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Successful Infection Control Through Persuasive Diplomacy in India

In the past few decades, there has been a surge in mortality rate owing to the rise of new infectious diseases and widespread prevalence of the existing ones in various parts of the world. Studies and statistics reveal that the number of people succumbing to pandemic diseases has been gradually increasing over years. Worse situation is observed in infectious diseases the cure for which has not been found yet and those that show increased resistance to antibiotics. This is attributed to the high pace at which these diseases are spread to healthy individuals due to poor methods of controlling infections. In a bid to reduce the number of deaths resulting from such diseases, various control measures have been adopted by health organizations which focus joint efforts to fight the diseases. The effectiveness of the control measures that are in place for different illnesses varies between regions depending on factors such as culture and the challenges faced in administering them. This research paper, therefore, discusses procedures and clinical importance of infection control, epidemiology of some infectious diseases, and successes and challenges faced in disease control in different regions of the world.

The bacterial infection resulting from Enterobacteriaceae poses a global threat due to its resistance to top antibiotics such as carbapenem. Oncology patients, particularly, are at a high risk of mortality from the pandemic since chemotherapy procedures administered to them significantly lower their immunity to numerous illnesses. Ghafur et al. (2012) discuss the results of a research conducted in Apollo Specialty Hospital in India that studied the effects of antibiotic stewardship programs which focused on infection control on the prevalence of the infection in the hospital. The study established that proper infection control strategies and practices are imperative in controlling the spread of the infectious disease.

Infection Control Strategies

An Infection Control Team (ICT) mandated to curb the spread of the disease prepared a restricted list of high-end antibiotics such as imipenem, tigecyline, colistin, and meropenem (Ghafur et al., 2012). The team then explained its importance to medical and paramedical personnel and discussed the importance of infection control measures through antibiotic stewardship activities. Ghafur et al. (2012) explain that the following strategies were put in place in a bid to embrace the infection control program:

  1. Total cooperation of the staff was ensured, and each department was issued with regular feedbacks on antibiotic wastage arising from resistance statistics. Compliance with the restrictions was monitored, and any violations were documented and communicated to the head of the team or medical superintendent;
  2. Education programs were conducted professionally to the medical staff, and diplomatic procedures were adopted in communication with consultnts in case of differing opinions on the need for restricted antibiotics;
  3. A nurse was assigned to the hospital’s Intensive Care Unit (ICU) department and was tasked with assessing compliance with the stewardship practices in the ICU;
  4. Another dedicated nurse was assigned to observe adherence to surgical prophylaxis, whereby he or she would check the choice of the antimicrobial agent, timing, dosage, and provide feedback to the management.

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Infection Control Policy Measures

A strict policy was formulated and implemented. According to Ghafur et al. (2012), the basic infection control measures used to reinforce the policy included:

  1. Isolation precautions: Sign boards in three languages depicting patients that need contact isolation for Multi-Drug Resistance (MDR) colonization were displayed on all doors. Provisions of aprons, gloves, and masks were located outside patients’ rooms, and their usage was rigorously monitored;
  2. Compliance with hand hygiene: Regular monitoring of hand washing was conducted as a measure of controlling the spread of disease-causing pathogens. A nurse was tasked with conducting weekly audits on compliance with this measure and providing reports to the relevant departments;
  3. Medical education activities: Periodic evaluation and detailed discussion of all aspects of infection control were held for doctors, health workers, and nurses to ensure maintenance of the infection control program standards;
  4. Education of patients’ kin: Regular distribution of brochures containing information on the importance of infection control practice was done among patients and their relatives. The aim of this measure was to resolve doubts about the importance and necessity of the program;
  5. Counseling: Upon isolation of an infected patient, the relatives of the patient were effectively counseled on the benefits of the control measure;
  6. Reviews: Weekly reviews of the disease spread prevention work were done, and outstanding health professionals were awarded tokens for recognition of their efforts and encouragement;
  7. Committee meetings: Workshops on infection control were held once in three months to analyze the trends, compliance to the policy and guidelines, and prepare plans for future activities.


The usage of carbapenem greatly dropped due to the vigilance of the Infection Control Team and health personnel in monitoring its prescription. Results from the findings showed that there was a significant reduction in the prevalence of the MDR Enterobacteriaceae over time. This is attributed to the embracement of infection control measures in attempts to fight the disease.

Risk Factors for the Houston-1 Strain Infection Among Paediatric Patients With Cystic Fibrosis

Pseudomonas aeruginosa (MRPA) is a multidrug-resistant respiratory disease-causing bacterium. It can lead to chronic pulmonary infections in patients with cystic fibrosis (Luna et al., 2013). This pathogen has various strains that have different structural forms in patients. However, routine molecular epidemiological surveys in a pediatric care center recognized an endemic strain of the pathogen, which is referred to as Houston-1. This strain is associated with some risk factors on the patients as illustrated below.

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A study carried out at Texas Children’s Hospital (TCH) revealed that recent hospitalization of pediatric patients was a significant risk factor for contracting the Houston-1 strain, which has an implication for increased morbidity (Luna et al., 2013). It was further established that effective infection control mechanisms resulted in minimized cases of infection with the strain amongst cystic fibrosis (CF) patients.

Molecular Epidemiological Surveillance

Initially, the Houston-1 strain of MRPA was identified through molecular typing project studies based on the repetitive Polymerase Chain Reaction (PCR) techniques. Luna et al. (2013) illustrate that the subsequent regular molecular epidemiological surveillance of the strain amongst CF patients was important in assessment and analysis of the infection trends among patient and provision of relevant data for additional research concerning the main risks and outcomes. In addition, it served as a metric for quality improvement in the health center.

The findings from these studies were consistent with reports from the CF centers in Australia and the United Kingdom. Increased morbidity, therefore, necessitated the need for adoption of infection control practices, which led to a decline in the prevalence of the Houston-1 strain. According to Luna et al. (2013), infection control practices that were employed by the hospital administration included isolation of all inpatients prior to availability of final results, immediate examination of suspected and known contact isolation outpatients, and improved accessibility of gloves and gowns to all medics and paramedics.

 

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The realization the spread of the Houston-1 strain of MRPA amongst CF patients in TCH led to enhanced infection control strategies in both clinical processes and inpatient protocols, which resulted in decreased prevalence of the strain. Moreover, absolute monitoring through recurrent molecular typing is aimed at eliminating common sources of MRPA infections in CF patients.

Infection Control in Northern India

In almost each season, healthcare associated infections (HAIs) tend to affect many individuals, particularly in low-income and middle-income nations such as India. They are also considered as the most common barriers to global healthcare delivery due to complicating clinical care, increasing hospital stay, and depriving patients and health centers of their limited resources. Efficient implementation of infection control practices is imperative in curbing the spread of HAIs. Barker et al. (2017) discuss results of a study on facilitators and barriers to disease control practices on HAIs that was carried out at a private hospital in Northern India. The findings indicated that the person, task, environment and organization level were the categories of the major challenges facing infection control in the health institution.

Methodology

The study involved twenty ten-minute semi-structured interviews of ten nurses and ten doctors from all clinical departments ranging from junior staff to senior consultants. The interviews were based on a conceptual framework that examines problems experienced in interaction between systems and people (the Systems Engineering Initiative for Patient Safety) (Barker et al., 2017). The hospital’s infection control policies were analyzed, and the focus was on how people, environment, tasks, tools, and organizational structures impacted success of the infection control program.

Findings and Recommendations

The results of the study revealed the main barriers to infection control. Thus, the authors suggested that the number of staff, issues in language proficiency, training of new employees, and a heavy workload pose the main challenges to efficient disease control. On the other hand, an efficient team and institutional climate that fosters infection control comprise the major facilitators.

Based on the findings from the study, Barker et al. (2017) offered the following suggestions to improve efficacy of infection control measures against HAIs that are adopted at the hospital:

  1. Support from the top leadership levels was required to implement policies that promote healthcare worker recruitment and retention to handle problems associated with staffing;
  2. Responsible management was advised to prioritize resource allocation to enhance intensive language training and infection control skills for new and existing workers;
  3. Embracement of systems development and capacity building at the organizational level to facilitate better implementation of infection control policies;
  4. Introduction and implementation of the appreciative inquiry concept to improve working relationships amongst the staff, decision-making skills, and compliance with the disease control policies and practices.


A work systems analysis is important in the identification of new areas of improvement in an organization. Barker et al. (2017) affirm that the study in the hospital established that tasks, person, environment, and organizational level concepts determine success of infection control practices. Therefore, institutional and resourceful endorsement for infection control programs is imperative for successful administration and implementation of disease control practices.

Clinical Importance and Epidemiology of Quinolone Resistance

Quinolones are antibiotics that have a wide range of applications in managing bacterial infections. Thus, they are administered for treating urinary tract infections (UTIs), respiratory diseases, intra-abdominal maladies, sexually transmitted diseases, dermal infections, and bone and joint diseases (Kim & Hooper, 2014). Moreover, quinolones are used for prophylaxis in urologic surgery, cirrhotic patients, and cancer patients with neutropenia. However, Kim and Hooper (2014) claim that their resistance to gram-positive and gram-negative bacteria has developed over the past years by forming drug-enzyme-DNA complexes which block DNA replication during transcription and translation. This resistance, therefore, impedes the use of quinolones in clinical procedures for treatment.

Resistance Mechanisms

Mechanisms of quinolone resistance are broadly classified into three categories, as described by Kim and Hooper (2014). They include:

  1. Chromosomal mutations which are responsible for reducing drug binding to the target enzymes by altering their structures;
  2. Resistance of plasmid-acquired genes that modify the drug, its efflux, or protect the target enzymes;
  3. Chromosomal mutations involved in exacerbating the activity of efflux pumps that transport antimicrobials out of the cells of the bacterial pathogens.


The above three modifications are the main risk factors regarding the use of quinolones in clinical practice. As a result, they have led to global cases of prevalence of bacterial infections which were previously controlled by quinolones. Adoption of infection control measures, therefore, can be important in decreasing their prevalence.

Epidemiology of Quinolone Resistance

Studies conducted in various parts of the world indicate that quinolone resistance rates have gradually elevated in the recent past. For instance, a research conducted by the Asian Network for Surveillance of Resistant Pathogens (ANSORP) revealed that representatives of Asian nations such as Korea and Taiwan have elevated rates of respiratory tract infections’ resistance to quinolones (Kim & Hooper, 2014). The surveillance study also revealed that Asian countries such as Korea have high resistance of respiratory pathogens to quinolones with rates of about 80%. Countries within the Asia-Pacific region also registered high rates of over 20% UTIs resistance to quinolone treatment (Kim & Hooper, 2014). Similarly, other bacterial infections showed corresponding trends in resistance to the antimicrobial remedy. The implication is that quinolones have declined in their effectiveness in treating bacterial infections. Infection control measures can thus be instrumental in containing the diseases.

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Infection Control in Healthcare Settings in Japan

Initially, universal precautions in the healthcare of Japan were disorganized and sometimes non-existent. This situation, therefore, exacerbated the chances of disease spread between patients and medical staff. According to Morikane (2012), the establishment of the Japanese Society for Environmental Infections (JSEI) in1986 brought about a revolution that resulted in organized endeavors in infection control activities within the healthcare system in Japan. Several major steps focusing on disease control have been made in healthcare delivery over years. As a result, Japan is currently on the verge of excellence in infection control in comparison with other countries such as the United States.

The Infection Control Team

Contrary to some developed nations, where the members of each medical profession work independently to sustain infection control, Japanese healthcare workers cooperate in achieving a common goal (Morikane, 2012). In this case, healthcare facilities have organized infection control committees that monitor infection control practices and conduct surveillance of multi-drug resistant micro pathogens.

Professional Certifications

Morikane (2012) explains that different occupations that participate in infection control in Japan are categorized into four professional groups. They have specialized certifications as follows:

  1. Certified Nurse for Infection Control (CNIC) certification accredited by the Japanese Nursing Association requires six months of comprehensive and intensive study at a recognized Japanese institution and excellence in examination;
  2. Infection Control Doctor (ICD) certification accredited by the ICD committee requires that one be an experienced medical doctor in infection control, a member of a society recognized by the committee, and a participant in educational conferences;
  3. Board-Certified Infection Control Pharmacy Specialist (BCICPS) certification is accredited by the Japanese Society of Hospital Pharmacists. It requires a candidate to be a pharmacist with a work permit, a certified ICD, an author of three articles in the pharmaceutical field and at least two publications on infection control, and pass a rigorous examination;
  4. Infection Control Microbial Technologist (ICMT) certification accredited by the Japanese Society for Clinical Microbiology requires one to be a clinical technologist and an active member of the society of infection control practices.

Challenges Facing Infection Control in the Japanese Healthcare System

The principal setback in the Japanese healthcare system is inadequate workforce designated to monitor and evaluate infection control in hospitals and healthcare facilities (Morikane, 2012). Due to the existing health insurance system, health workers are often dispatched to areas that generate direct revenue. However, other challenges affect medical research, whereby very few publications are in English. This is attributed to reasons such as the lack of the infection control department in universities, the medical insurance structure limiting resources, and limited educational opportunities in healthcare research.

Zika Virus (ZIKV) Infection in Pregnant Women in Rio de Janeiro

Zika virus poses a serious challenge the health of people wordlwide. For instance, Zika’s vector, Aedesaegypti mosquito, has recently contributed to extensive prevalence of flavivirus among the Brazilian population (Brasil et al., 2016). Particularly, in expectant women, ZIKV has been associated with central nervous malformations in fetuses resulting in abnormalities such as neonatal microcephaly, growth restriction, and fetal death. According to Brasil et al. (2016), ZIKV diagnosis is dependent on the virus identification through Reverse-Transcriptase-Polymerase-Chain-Reaction (RT-PCR) assays in blood and urine during acute infection. However, most infections are clinically diagnosed without laboratory confirmatory tests due to unavailability of the assays.

Symptoms of ZIKV Infection

A surveillance study carried out on pregnant women in Rio de Janeiro established that the period within which ZIKV develops varies from the second to the ninth month of gestation. According to the study carried out at the Oswaldo Cruz Foundation, Computed Tomography (CT) and ultrasound scans indicated that fetuses infected during the first three months of pregnancy manifested physically defective changes in development, while those infected in the last three months had central nervous system (CNS) abnormalities (Brasil et al., 2016). ZIKV manifested in pregnant women in conjunctiva injection, descending macular or maculopapular rash, headache, short-term fever, pruritus, fatigue, and arthralgia.

Effects of the Disease

According to the findings of the study, spontaneous miscarriage, fetal death, still birth, and other abnormalities including visual and hearing impairment in infants resulted from the disease (Brasil et al., 2016). In other cases, infants had congenital heart disease, clenched fists as a result of CNS defects, cortical thumbs, foveae in the knees or elbows due to contractures of the limbs, and redundant skin on the scalp. These findings imply that infants exposed to ZIKV are likely to need critical medical attention soon after birth compared to those who are not pre-exposed.

Conclusion

Infection control is imperative in curbing the spread of diseases, whether curable or not. Adoption and administration of proper infection control measures in healthcare institutions have led to a decline in morbidity rate and prevalence of various diseases. Thus, the significance of disease control is demonstrated in India, where persuasive diplomacy was used to successfully manage the spread of the resistant bacterial infection. The measures applied in the exercise have been reviewed, and their implications clearly illustrated a drop in the usage of the relevant antibiotics. In another case in Texas, the epidemiology of the MRPA was surveyed among predisposed patients, and risk factors for the Houston-1 strain were determined. The discussion illustrates how infection control strategies were used to contain the epidemic. Similarly, another study carried out in India revealed the use of infection control measures in managing disease morbidity. The barriers and facilitators to effective disease control were analyzed and recommendations on how they can be regulated were provided. Moreover, the clinical importance of quinolones and their resistance mechanisms have been reviewed. Their resistance statistics indicate that infection control procedures are significant in controlling bacterial infections initially treated by quinolones. This essay also reviewed the Japanese healthcare system, whereby the focus is on its infection control practices. Challenges facing them are described in detail. Finally, Zika virus infection in pregnant women living in Brazil’s capital is analyzed. An overview of the diagnosis, symptoms, and effects of the infection was presented. Thus, a review of various dimensions of disease control, its applications, challenges, and related concepts shows that effective control measures are necessary to reduce prevalence of infectious diseases.

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