Question

Infection control. Professional Nursing 1.

From Hebden, J. (2012). Rationale for accuracy and consistency in applying standardized definitions for surveillance of health care-associated infections. American Journal of Infection Control 40(2012). Accessed from http://www.ajicjournal.org/pb/assets/raw/Health%20Advance/journals/ymic/YMIC_40_5_S.pdf

CASE STUDY

COMPLETE THIS CASE STUDY. FIND A MINIMUM OF 10 ARTICLES THAT RELATE DIRECTLY TO THIS SCENARIO OR RELATE TO INFECTION CONTROL MEASURES THAT MAY HAVE ALTERED THE COURSE DESCRIBED IN THIS SCENARIO.

On April 7, a 65-year-old female was admitted with congestive heart failure from a long-term acute care facility where she was undergoing rehabilitation. Her past medical history included morbid obesity, hypertension, diabetes, and obstructive sleep apnea. Because of deteriorating respiratory status in the emergency room, the patient was intubated and placed on a ventilator. Chest X-ray revealed pulmonary edema. She was taken emergently to the cardiac catheterization laboratory, where left and right heart

catheterization was performed. A right internal jugular (IJ) catheter was placed to monitor pulmonary wedge pressures and to infuse fluids and medications, and an indwelling urinary catheter was

inserted. She was then transferred to the coronary care unit. On April 8, the patient was afebrile and normotensive, and demonstrated improving ventilatory status after aggressive diuresis. Rales were still present bilaterally in the lung bases on auscultation, with one fingerbreadth of jugular venous distension

noted on the left side of the neck. The right IJ catheter was dry with an intact dressing. A pressure dressing was in place over the cardiac catheterization site in the right groin. The admission rectal swab

screen was positive for vancomycin-resistant enterococcus (VRE). The patient was placed on Contact Precautions. On April 9, the patient had a low-grade fever of 37.5C. She was being weaned from the ventilator. Chest X-ray revealed atelectasis in the right lower lobe, with small pleural effusions bilaterally and resolution of pulmonary edema. The nursing notes reported clear yellow urine with adequate output. After the pressure dressing in the right groin was removed, slight redness of the site was documented. The right IJ catheter site showed no signs of inflammation through the transparent dressing. On April 10, the patient was successfully extubated, and the IJ catheter was removed. Her activity was increased to walking with assistance. During transfer from the bed, the patient complained of pain in the right groin. Examination of the site revealed increased redness with swelling and purulent drainage. The patient’s temperature was 38.3C, and a fever workup was initiated. Blood, urine, and groin drainage cultures were sent for laboratory analysis, and empiric antibiotic therapy was started.

On April 11, blood cultures were reported as growing gram-positive cocci in chains, and Gram’s stain of the groin drainage showed moderate polymorphonuclear cells with many gram positive cocci. The groin tenderness and redness had improved. Rasmussen College School of Nursing Nu231: Professional Nursing 1 Clinical make up packet-infection control PSH 12/3/14

From Hebden, J. (2012). Rationale for accuracy and consistency in applying standardized definitions for surveillance of health care-associated infections. American Journal of Infection Control 40(2012). Accessed from http://www.ajicjournal.org/pb/assets/raw/Health%20Advance/journals/ymic/YMIC_40_5_S.pdf

On April 12, the following laboratory results were available:

Urine: no growth

Blood: Enterococcus faecium in 2 of 2 bottles, sensitive to vancomycin

(vancomycin-sensitive enterococcus [VSE])

Groin wound drainage: E faecium, resistant to vancomycin

(vancomycin-resistant enterococcus [VRE])

QUESTION:

What infection prevention measures do you think would have altered the outcome of this scenario? Why do you think those measures would be effective?

Write one page defending your answer citing at least two scholarly sources to support your stance.

Attach an APA formatted reference page

Answer 1

infection prevention measures

strict adherence to Hand hygiene practices- with antimicrobial soap

Proper donning of Gloves- double gloves

Proper donning of surgical scrubbing- with antiseptic agent

Sterile preparation patient-antiseptic skin preparation, use of large sterile sheet to cover the complete patient with equipments going to handle

Appropriate choice of antibiotics pre procedure as prophylaxis

Technique of catheterization- pressure dressings after skin closure inorder to prevent hematomas and single use of devices

Wound care-Sterile semi-permeable dressing or sterile gauze dressing in the site of bleeding.

Use of PPE- use of sterile gown, glove, mask, eyeglasses etc

Impregnated anti-infective devices

A retrospective study by bloom et.al recently published reported the less chance of infection using these measures.