This paper examines three interrelated areas of clinical infection control and epidemiology. Part A addresses a pregnant registered nurse who develops chickenpox (varicella zoster), covering immunoglobulin prophylaxis, breakthrough varicella, risks of maternal infection during pregnancy, and six infection control issues the case raises. Part B discusses methicillin-resistant Staphylococcus aureus (MRSA), including wound care protocols, treatment options, and the signs and symptoms healthcare workers should recognize. Part C defines and distinguishes core epidemiological terms — incidence, prevalence, endemic, epidemic, and pandemic — using examples such as malaria, the Black Death, and HIV/AIDS to illustrate each concept in practice.
As standard procedure warranted in this case, the obstetrician injected the registered nurse (RN) with varicella zoster-specific immunoglobulin. Although the injection occurred too late to be fully effective, it was administered as a prophylactic measure to protect the unborn baby. A few days later, the RN developed chickenpox regardless. The likely reason the vaccine did not take was that she had already been exposed; this situation is referred to as "breakthrough varicella" (National Centre for Immunisation, 2009, p. 3). Breakthrough varicella is a mild form of the infection, yet it remains contagious.
The varicella vaccine should not be given to the baby until it is twelve months of age, but it may not be necessary at all due to potential in utero exposure to the varicella zoster virus. Infants "should receive no specific treatment or vaccination after exposure to Varicella zoster virus (VZV) but can later receive acyclovir" (Immunization Action Coalition, 2014).
According to the Immunization Action Coalition (2014), "There has been only one published report of mother-to-child transmission of varicella vaccine virus." Moreover, "if the mother is at high risk of exposure to varicella, the benefits of vaccination probably outweigh the risk of transmission to the infant" (Immunization Action Coalition, 2014).
If the mother contracts chickenpox during the first half of her pregnancy, there is a small chance the baby will experience serious effects, including scarring and birth defects (Children, Youth, and Women's Health Service, n.d.). The risk is substantially higher when the woman contracts chickenpox closer to the delivery date, which is why vaccination may be administered in those cases.
Six infection control issues this case raises are as follows. First, there is a clear need to monitor all healthcare staff for their exposure to specific infectious or contagious diseases. In this instance, the nurse should have reported her chickenpox exposure earlier and should have been vaccinated in advance. Second, chickenpox cannot be prevented solely through hand washing, so hand hygiene is not the primary concern here. Third, environmental cleaning alone is also insufficient; only nurses with proven immunity should care for potentially or actually infected patients. Fourth, the most important issue is exposure awareness and timely reporting. Fifth, all pregnant nurses and healthcare workers should be required to report their pregnancy status to occupational health so that appropriate precautions can be arranged. Finally, negative-airflow rooms and patient isolation may be warranted in these cases (Centers for Disease Control and Prevention, 2014).
Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to many antibiotics and can "cause severe problems such as bloodstream infections, pneumonia, and surgical site infections" (Centers for Disease Control and Prevention, 2014). Treatment of wounds must therefore be thorough and immediate. Once a person is infected, wounds must be covered fully and bandages kept clean and dry until healing is complete. Drainage must be performed professionally. Frequent hand washing is essential for the infected patient and all surrounding healthcare employees. The patient should not share personal items — such as towels or bed sheets — that may have come into contact with wound drainage during this period.
Treatment options for a patient with MRSA or similar infections include having healthcare professionals treat and drain the wound using proper procedures. In some cases, a physician may need to prescribe antibiotics, though the infection may not respond to treatment (Centers for Disease Control and Prevention, 2014). Keeping the patient relatively isolated, ensuring that the patient's sheets and towels are handled properly, and preventing the patient from contacting others with open wounds will all help, as will frequent wound care. It is important to coach patients regularly about their wound care responsibilities.
The signs and symptoms of MRSA range from mild to severe. According to the Centers for Disease Control and Prevention (2014), patients may initially believe they have only a spider bite, but "unless a spider is actually seen, the irritation is likely not a spider bite." Healthcare workers should therefore remain vigilant for MRSA signs and symptoms to prevent its spread. The infected area may appear red and swollen and is often painful or tender to the touch; the skin may also feel warm. When the area fills with pus, the infection is becoming more severe. The development of fever likewise indicates an active infection. In the most extreme cases, particularly in patients with compromised immune systems, MRSA can lead to bloodstream infections, pneumonia, and surgical site infections (Centers for Disease Control and Prevention, 2014).
"Defining incidence, prevalence, and disease occurrence rates"
"Distinguishing endemic, epidemic, and pandemic with examples"
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