide range of hand hygiene activities.  Resources that are important in learning about various ways through which hand hygiene can be improved in an organization arte also made available through their website. These resources range from worldwide resource links, well-researched and published scholarly literature on hand hygiene, videos on hand hygiene, and facts surrounding hand hygiene. The hand hygiene human factors toolkit is meant to help users in conducting an assessment that seeks to ensure that hand hygiene products are in the correct location as per the requirement, they are in correct amounts and form, and they are reachable and functional.  The hand hygiene observation tools by the CSPI aims at helping relevant organizations in conducting direct observations using homogeneous and authenticated audit tools.

How to Perform Hand Hygiene

Hand hygiene refers to the act of cleaning hands notwithstanding the procedure or process of doing it. This can be done through hand washing using soap and water or the use of alcohol-based hand rubs commonly abbreviated as ABHR. Hand washing is undoubtedly one of the oldest methods of achieving hand hygiene. In recent years, the use of the alcohol based hand rubs when dealing by providers of health care when dealing with patients has increased because of its efficiency and convenience, as it does not require running water. Alcohol-based hands rubs are the most convenient unless the hands of the one handling the patients are visibly soiled. The products are rubbed on the hands until they run dry. This usually takes between 15 and 20 seconds if the product that is being used is enough. On the other hand, soiled hands require that they be washed in warm running water and soap with friction for not less than thirty seconds. It is also important that all wrist jewelry and rings are removed during washing as some have been seen to hide the organisms such as bacteria. Also, the use of gloves I not a substitute for hand hygiene and thus hands should be kept safe before and after using gloves. Usually, the measure for hand cleanliness is the proportion of the care providers who comply with the appropriate hand hygiene guidelines.

Canada’s Hand Hygiene Challenge Moments for Hand Hygiene

The Canada’s Hand Hygiene challenge encourages the practice of keeping hands safe and free of disease causing microorganisms especially in a health provision center. “My five moments for Hand Hygiene” refers to various situations at the point of care that makes hand washing necessary (Hand hygiene.ca, n.d.). They are usually simplified and made easier in order to be easily remembered, understood and practiced by care providers at the point of care. The first one requires that the provider’s hand be clean before touching the patient. This reduces the chances of transmitting the infections from the previously touched patient. Secondly, before carrying out a clean or aseptic procedure, hand hygiene is indicated. Being exposed to body fluids of a patient such as blood is an indication for washing hands as such fluids are highly infective if they contain any infectious organisms. The fourth indication for hand hygiene is immediately after finishing with the patient especially if the provider touched him or her. Lastly, a provider should clean her hands after touching a patients surrounding or environment. This means that coming into contact with a patient’s beddings pr belongings at the point of care can be dangerous.

Core Components of Canada’s Hand Hygiene challenge

The Canada’s hand hygiene challenge involves five core components that aim at improving hand hygiene in health-care settings. The evidence based approach has been implicated in the drastic drop in the number of Heath care associated infections across many hospitals in Canada. These components include system change, training and education of the health care staff, observation of hand hygiene and the giving of feedback to the staff, reminders in the workplace and lastly the establishment of a safety climate. System change in this case refers to the adoption of modern and effective ways of ensuring hand hygiene when dealing with the patient at the point of care. The use of alcohol-based hand rubs at the very point of care is effective in ensuring that hospital associated infections are reduced. Training those involved in the direct handling of patients by qualified trainers is another component of hand hygiene. A report published by the CPSI shows that even though most health care providers argue that they practice hand hygiene, the practice is still alarmingly at less than 40%. Training and educating providers on how to enhance patient safety through ensuring hand hygiene is important as it makes the effort worth the while. Reminders in the workplace such as charts and messages that encourage and sensitize both patients and providers on the importance of hand hygiene can go a long way in upholding the culture of hand washing.  The Canada’s Hand Hygiene challenge encourages and spearheads the use of reminders at workplaces and at points of care in order to keep the campaign alive and involving both to the providers and patients. Lastly, the component of establishment of a safety climate that involves active participation of individuals and institutions in supporting the hand washing culture is key in the realization of a safer health care setting.

Question Two

Question Three

How does using antibiotics contribute to the development of C. difficile?

Clostridium difficile is a bacterium that is highly implicated in diarrhea caused by prolonged use of certain types of antibiotics. The bacteria leads to mild to sometimes severe diarrhea and other intestinal conditions such as pseudmembranous colitis which is in simple terms the inflammation of the membranes of the colon. According to a report by The Public Health Agency of Canada (2013a), Clostridium difficile is the most common cause of diarrhea in hospitalized patients not only in Canada but also in other industrialized countries around the world. This bacteria has various strains with some having serious effects than others but most particularly is the NAP 1 which is known to cause serious illness to humans. In the intestines of a normal person, little amounts of this bact6eria can be found as normal flora and thus can only become pathogenic if they multiply beyond normal amounts like in the prolonged use of certain types of antibiotics. People usually get infected through touching surfaces contaminated with feces that have the bacterium and later introducing it into their mouth. Usually, health care workers can transmit this microorganism to their patients through contaminated hands.

The use of specific antibiotics in high does or for a protracted period such as Vancomycin predisposes patients to getting C. difficile infection. This is because antibiotics and particularly the broad-spectrum antibiotics have the capacity to alter the normal compositions and levels of other bacteria within the gut of a patient. These antibiotics may arrest the proliferation of other bacteria that make up the normal flora of the gut or completely kill them shifting the balance and in favor of Clostridium diffficile, which is resistant to most of the antibiotics. The bacterium gets an opportunity to thrive, overgrow and in the process of colonizing the gut, it produces toxins that are harmful and irritating to the gut (Public Health Agency of Canada, 2013a). Toxins produced trigger inflammation of the gut and diarrhea follows since the body tries to remove the harmful toxins. With increased diarrhea amongst patients, a clostridium outbreak is a normal occurrence in hospitals with patients on wide spectrum antibiotics. If hand hygiene and other control measure are not taken into consideration, these infections become common and deaths can result due to severe diarrhea, sepsis, perforations and life threatening pseudomembranous colitis.

What is Methicillin Resistant Staphylococcus aureus (MRSA)?

Methicillin resistant Staphylococcus aureus abbreviated as MRSA refers to a strain of the staphylococcus a bacterium that is resistant to penicillin drugs and specifically methicillin. It causes serious infections in many different parts of the body. It is significant to those involved in the provision of health care because it is tougher and difficult to treat because of its resistance to the commonly used antibiotics (Public Health Agency of Canada. (2013a). The symptoms as a result of MRSA infection depend on the site of infection. In most cases, MRSA causes mild infection on moist sites of the skin such as boils or even sores, sometimes, this strain of bacteria can enter surgical openings and cause serious infections, can infect the bones to cause wasting of the bone with severe pain alongside others such as urinary tract infections and lung infections.

Who Gets MRSA?

This dangerous bacterium has been seen to affect more people who have severely suppressed immune system and are hospitalized. This is because of transmission of the bacteria from contaminated hands of those who are charged with providing health care. Nursing homes, Health centers and hospitals in Canada and in many other regions of the world have recorded an increase in the number of infections caused by MRSA (Public Health Agency of Canada, 2013a). Majorly, the infections are found around poorly managed surgical wounds of patients who are hospitalized and are being attended to. Sites around invasive devices are also hotbeds for infections by the MRSA such as catheters, chest tubes and implanted feeding tubes. Over the years, invasive MRSA infections that begin in health centers have reduced drastically.

The community associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) is another type of MRSA that is showing up in healthy individualized who have never been hospitalized. This type of MRSA affects healthy individuals with skin infections being identified amongst people who share residences or have close skin contacts with each other. Unlike the hospital associated MRSA which tends to affect the elderly people averaging at 68 years according to a research in Minnesota published in The Journal Of American Medical Association, CA-MRSA tends to affect much younger individuals averaging at 23 years old (Public Health Agency of Canada, 2013a).  Examples of people at a risk of being infected by MRSA include team athletes, prisoners, young children kept in a day care, and armed forces recruits. This can be attributed to the fact that these groups of people are in a constant state of close contact that involves that skin. This makes the bacteria easily transmitted from one person to the other.

Members of the health care team such as nurses, physicians, nutritionists amongst others are also at risk of being infected with MRSA. This is because they are in constant contact with patients are other infective surfaces that have these bacteria. Alongside being in direct contact with infected surfaces, these people are at risk of inhaling cough droplets from patients that have MRSA. This is because people are carriers of MRSA even though they might not be sick a phenomenon called colonization. The commonest site of MRSA colonization is inside the nose where these organisms can be expelled during sneezing or coughing into the surrounding. Further, care providers come into contact with infected patient environments such as the beds, blankets and dishes which pose a risk of being infected.

How is MRSA Spread?

MRSA is spread through various ways but the main transmission mechanism is through direct contact with an individual who is infected. While MRSA can occur in many categories of rather healthy people, the incidence of infection amongst people who take part in contact sports has been seen to be on the rise. Such sports include rugby, wrestling, soccer and baseball because players are involved in constant rubbing of each other’s bodies. Also, direct contact becomes apparent in hospitals where the hospital acquired MRSA is due to contact between infected hands or surface of the care providers and the patients and vice versa. Children in day cares are in constant skin constant with each other increasing their chances of being infected with MRSA, same to prison inmates.

Touching or coming into contact with infected surfaces is another way through which MRSA is spread. In the case of a hospital, the care providers can easily contaminate dishes, or even surgical equipment with MRSA due to indiscriminate handling. At the point of care, care providers can touch the contaminated equipments and transfer the bacteria to patients rendering them infected. Additionally, infected patients can infect the hands of the care providers during the process of treatment. In this case, the care provider acts as a medium for transport and transmission of the bacteria from one patient to another.  In normal daily life, touching surfaces such as door, which are infected, can lead to a healthy person being infected with MRSA. Other methods of transmission include inhalation and swallowing of infected droplets or particles even though it is not so significant.

4. State of Infection in Canada

In as much as the medical focus is slowly but steadily shifting towards non-infectious lifestyle diseases, infection still lingers around. The situation in Canada is not any different. Infections are responsible for many hospital admissions and many outpatient clinic visits in the country. One worrisome trend about infections noted by the Chief Public Health Officer’s report is that most infections are acquired in healthcare facilities. The report notes that up to 80% of clinically significant common infections are spread among healthcare workers, hospitalized patients, visitors, and health facilities (Public Health Agency of Canada, 2013b). More than 200,000 patients acquire infections while in healthcare; 4% of these patients end up dying. Such healthcare-associated infections (HAIs) are called nosocomial infections (Public Health Agency of Canada, 2013b). The most common of these in Canada are Central Venous Catheter Bloodstream Infections (CVC-BSI), Surgical Site Infection (SSI), Clostridium difficile, Vancomycin-resistant Enterococci (VRE), and Methicillin-resistant Staphylococcus aureus (MRSA). Many other infections and infectious agents can be acquired while in a hospital setting but the five mentioned above have been the most problematic as they are mostly associated with antimicrobial resistance. In fact, it is the antimicrobial resistance of these organisms, which makes them highly prevalent in a hospital environment. Some of these infections are associated with continued antibiotic use. Clostridium difficile is a good example of those infections, which result from continued antibiotic use; the disease is usually caused by the use of antibiotics which kill the targeted organisms and other normal flora but spare Clostridium difficile because of its anaerobic nature.

In order to prevent nosocomial infections, more attention should be paid to hygiene, healthcare providers and staff should be trained better, stringent hygiene measures starting with proper handwashing should be observed, and better equipment and engineering should be provided. Maintenance of good environmental hygiene can prevent situations, which cause these infections. The fast and easiest but also most important of maintaining good hygiene is handwashing (Public Health Agency of Canada, 2013b). Better training of healthcare providers and staff can ensure that such infections are not spread much faster and will aid in prompt diagnosis and proper management of such infections to limit their prevalence. Better equipment and better engineering will assist in determining the best antibiotics for eradication of these problematic infections (Public Health Agency of Canada, 2013b).

Staphylococcus aureus is one of the oldest known but still most feared infectious agents in man. Most infections caused by this agent are hospital acquired. Several antibiotic-resistant strains of this organism have been cultured. However, the Methicillin Resistant form (MRSA) ranks as one of most public health importance in Canada (Public Health Agency of Canada, 2013b). The other problematic antimicrobial-resistant strain of the bacterium is the vancomycin-resistant strain (VRSA). The bacterium is spread by direct skin-to-skin contact or sharing of items that could carry the bacterium from one person to the other. The bacterium colonizes bodies of many healthy individuals without causing any problems. The most colonized body parts are the skin and the upper respiratory tract. However, entry of this bacterium in individuals with somewhat compromised immunities causes infection of the skin, bone, blood, lungs, and the heart. Infection caused by this organism are frequently life-threatening (Public Health Agency of Canada, 2013b).

The biggest worry with MRSA is the steadily increasing rates of colonization and infection among hospitalized patients in Canada. With increasing rates of immune-compromise over the years due to HIV/AIDS, cancer, cancer treatment, and steroid use, the rate of mortality due to MRSA has been on the increase (Public Health Agency of Canada, 2013b). It is time the amount of Staphylococcus aureus in our facilities be reduced. Stringent hand-washing practices in health facilities have been identified as an intervention that will limit the spread of this life-threatening infection to hospitalized patients. Maintenance of proper environmental hygiene and prompt diagnosis and treatment of this infection with a suitable antibiotic are the other measures, which can aid in control of the disease (Public Health Agency of Canada, 2013b).

The report by the Chief Health Officer of Canada is a timely emphasis on the importance of stringent handwashing in disease prevention. Handwashing is by far the most important but somewhat the most underrated infectious disease prevention intervention. The report concludes that regular washing of hands with soap of alcohol-based sanitizers is the best way of preventing nosocomial infections (Public Health Agency of Canada, 2013b). Despite the many campaigns on the importance and best technique of handwashing, the practice is still not done effectively probably due to childhood hand-washing habits in subjects. Canadian Public Health Agency recommends that hands should be washed with warm and running water and soap for at least twenty seconds after all jewelry have been removed from the hand (Public Health Agency of Canada, 2013b). During handwashing, it is important to concentrate on areas that are likely to be forgotten like the fingertips and the space between fingers. After this, the hands should be rinsed properly with running water for about ten seconds and dried completely. In case any non-sterile surfaces are trounced with cleaned hands, hands should be cleaned again. Alcohol sanitizers can be used where handwashing is not possible.

In a hospital environment, it is prudent for health workers to ensure that their hands are cleaned after touching a patient and before touching any patient. Health workers frequently spread infection from one patient to another just by touching them during physical examination, drug administration and in introductory meetings. Handwashing should be made to be a policy in hospital wards where it should be mandatory for anyone to wash their hands thoroughly before entering and after leaving a ward. This should apply even to the relatives who come to see patients. As the report suggests, hands of visiting relatives can also carry enough microorganisms to cause nosocomial infections to inpatients. In addition to hand-washing, other aseptic techniques such as proper disposal of waste and use of a pair of gloves only on one patient should be followed strictly.

5. Bacterial Pneumonia

I once suffered from an attack of acute bacterial pneumonia when I was in high school. Alveolar lavage washings from my lungs were cultured and the causative agent identified as Moraxella catarrhal. The organism is a Gram-negative bacterium that causes respiratory tract infections in people of all ages. It also causes infection middle ear, meninges, and eyes (Engelkirk & Duben-Engelkirk, 2008). The bacterium is described microbiologically as fastidious, non-motile, and aerobic (Engelkirk & Duben-Engelkirk, 2008). Its aerobic nature is one of the reasons why the bacterium likes to reside in the respiratory tract.

The disease started as a febrile illness. The fever was initially low grade but had risen to 40 degrees centigrade by the fourth day; something which prompted me to seek medical advice. With the fever, was also malaise and general body weakness. I experienced severe chills in mornings and evenings and had a generalized headache for most of the day. I also started coughing on the second day of the illness. The cough produced a thick sputum that was blood stained in one episode on the fourth day. The sputum was mostly cream in color and had a volume of about three milliliters with each episode of cough. Coughing and inspiration were associated with severe chest pain especially on the right side of the chest. The pain was reminiscent to that of overstretching the lungs during a forced inspiration but was more burning in character. On a scale of one to ten, I would rank the pain I experienced at six. After the third day, I noticed that I had frequent breathlessness on doing a little activity like climbing a flight of stairs. After slight exertion, I would start breathing very fast and the chest pain would increase. Breathlessness would resolve spontaneously with rest.

The disease generally lasted for ten days. I sought treatment on the fourth day. Since the initial febrile illness, my body kept worsening. Conversion of the fevers from low grade to high grade and bloodstains in sputum are what prompted me to seek medical attention.  On hospitalization, I was stabilized and put on analgesics as investigations were carried out. A definitive diagnosis was made the day that followed and treatment started. The disease slowly regressed over the five days that followed. By this time, I had two more days before completing my treatment. I completed my dose as I had been advised by my doctor, though. With my condition improving markedly, I was discharged from hospital on the fifth day of admission; this coincided with the ninth day of disease.

After the definitive diagnosis, the doctor described a dose of ceftriaxone and clarithromycin. I was injected with 1g of ceftriaxone intravenously every morning for four days. I was also to take one 100mg tablet of clarithromycin every morning and evening for seven days. The doctor said that this combination of antibiotics was enough to eradicate the organism that caused disease and could cover for any other organisms that were not identified. I was also given ibuprofen for my pain and fever. I had been started on paracetamol at admission. However, after the definitive diagnosis was made, ibuprofen was thought to be a better analgesic for me. I was to take one 400mg tablet of ibuprofen three times a day for three days.

The treatment was generally successful. The fever and chest pain had regressed by the second day of treatment. Chills and the general body weakness had resolved in the next four days. The Cough was the last sign to go: I noticed the last episode of a productive cough on the tenth day of disease. The fact that I felt normal health before even completing treatment reveals the success of the treatment. As the doctor had highlighted, the combination of antibiotics was effective in eradicating the causative agent of the disease. Ibuprofen had also done well in reducing the fever and the inflammation of the lungs and pleural lining, which was causing chest pain on coughing and inspiring.

Immediately after the first ceftriaxone injection, I experienced severe nausea. I vomited after the second ceftriaxone injection. My doctor told me that nausea and vomiting were anticipated side effects of ceftriaxone. I also felt dizziness, which the doctor attributed to ceftriaxone. The point of IV injection of the drug became swollen and painful on the second day of treatment. I also noticed extreme perspiration immediately after the ceftriaxone injections. I lost appetite due to an unpleasant taste in my mouth – the doctor attributed this to clarithromycin. According to my doctor, clarithromycin was also responsible for a slight increase in headache on the first day of treatment and the indigestion that I felt throughout the cause of treatment. Moreover, clarithromycin could have contributed to the occurrence of nausea and vomiting. Generally, I did not experience any adverse effects of the drugs prescribed. I only experienced mild side effects. The most severe adverse reactions that can be experienced with ceftriaxone are hypersensitivity reactions and nephrotoxicity. Clarithromycin could cause sleep disturbances and insomnia.

From my chat with my doctor, I learned a lot about Moraxella catarrhal. I learned that the bacterium is most problematic in children under five years. As earlier stated, the bacterium mainly colonizes the upper respiratory tract but can cause lower respiratory tract infections like pneumonia whenever one’s immunity is compromised. I think that my immunity had been compromised by long-term steroid use for management of frequent asthmatic attacks. I also learned a valuable lesson that even though pneumonia is one of the most common causes of hospital admission and mortality, pneumonia does not occur in normal people. The occurrence of pneumonia is usually an indicator of some level of incompetence in one’s immune system. It is the role of the doctor to find out what this cause of incompetence in the patient’s immune system is and help the patients solve it to prevent them from acquiring pneumonia in future. In that regard, my doctor advised me to seek the advice of a pulmonologist on the continued use of steroids for prevention of asthmatic attacks.

6. Define and provide an example of the following epidemiology terms
7. a) Incidence of a disease

This is the rate of occurrence of new cases of a particular disease arising in a given period in a specific population. The incidence of a disease in a research study presents in the form of a rate. This rate represents the number of new events in a particular period over the number of persons exposed to risk during this period per 10n people. The numerator refers to the first events of disease while the denominator refers to the sum of all the disease-free person time 000periods during the period of observation of the population at risk. For instance, the incidence rate of stroke in a population of 118 539 women who are 30-55 years of age will be 30.2 per 100 000 person-years of observation. This is if the number of stroke cases since the beginning of the study is 274 cases and the study took eight years, which is equal to 908 447 person-years.

1. b) Prevalence

This is the frequency of recorded disease cases in a defined geographical area or population at a given time. It represents the the number of people with a condition or particular disease over the number of individuals in the population at risk during the same period per 100% or per 1000 population. For instance, the prevalence of type 2 diabetes among 50 women who are at risk of getting type 2 diabetes will be 16%. This will be true if eight women among these women who are in danger of getting type 2 diabetes gets diagnosed with type 2 diabetes. The prevalence of type 2 diabetes among these women can also be 160 per 1000 population.

1. c) Morbidity rate

This is the frequency with which the cases of a particular disease appears in a population. Morbidity rate constitutes of measures of morbidity that comprises measures such as incidence rate, cumulative incidence, attack rate, and prevalence. Examples of sources of morbidity rate data include sources such as the hospital admissions records, primary health care consultation records, discharge records, outpatient records, the registers of disease events and the specialist service records. These sources provide the basis for the calculations of the measures of morbidity mentioned above.

1. d) Communicable disease

This is a disease that occurs due to the transmission of a particular pathogenic agent to a susceptible host. The transmission of the pathogenic agent can either be directly from an infected patient or animal to a healthy person or indirectly through vectors, airborne particles or vehicles. Examples of the common communicable diseases include; malaria, which spreads as a result of the transmission of Plasmodium parasites from an infected Anopheles mosquito to a healthy person; tuberculosis that spreads as a consequence of the transmission of Mycobacterium tuberculosis from an infected person to a healthy person; acute respiratory infections that occur as a result of bacterial infections to the respiratory tract; and diarrheal diseases that occur due to ingesting infected food and water.

1. e) Contagious disease

This is a disease that can spread from an infected patient to a normal healthy person without the intervention of a vector. Contagious diseases mostly spread from one person to another when the infected patient touches a healthy person. Examples of the commonly diagnosed contagious disease include diseases such as measles, syphilis, Ebola disease, enterovirus D68 infections, hepatitis B infections and Hantavirus infection.

1. f) Sporadic disease

This is a disease that occurs irregularly in single or scattered cases. They occur in the absence of any environmental or inherited causative agent. Examples of sporadic diseases include diseases such as sporadic breast cancer, sporadic fatal insomnia and sporadic Creutzfeldt-Jacob disease.

1. g) Endemic disease

This is a communicable disease that has a relatively high prevalence and incidence of occurring in a given a given population group or a geographical area at a stable pattern. The diseases that are considered to be endemic include diseases such as malaria that is prevalent in the tropical regions, smallpox in Europe and dengue fever which occur within the tropical regions.

1. h) Epidemic disease

This is a disease that occurs at a higher rate than the normal expected rate of the disease’s occurrence in a given community or region at a particular period. For a disease to qualify as an epidemic the number of cases needed to qualify the disease as an epidemic will depend on the agent causing the disease, the size of the population exposed to illness and the type and susceptibility of the population exposed to the disease. Examples of diseases that are commonly epidemic include diseases such as Acquired Immune Deficiency Syndrome, malaria, cholera, epidemic typhus, smallpox and polio.

1. i) Pandemic disease

This is the spread of a new disease around the world. This happens when cases of the disease’s new infection are reported from all over the world due to the spread of the causative agent of the disease to various places around the world by the infected patients that are moving around the world. Examples of cases of diseases that become pandemic include diseases like pandemic influenza disease, HIV/AIDS and H1N1 pandemic.

1. j) Zoonotic disease

This is a disease that can spread between animals and people. The disease occurs as a result of infections from organisms such as viruses, bacteria, parasites and fungi which are transmitted from the animals to human beings. Examples of Zoonotic diseases include diseases such as Cryptosporidiosis which affects humans and animals such as cattle and pigs due to Cryptosporidium infections, Trichinellosis which affects both humans and livestock because of Trichinella infections and roundworm and hookworm infections from pets such as cats which affect people who are in contact with them.

7. Define the following infection control terms
8. a) Aseptic technique

It is a method or a set of strict rules and guidelines that are used to prevent the contamination of surfaces and objects by microorganisms during medical procedures in the areas such as outpatient care clinic and other clinics when handling of syringe vaccines, surgical equipment, and when accessing dialysis catheter or performing dialysis to patients with renal complications.

1. b) Sanitization

This is the process of making a particular object or surface completely clean and free from the contamination caused by infectious microorganisms such as pathogenic bacteria, infectious viruses and other infectious microorganisms that might be found on the surfaces or on the objects, which can cause infections. This process requires the use of a disinfectant to remove the microorganisms.

1. c) Disinfectants

These are the antimicrobial agents with a particular set of necessary chemical properties which are used to destroy and kill the infectious microorganisms found on the surface of the nonliving agents. The disinfectant does not completely make the cleaned surface or object. Examples of these disinfectants include substances such as aldehydes, oxidizing agents, alcohol, air disinfectants and phenolics.

1. d) Autoclave

This is a strongly heated container which is used to sterilize various types of equipment and apparatus at a high temperature and pressure due to the ability of the container to withstand the necessary high pressure and temperature needed for sterilization.

1. e) Antiseptics

These are antimicrobial substances that are used to reduce the chances of an infection occurring to a particular tissue, sepsis, and putrefaction of a particular living tissue or the skin when applied to that particular living tissue or skin.

1. f) Radiation

This is the use of radiation lights to destroy the available the microorganisms that are present on objects or the various surfaces. The process includes two methods of radiation sterilization such as the use of ionizing sterilization and the use of non-ionizing sterilization techniques.

1. g) Sterile technique

This refers to the process by which one manipulates the cultures of a particular microorganism without infecting the person doing the experiment, without contaminating the culture, or the laboratory equipment used in the culture experiment.

1. h) Sepsis

This is the process where harmful bacteria, other pathogenic microorganisms, and their toxins enter the tissues of the body through the infections of a wound and causes the body to give an overwhelming response, which injures its organs and tissues in the process.

1. i) Desiccation

This is the process of controlling the growth and multiplication of microorganism through the complete removal of water from tissues, which slows its growth or makes it inactive.

1. j) Ultrasonic waves

This is the process of cleaning equipment and apparatus using ultrasound waves and an appropriate cleaning solvent to clean the various equipment. The cleaning solvents are used to enhance the effect of the ultrasound.

1. k) Pasteurization

This is the partial sterilization of foods and drinks such as a milk and canned foods at a high temperature and for a specific period of exposure that destroys the objectionable organisms without major chemical changes of that particular substance. The process mainly involves the use of heat to remove or inactivate any pathogenic microorganisms.

1. l) Filtration

This is the process of cleaning a particular substance through the exclusion of organisms basing on the sizes of the microorganisms and is mostly used to remove microbes from solutions that may be sensitive to some sterilization techniques such as heating.

1. m) Sterilization

It is the through process of removing or killing bacteria and other pathogenic microorganisms through chemical methods, radiation, gas plasma, filtration, and heat among other techniques. The process focuses on ensuring that all pathogenic microorganisms are killed.

1. n) Disinfection

This refers to the process of cleaning to prevent pathogenic microorganizms that may cause an infection such as bacteria from being active through the use of specialized techniques by not necessarily killing the antimicrobial agents, as in sterilization; but the process can also involve making them inactive. These techniques may include heat disinfection and chemical disinfection depending on the process involved.

8. Define the “Chain of Infection” and for each step in the chain describe the step and how it can be broken from a Pharmacy Technicians point of view.

A chain of infection is defined as a set of conditions that must be present for infectious microorganisms to move from one host to another. In order to curb an infection, pharmacological interventions can be carried out at each step in the chain. The chain is as follows:

1. Causative agent – this is usually the microorganisms. Pharmacologically, antimicrobial agents are designed to kill such organisms including bacteria, viruses, fungi, protozoa, and helminthes.
2. Reservoir – a host where the microorganism lives and multiplies but does not cause disease. Pharmacologic interventions include design of drugs and chemicals, which can target these hosts for instance rodenticides.
3. Portal of exit – a path which microorganism uses to escape from the reservoir host. Includes skin, blood, respiratory tract and gastrointestinal tract. Interventions include examination of such body parts in search of microorganisms, which can infect man.
4. Mode of transmission – means by which microorganism leaves the reservoir host and gets to portal of entry in the definitive host. Some microorganisms require vectors for them to be transmitted. Pharmacologic interventions like insecticides can be used to target these vectors, which include mosquitoes and sand flies.
5. Portal of entry – the path by which microorganisms enter a new host. It is usually similar to portal of exit. Pharmacologically, antibodies like IgA and prophylactic antibiotics have been used to make the portal of entry hostile for the microorganisms.
6. Susceptible host – a host that is likely to be infected and affected by the microorganism. Pharmacologically, vaccines and prophylactic antibiotics are designed to reduce susceptibility of the host to microorganisms.
7. Define bacterial conjunctivitis.

Bacterial conjunctivitis is an acute infection leading to inflammation of the outermost vascular layer of the eyeball and eyelid – the conjunctiva.

1. How common is it?

According to Azari and Barney (2013), the prevalence of bacterial conjunctivitis is 135 in every 10,000 individuals in America.

1. Who is most at risk?

The disease is far more common in children below five years of age than other children.

1. Is it contagious?

The disease is contagious. The bacteria that cause the disease are spread through aerosol drops, which cause conjunctivitis when they contact the eye.

1. Find three antibiotics that are used to treat it.

The most commonly used antibiotics for treatment of bacterial conjunctivitis in Canada are gentamicin, levofloxacin, and tetracycline.

1. Identify all dosage forms these antibiotics are available in (Canada only).

Gentamicin and levofloxacin have injectable forms though the latter is mainly administered orally. Tetracycline is mainly given orally for systemic illness. For treatment of bacterial conjunctivitis, gentamicin is given as 0.3% eye drops while levofloxacin is given as 0.5% eye drops; tetracycline is given as an ointment.

1. Choose one of these drugs and dosage forms and answer the following:

i). Is the medication bacteriostatic or bacteriocidal?

Tetracycline given orally for treatment of systemic illness like chlamydia, which can cause conjunctivitis is bacteriostatic by inhibiting protein synthesis in bacteria.

1. What is the usual dosage?

The drug is usually given orally as one 100mg tablet twice daily for 5-14 days.

iii. Explain two common adverse effects.

The most common adverse effects of systemic tetracycline are thrombocytopenia, which causes easy bruising and a bleeding tendency, and disturbance of bone formation leading to bone weaknesses and malformation.

1. Are there serious life threatening adverse effects using this drug and dosage form?

Systemic tetracycline can have life threatening adverse effects in some patients. One such effect is acute renal failure.

10. Visit the following website where you will find a free journal. Find one article of interest and write a brief one paragraph synopsis.

Centers for Desease Control and Prevention. (n.d.). Emerging infectious disease journal. Retrieved from http://wwwnc.cdc.gov/eid/

Drug-resistant Non-typhoidal Salmonella Infections in America

Non-typhoidal salmonella infections are quite common causes of gastroenteritis in humans. These infections are mainly treated with ceftriaxone, ampicillin and ciprofloxacin. However, like any other infections, drug resistance is quickly setting in and making these infections even more difficult to treat. A study done from 2004 to 2012 indicated an increasing level of resistance to the commonly used antibiotics. The rate of the resistance each antimicrobial agent was as follows – 1.07/10000 for ampicillin, 0.51/10000 for ceftriaxone and 0.35/10000 for ciprofloxacin. Organisms that showed combined resistance to either two or all three agents were also identified. Among the major drivers of this antimicrobial resistance as identified in the journal are antimicrobial drug use in food producing organisms which leads to human infection by already resistant organisms and empiric use of antibiotics for treatment of gastroenteritis. In this regard, we can carb antibiotic resistance among non-typhoidal Salmonella species by limiting antibiotic use in food producing animals like poultry, cattle, and pigs; we should also look to run antibiotic sensitivity cultures before prescribing drugs for gastroenteritis instead of giving antibiotics empirically.

11. Using the following chart, fill in the information on HUMAN MICROFLORA using reliable websites.

12. Explain TWO important facts you learned from your research using the report titled “Prevention and Control of Hospital-acquired Infections”

From the report, “Prevention and Control of Hospital-acquired Infections”, I learned a number of important lessons. First, I learned is that health workers are responsible for the spread the bulk of hospital-acquired infections (HAIs). Health workers may transmit these infections primarily with their hands as they touch patients who might be carrying the infectious agents during examination and other procedures and transmit the infection to the next patient. This, therefore, means that handwashing is by far the most important intervention in preventing Hospital-acquired Infections. Even though other interventions can be done, the hands of health workers also require an intervention; the intervention is simple washing.

I also learned that the main reason as to why HAIs are dreaded is that they are mainly caused by antibiotic-resistant organisms. This makes the management of these diseases quite difficult. The development of drug resistance in these pathogenic organisms has been attributed to exposure to numerous antibiotics in the hospital environment, which can be a good point of intervention. One way of limiting future drug resistance will be to stop prescribing antibiotics without a significant reason to do so. Additionally, for management of HAIs, sensitivity cultures should be done to choose an antibiotic that will eradicate the bugs and not to broaden their range of drug resistance

13. Choose two (2) common adverse effects of Antibiotics and explain why they occur

Diarrhea is a common adverse effect of many antibiotics including penicillin, cephalosporin, and clindamycin (Golan, 2008). Diarrhea can be attributed to gastrointestinal upsets that are caused by the direct effect of the drug on the cells of the gut wall. Diarrhea can also result from preferential sparing of some microorganisms by the antibiotic. For example, the aforementioned drugs have been known to preferentially spare anaerobic organisms including Clostridium defficile. Overgrowth of this organism then causes pseudomembranous colitis – a form of inflammation of the colon, which presents with severe diarrhea.

A second common adverse effect of antibiotics is hypersensitivity (Golan, 2008). Among antibiotic drugs that have been known to cause hypersensitivity reactions are penicillin, cephalosporin, vancomycin, diethycarbamazine, tetracycline, flouroquinolones, and aminoglycosides. Hypersensitivity reactions are usually seen in systemic antibiotics and occur in previously sensitized patients (Golan, 2008). In such patients, the drug acts as a hapten and induces an immune reaction in the same way an antigen-antibody reaction does. Hypersensitivity reactions range from anaphylaxis for penicillin, through Steven-Johnson Syndrome for sulfonamides and Mazotti reaction for diethylcarbamazine to bradycardia for flouroquinolones.

Reference

Azari, A. A., & Barney, N. P. (2013). Conjunctivitis: A Systematic Review of Diagnosis and Treatment. JAMA : The Journal of the American Medical Association, 310(16), 1721–1729. http://doi.org/10.1001/jama.2013.280318

Engelkirk, P. G., & Duben-Engelkirk, J. L. (2008). Laboratory diagnosis of infectious diseases: Essentials of diagnostic microbiology. Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Golan, D. E. (2008). Principles of pharmacology: The pathophysiologic basis of drug therapy. Philadelphia: Lippincott Williams & Wilkins.

Hand hygiene.ca (n.d.). Canada’s hand hygiene challenge. Retrieved from http://www.handhygiene.ca/English/Pages/default.aspx

Public Health Agency of Canada. (2013a). Antimicrobial resistance. Retreived from http://www.phac-aspc.gc.ca/amr-ram/index-eng.php

Public Health Agency of Canada. (2013b). The Chief Public Health Officers Report on the State of Public Health in Canada, 2013 Infectious Disease: The Never-ending Threat. Retrieved from http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/infections-eng.php

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