Chain of Infection of Tuberculosis - Research Paper Example

CHAIN OF INFECTION OF TUBERCULOSIS Introduction Tuberculosis refers to a bacterial infection that can spread through the lymph nodes and bloodstream to any other organ in the human body. The disease mainly affects the lungs. Most people who are exposed to TB never develop symptoms because the bacteria can live in an inactive form in the body. One can stay with the T.B bacteria for a long time in the body without developing the symptoms of the disease provided that they have strong humane system. However groups such as people with HIV or elderly adults the TB bacteria can become active. In their active state, TB bacteria cause death of tissue in the organs that they infect. According to the recent statistics by the Center for Disease Control (CDC), tuberculosis is one of the world’s deadliest diseases. It is recoded that one third of the world’s population is infected with tuberculosis. In the year 2013, it is recorded that 9 million people around the world became sick with tuberculosis disease. In the same year, there were around 1.5 million TB-related deaths worldwide. For people living with HIV, T.B is the leading killer. A total of 9,582 TB cases (a rate of 3.0 cases per 100,000 persons) were reported in the United States in 2013. Both the number of TB cases reported and the case rate decreased; this represents a 3.6% and 4.3% decline, respectively, compared to 2012. The rate of infection for Tuberculosis is very high and it is reported that one infected person can infect 10 to 15 people each year. Tuberculosis exists in three forms namely latent and active forms. People with latent TB infection do not feel sick and do not have any symptoms. They are thus said to be infected with M. tuberculosis, but do not have TB disease itself. The only indication of tuberculosis infection is a positive reaction to the tuberculin skin test or TB blood test. Persons with latent TB infection are not infectious and cannot spread TB infection to others. The chest X-ray for a person with latent tuberculosis looks very normal and is treating by taking a medication that lasts 9 months. On the other hand, active tuberculosis is manifested by the reproduction and spread of tuberculosis germs in the body leading to tissue damage. A person usually feels sick and symptoms include cough that lasts 3 weeks, weight loss, night sweats, and fever. In this case, a chest x-ray and other tests are needed to diagnose TB disease. According to the World Health Organization it is a proven fact that one-third of the world is infected with the Tuberculosis bacterium. Treatment of Tuberculosis is no fast and easy fix procedure as it requires a lot of caution and care from the healthcare service providers as well as the infected individuals. Many months of antibiotics such as Rifampin and other drugs is needed and the patients must adhere to the set instructions as failure to do so may be fatal. It is vital to take the full course of antibiotics to prevent new, stronger strains of drug-resistant Tuberculosis to emerge (Vaishnavi, 2013). BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. The vaccine is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. However, the vaccine is not highly recommended in the United States since the country has low risk of infection by the Mycobacterium tuberculosis. Positive skin test is an indication that the person being tested have their body infected with TB bacteria. In this case, additional tests are needed to determine if the person has latent TB infection or TB disease. Negative skin test means the person’s body did not react to the test, and that latent TB infection or TB disease is not likely. Chain of infection of Tuberculosis An infectious agent is any disease causing microorganism or pathogen. Infectious agents can be bacterial, viral, fungal or parasitic. The infectious agent for tuberculosis is Mycobacterium tuberculosis. The chances of this bacterium causing infection is catalyzed by its ability to grow, invade the body tissues and cause the disease. The reservoir is where microorganisms live as well as reproduce. Examples of reservoir include humans, animals, food and water. Reservoir offers the microorganism a place to thrive as well as reproduce. The only reservoir for Tuberculosis is humans. Portal of exit is the route of escape of the pathogen once they leave the reservoir. General examples of portal of exit include cold or flu from mucous secretions, West Nile Virus which arises when the mosquito bites and feeds on the blood of birds, from Hepatitis in the stool and from droplets or other contact from Severe Acute Respiratory Syndrome. The portal of exit for Tuberculosis is the mouth and nose. This takes place when a person with Tuberculosis sneezes or coughs resulting to the release of large numbers of the bacterium causing Tuberculosis (Antas, et. al, 2012). Means of transmission relates to the manner in which the pathogens get from the reservoir to the new host. Means of transmission include the respiratory tract through which an infected person releases secretions such as cough or sneeze. A large number of bacterium are transported through lack of proper hand washing and they are left on any surface that the person touches. The mode of transmission for Tuberculosis is through the cough or sneeze that releases Tuberculosis bacterium into the air. This can easily be inhaled by another person present in the room. Portal of entry is the route through which the pathogens are able to enter into the system of the new host. Many portals of entry exist for microorganisms. These include breaks in the skin, mucus membranes located in the nose and mouth and orifices found in the body. The portal of entry for Tuberculosis is also its portal of exit which in this case is the human respiratory system. Just as the Tuberculosis bacterium can be expelled by sneezing, it can be inhaled by the nose and mouth (McHugh, 2011). Susceptible Host refers to a person who can fall sick as a result of exposure to any disease causing pathogen. Microorganisms such as bacterium will always consider a host who can easily be invaded, such as someone who is already sick or has a low immune system. For example, an older person with HIV or AIDS will have a much harder time surviving Tuberculosis than a young, healthy 25-year-old. Breaking the chain of infection An effective Tuberculosis infection control program has been organized into three different throngs among other measures that are aimed at breaking the chain of transmission. Such include early identification, isolation and effective treatment of people who have been diagnosed with active Tuberculosis. Every healthcare facility should have written policies and guidelines that have been put in place and such need to be reviewed periodically so as to ensure their effectiveness. The Center for Disease Control recommends a Tuberculosis infection control program that is based upon the earlier mentioned three levels of control (Dyer, 2010). The first level aims at full implementation of administrative measures that include written policies and procedures. This need to be backed up with quick identification as well as isolation of infected individuals. The nurses need to be trained about Tuberculosis and they further need to be screened on timely basis to ensure Tuberculosis infection and disease itself. The second phase in the treatment of Tuberculosis include engineering controls to prevent Tuberculosis from spreading thus breaking down the chain of transmission. Such steps involve developing a proper ventilation and filtration systems that operate effectively and efficiently. The use of personal respiratory protective equipment will further help in preventing the spread of the microorganism causing Tuberculosis. The infectious agent can be tackled through prompt treatment of those who have been infected by the microorganism and have developed signs and symptoms of the disease. Rapid identification of the organism as well as decontamination of the surrounding area can serve to cut the chain by destroying the infectious agent. The reservoir can be broken by ensuring proper health and hygiene, promoting proper sanitation of the surrounding environment as well disinfection or sterilization of items that are used by several people. Hygiene can be ensured through washing of hands frequently with soap and warm water for at least 20 seconds and the use of alcohol hand gels that removes germs. All contaminated surfaces need to be cleaned with commercial germicidal cleanser or wipes. People need to consider maintaining cough etiquette such as covering the sneeze with tissue and doing it away from other people (Kulʹchaveni︠a︡, 2014). The portal of exit is broken by putting on proper attires such as hand gloves especially when one comes into close contact with secretions and body excretions. Proper waste disposal mechanisms need to be embraced. The mode of transmission for TB can be broken by ensuring proper handling of foods as well as restricting the infected persons from handling foodstuffs to be eaten by other people. This is broken through the use of aseptic technique and taking good care of any wound on the body that can allow entrance of the microorganism. One need to avoid close contact with people who are sick from TB as well as covering the mouth or nose with tissue when coughing or sneezing. Washing of hands often with soap and much water or using alcohol rub. Susceptible hosts for TB include cancer patients, diabetes mellitus patients and the elderly. This chain can be broken through proper treatment of the primary diseases and recognition of the high risk people and giving them the care that will ensure they do not fall susceptible to the infection (Vaishnavi, 2013). Tuberculosis screening tests are not used as general population screens but are used to screen people who are at high risk for TB exposure. Such groups of people include those with diseases that seem to weaken their immune systems, those in confined living conditions, healthcare workers who interact frequently with active tuberculosis patients and those who have signs and symptoms of active tuberculosis. Screening of TB is done through tuberculin skin test (TST) or an interferon gamma release assay (IGRA) may be performed to screen for TB. The tuberculin skin test is composed of two steps namely the injection of a small amount of purified protein derivative (PPD) solution under the first layer of skin of the forearm and an evaluation of the injection site conducted by a health practitioner at 48 and/or 72 hours to see if a local skin reaction has occurred. On the other hand, the IGRA test measures the release of a substance called gamma interferon by white blood cells in a sample of blood when the cells are exposed to specific TB antigens. The IGRA test is not performed by all laboratories. The test requires viable white blood cells, so the IGRA blood sample must be received and tested by a laboratory within a designated window of time. Treatment of Tuberculosis Latent tuberculosis requires one to take only one type of Tuberculosis drug while active tuberculosis patients will need several drugs at once. The most common medications used to treat tuberculosis include Isoniazid, Rifampin, Ethambutol and Pyrazinamide. In case of a drug-resistant Tuberculosis, one will need a combination of antibiotics known as fluoroquinolones and injectable medications, such as amikacin, kanamycin or capreomycin, that are generally used for 20 to 30 months. New drugs are being have recently been introduced as add-on therapy to the current drug-resistant combination treatment and they include Bedaquiline, Delamanid, PA-824, Linezolid and Sutezolid. The patients with possible tuberculosis need to be isolated in private rooms with negative pressure. The nurses in charge must wear high-efficiency disposable masks sufficient to filter the tubercle bacillus. For initial empiric treatment of tuberculosis, the patients need to be initiated with 4-drug regimen namely isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Patients with tuberculosis who are currently receiving pyrazinamide should undergo baseline and periodic serum uric acid assessments while those with tuberculosis who are receiving long-term ethambutol therapy should undergo baseline and periodic visual acuity and red-green color perception testing. Nurses perform a very crucial role in tuberculosis control program. The International Council of Nursing have a basis that nurses are in a better position to advocate for strong tuberculosis control programs well implementing the five elements of Directly Observed Treatment Short-course (DOTS). It is a proven fact that most tuberculosis treatment is recently carried out in the community settings. Treatment is best supervised by nurses because they usually have regular contact with the patients. The main principle of nursing intervention is the integrated organization of multiple activities to achieve specific outcomes for patients. The nursing intervention needs a system of recommendations that promotes performance and support the quality of health care services. The system of recommendations can be availed through developing evidence-based clinical practice guidelines that have a clear definition. The definition can be used to mean systematically developed statements to assist practitioner and patient decision about appropriate health care for specific clinical situations (In Acton, 2012). The role of nurses is very vital in the control of TB and for the successful completion of the patient’s therapy. Once a diagnosis has been made, the patient needs to be established on the correct treatment and this can only be monitored by the nurses. Many patients find the treatment course difficult at the start because they have to take many tablets, some of which are very complicated and have various side-effects. It is the role of the nurses to instill the discipline of taking all the medication as required by the doctor for the patients to experience full recovery. Some patients may easily consider giving up especially when they are almost through with the doses yet no positive outcome is forthcoming. Nurses who have been trained in counselling can offer advice to such patients as well as assuring of recovery even after completion of the doses. TB nurse specialist can assist in the management of side-effects or drug formulations that may come up among patients. They are also trained to take routine blood samples or occasionally arrange admission to hospital from time to time. Nurses have had to visit the patients at home three times a week and administering the treatment to them. They may consider increasing the dose of medication should they fail to realize any improvement on the patients (McHugh, 2011). Proper hand hygiene offers an essential aspect of hospital-associated infection-reduction. Strategies that is applied by the nurses in their role as caretakers to the patients. Nursing care measures can directly contribute to prevention of TB particularly in patients who are most at highest of being infected such as those in advanced age, those suffering from other diseases and those exposed to patients with TB. The evidence shows that the most important contributions of nursing care to prevention of hospital-associated TB are in four areas namely hand hygiene, respiratory care, patient positioning, and education of staff Ensuring control of patient-to-patient spread of infection with hand hygiene and general infection control practices are the most effective means for controlling the spread of resistant organisms by the nurses. They also keep up to date with evidence-based and research practices that are aimed at preventing health care–associated infections which is an integral part of their work (Nugent, & Vitale, 2014). Conclusion The ever increasing close association between TB and Human Immuno Deficiency Virus (HIV) is a cause of concern globally as the management and outcome of both the diseases is affected. This has presented serious challenges to the health care personnel as they have to come up with means to address the ever increasing challenge. As a result, proper planning needs to be undertaken by nurses at various levels of treatment in a bid to ensure that the transmission of infection can be controlled. Adopting policies that affect the transmission of TB infection along with proper disease management options can go a long way in suppressing the menace of TB and can possibly control the growing incidence of TB and that of HIV. Transmission control methods can also decrease the risk of spread of TB among health care workers such as the nurses who have undergone special training to handle such cases. References Antas, P. R. Z., Santos, D. O., & Pinheiro, R. O. (2012). Current Diagnosis of Infant Tuberculosis Infection. Sharjah: Bentham Science Publishers. Dyer, C. A. (2010). Tuberculosis. Santa Barbara, Calif: Greenwood. In Acton, Q. A. (2012). Advances in HIV/AIDS research and treatment. Kulʹchaveni︠a︡, E. V. (2014). Urogenital tuberculosis: Epidemiology, diagnosis, therapy. McHugh, T. D. (2011). Tuberculosis: Diagnosis and treatment. Wallingford, Oxfordshire: CABI. Nugent, P., & Vitale, B. (2014). Fundamentals of Nursing: Content Review Plus Practice Questions. Philadelphia: F.A. Davis Company. Vaishnavi, C. (2013). Infections of the gastrointestinal system. New Delhi: Jaypee Brothers Medical Pub. World Health Organization. (2009). Global tuberculosis control: Epidemiology, strategy, financing : WHO report 2009. Geneva: World Health Organization. http://www.cdc.gov/tb/statistics/ Read More