Infection Control Issues for Patients with Conjunctivitis - Essay Example

A Critical Evaluation of Infection Control Issues for Patients with Conjunctivitis Introduction The image below, which shows a so-called “pink-eye”, or conjunctivitis, and a nurse’s cap, fairly exemplifies the main idea of this paper— an evaluation of infection control issues among patients with conjunctivitis in the eyes of an ophthalmic nurse practitioner. (Image adapted from Columbus Vision Associates, Inc. (2004) ‘Conjunctivitis’ [Online Image] and School of Nursing University of Wisconsin-Madison (2009) ‘Nurse’s Cap’ [Online Image]). According to Black, Hawks, and Keene (2001), “the specialty practice of ophthalmic nursing is devoted for clients with eye disorders”. Moreover, Ophthalmic Registered Nurses perform roles of caregiver, advocate, educator, counselor, technician, coordinator, and researcher (Black, Hawks, and Keene, 2001: 1830). In so doing, the said specialty nurses are expected to attend to the actual and potential needs of the clients who are experiencing visual impairment or deficits. As such, this paper aims to critically analyze infection control issues pertaining to conjunctivitis, which is one of the ophthalmic ailments that are of major concern to ophthalmic nurses. ANYONE can get conjunctivitis (Health Protection Agency [HPA] North West, 2007) — students in school, patients in hospital or long-term care facilities, and even doctors and nurses in any health care institution. Due to its highly infective nature, prompt intervention and appropriate management are definitely indispensable. In this regard, nursing interventions that are particularly focused on infection control issues in clients with conjunctivitis shall be typified in due course of this paper. Hence, the discussion and critical analysis herein shall be guided by reputable references and relevant literatures in order to exemplify the aforementioned purpose of this essay. Discussion and Analysis Definition and Description of Conjunctivitis Conjunctivitis, which is commonly called “pinkeye”, is an inflammation of the mucous membrane that lines the eyelids― bulbar and palpebral conjunctiva― and extends over the white of the eye (sclera) (Berman et al., 2008). In general, according to the Health Protection Agency (HPA) North West (2007), the characteristics of conjunctivitis are (1) swollen eyelids - sometimes causing the eye to almost fully close, (2) pink/red eyes, (3) sore, itchy and sometimes painful eyes, (4) a discharge causing the eye to be sticky and crusty, and (5) sometimes the sticky discharge may cause the eyelids to stick together after sleeping (HPA, 2007). Moreover, conjunctivitis can be caused by bacteria, virus, allergy, chemical, or other irritants (San Diego City Schools Nursing and Wellness Program, 2002). On the other hand, conjunctivitis can also be caused by foreign bodies (HPA, 2007; Berman et al., 2008: 586). An example of this would be a piece of grit. In this case, conjunctivitis of only one eye may well indicate the presence of a “foreign body” (HPA, 2007). Types of Conjunctivitis The following are the general types of conjunctivitis and the essential facts about each type, respectively. Bacterial Conjunctivitis Bacterial conjunctivitis can be transmitted through: 1. contact with eye discharge 2. contaminated fingers, clothing, or other articles 3. upper respiratory tract of infected persons (San Diego City Schools Nursing and Wellness Program, 2002: 2) Incubation period: 24 to 72 hours Contagious period: anytime during course of active infection Signs and symptoms: 1. Sclera red or pink 2. Lining of eyelid inflamed in one or both eyes 3. Photophobia (sensitivity to light) 4. Moderate tearing 5. Minimal or no itching 6. Blurred vision that clears with blinking 7. Purulent discharge (yellow pus) 8. Dried discharge (crusting) on eyelids upon awakening (often matted shut) 9. Swollen eyelids (San Diego City Schools Nursing and Wellness Program, 2002: 2) Viral Conjunctivitis In the same way as bacterial conjunctivitis, viral conjunctivitis can also be transmitted through: 1. contact with eye discharge 2. contaminated fingers, clothing, or other articles 3. upper respiratory tract of infected persons (San Diego City Schools Nursing and Wellness Program, 2002: 2) Nevertheless, some viral conjunctivitis is spread via air-borne and thus, more difficult to control (HPA, 2007). Incubation period: 5 to 12 days Contagious period: Usually the later part of incubation period up to 14 days following onset Signs and symptoms: 1. Minimal itching 2. Sudden onset 3. Initially only one eye involved 4. Inflamed eyelid in one or both eyes 5. Profuse tearing 6. Photophobia 7. Red or pink sclera 8. Preauricular node (in front of ear) (San Diego City Schools Nursing and Wellness Program, 2002: 2) Accordingly, viral conjunctivitis is not helped by antibiotics and will clear up on its own, taking between 5-14 days (HPA, 2007). *** It is important to note that, according to the Health Protection Agency (HPA) North West (2007), bacterial and viral conjunctivitis are also called infective conjunctivitis, which may occur in isolation or be part of another illness such as measles. Additionally, it sometimes not clear whether the infection is bacterial or viral, thereby necessitating the physician to take eye swabs which will be sent to the laboratory for testing (HPA, 2007). Allergic Conjunctivitis According to HPA (2007), allergic conditions such as hay fever can cause conjunctivitis. In the same manner, allergies to eye make-up may also cause conjunctivitis (HPA, 2007). Signs and Symptoms: 1. Red and swollen lining of eyelids (conjunctiva) 2. Profuse tearing (watery at first, later can become purulent) 3. Both eyes involved 4. Intense itching, burning, rubbing 5. Nasal mucosa swollen and pale (San Diego City Schools Nursing and Wellness Program, 2002: 2) In addition, Freshwater and Maslin-Prothero, editors of Blackwell’s Nursing Dictionary (2005), enumerated more specific types of conjunctivitis according to their specific causative agents, which are enlisted in the table below: Specific Types of Conjunctivitis Adapted from Blackwell’s Nursing Dictionary (2005) Type Causative Agent Description(s) Catarrhal May be due to Haemophilus or staphylococcal organism, or to pollutants in the atmosphere Burning sensation of the eyes, photophobia, , and mucous or purulent discharge Follicular May be due to irritation or virus dense infiltration of the connective tissue of the conjunctiva Gonorrheal Caused by Neiseria gonorrhoeae A severe form of conjunctivitis, which may progress to panophthalmitis, which is a purulent inflammation in all parts of the eye. Inclusion Caused by Chlamydia Trachomatis Conjunctivitis of the newborn, which is acquired through the birth canal Purulent Not specified Characterized by discharge of pus ‘Swimming Pool’ Not specified Often acquired in swimming pools, which can be acute and purulent. General Interventions for Conjunctivitis Initial Management 1. Refer to physician for treatment 2. If the patient is a student, it is recommended to exclude him or her from school 3. Good handwashing technique 4. Cool compresses (San Diego City Schools Nursing and Wellness Program, 2002: 2) Medical Treatment 1. Differential diagnosis by the physician DIFFERENTIAL SYMPTOMOLOGY OF CONJUNCTIVITIS Taken and Adapted from the San Diego City Schools Nursing and Wellness Program (2002: 2) Bacterial Viral Allergic Onset Gradual Sudden Sudden Discharge Purulent, crusting Watery to purulent Watery upon awakening later Vision Blurred that clears Normal Normal with blinking Itching/Pain Minimal to none Minimal Intense Tearing Moderate Profuse Profuse (watery) Eyelids Swollen and inflamed Inflamed Inflamed and swollen Photophobia Yes Yes No Eyes Involved One or both One or both Both Nasal Mucosa Normal Normal Swollen and Pale Exclusion from school Yes Yes No Sclera Red or pink Red or pink Clear or pink 2. Ophthalmic solution or ointment prescribed by physician 3. Bacterial conjunctivitis will require antibiotic eye drops and/or ointment from the physician, whereas viral conjunctivitis is not helped by antibiotics but will clear up on its own, taking between 5-14 days (HPA, 2007). Exclusion from School or Work 1. Exclusion from school or work is not usual if the person is feeling well. However, sometimes the discomfort of conjunctivitis can make the affected person feel generally unwell and “miserable”. In particular, young children especially may suffer more than adults, thus necessitating to be kept off school until they feel better. In circumstances where there may be a number of cases in one nursery or school, the parents may be requested to keep their children away from school (or implementing quarantine)until the infection has cleared, but this is not usually required (HPA, 2007). 2. In case of bacterial and viral conjunctivitis, a student should be excluded from school until specific treatment from a physician has begun or until eyes are clear. Once student has started prescribed treatment and verification of treatment by physician is made, the student may attend school (San Diego City Schools Nursing and Wellness Program, 2002: 2). 3. In case of allergic conjunctivitis, a student does NOT need to be excluded (San Diego City Schools Nursing and Wellness Program, 2002: 2). Health Education 1. The spread of infective conjunctivitis is common in families, so it is crucial to adopt and implement good hygiene practices in order to prevent spread of the infection. 2. Complete the course of any drops and/or ointment as prescribed by the physician and only be applied or used by the person whom the medications are prescribed for. 3. Never share towels, flannels or eye make-up. 4. Try not to touch or scratch the infected eye/eyes and perform handwashing in case a person touches the affected eye(s) (Health Protection Agency [HPA] North West, 2007). Nursing Management Nurses must take extra care when inspecting the conjunctivae (Potter and Perry, 2001). Since conjunctivitis is a highly infectious condition, ophthalmic nurses must implement proper infection control measures such as wearing gloves and washing hands before and after performing eye examination and administration of prescribed medications to the clients (Potter and Perry: 757). Critical Analysis of the Interventions for Conjunctivitis Indeed, the interventions for conjunctivitis —referring the clients to the physician for appropriate management; careful implementation of care; and performing infection control measures (handwashing and gloving)― are acceptable and vital in the practice of ophthalmic nursing. Truly, it can be said as the “cornerstones” in the effective management of conjunctivitis and in the prevention of its spread. Nevertheless, Smith and Rusnak (1997), in their study, added the following for efficient infection control of conjunctivitis, which has been pointed out as one of the highly infective and can even become an epidemic in a long-term care facility: Most authors feel that an infection control program should include some form of surveillance for infections, an epidemic control program, education of employees in infection control methods, policy and procedure formation and review, an employee health program, a resident health program, and monitoring of resident-care practices. The program also may be involved in quality management (QM), environmental review, antibiotic monitoring, product review and evaluation, and reporting of diseases to public health authorities (Smith and Rusnak, 1997: 496). Conclusion Consequently, the essential aspects in the management and infection control issues of conjunctivitis have been exemplified in the sections of this paper. We have learned about the definition, description, medical and nursing interventions for conjunctivitis. Moreover, a critical evaluation has also been made, employing relevant references, thereby typifying the essence of this paper. Bibliography Berman, A., Snyder, S. J., Kozier, B., & Erb, G. (2008) Fundamentals of Nursing Concepts, Process, and Practice (pp. 26-28). 8th Edition. New Jersey: Pearson Prentice Hall. Black, J. M., Hawks, J. H., & Keene, A. M (2001) Medical-Surgical Nursing – Clinical Management for Positive Outcomes. Philadelphia: W. B. Saunders Columbus Vision Associates, Inc. (2004) ‘Conjunctivitis’ [Online Image]. Available at: http://www.cvavisioncare.com/conjunctivitis.htm (Accessed 26 July 2009). Freshwater, D. & Maslin-Prothero, S. E. (Eds.) (2005) Blackwell’s Nursing Dictionary. Second Edition. Oxford: Blackwell Publishing. Health Protection Agency (HPA) North West (2007) ‘Conjunctivitis’ (Information Leaflet). [Online] Available at: http://www.manchesterpct.nhs.uk/document_uploads/Infection%20Control(information%20leaflets)/conjunctivitis.pdf (Accessed: 25 July 2009). Marquis, B. L., & Huston, C. J. (2003) Leadership Roles and Management Functions in Nursing - Theory & Application (pp. 219-220). 4th Edition. Philadelphia: Lippincott Williams & Wilkins. Potter, P. A., & Perry, A. G. (2001) Fundamentals of Nursing (pp. 380-383). Fifth Edition. St Louis: Mosby. San Diego City Schools Nursing and Wellness Program (2002) ‘Conjunctivitis - Fact Sheet’. [Online] Available at: http://www.sfcs.net/media/77764/conjunctivitis%20facts.pdf (Accessed: 28 July 2009). School of Nursing University of Wisconsin-Madison (2009) ‘Nurse’s Cap’ [Online Image]. Available at: http://www.son.wisc.edu/alumni/history/historical_collections/caps/caps.html (Accessed 26 July 2009). Smith, P. W. and Rusnak, P. G. (1997) ‘Special Communication - Infection prevention and control in the long-term–care facility’. The Association for Professionals in Infection Control and Epidemiology, Inc and the Society for Healthcare Epidemiology of America. American Journal of Infection Control (AJIC) 1997; 25: 488-512. Smith, P. W. and Rusnak, P. G. (1997) Special Communication - Infection prevention and control in the long-term–care facility. The Association for Professionals in Infection Control and Epidemiology, Inc and the Society for Healthcare Epidemiology of America. Infection Control and Hospital Epidemiology 1997; 18: 831-849. Critical evaluation can be demonstrated in the following ways: Finding literature which supports rationale for ophthalmic nurse practice Present alternative viewpoints if there is more than more, which is best for ophthalmic practice and ophthalmic patients? Challenge accepted clinical practice: Is what we currently do valid and reliable or is there a better way to do it? Offer new or alternative perspectives resulting from nurses learning. Introduction Must begin with a strong statement relating to the chosen topic (referenced) Clearly identify the relevant nursing issue(s) and (key concept) that will be explored in the essay. Give my rationale for choosing the topic (include statistics here to highlight the scale of the problem and therefore its importance). Body of Essay/Discussion and Analysis Critically evaluate the evidence base for your key concept (the relevant nursing issue). My issue may be a professional issue, a psychosocial or any other issue relevant to patients on nurses selected care pathway. Relate relevant knowledge and evidence-based practice (e.g. biomedical sciences, nursing, psychology) to the planned care of the patient and the nurses role in its successful outcome. Constantly refer back to the title of the essay to ensure I am staying focused on the topic. Analysis of the nurse’s role around the issue and application of any research findings to my practice is essential. Critical conclusion needs to back to essay. Draw conclusions resulting from my analysis of the topic. Make suggestions for developing the practice as a result of my study (synthesis). How would I evaluate any suggested change? May good idea to mentioned types of conjunctivitis and why it happened etc... The nurses needs to take swabs that infection issue (such as bacterial, viral, chlamydial) Read More