Question

Between March 9 and April 12, five chronic peritoneal dialysis patients at one hospital became infected with Pseudomonas aeruginosa. Four patients developed peritonitis (inflammation of the abdominal cavity), and one developed a skin infection at the catheter insertion site. All patients with peritonitis had low-grade fever, cloudy peritoneal fluid, and abdominal pain. All patients had permanent indwelling peritoneal catheters, which the nurse wiped with gauze that had been soaked with an iodophor solution each time the catheter was connected to or disconnected from the machine tubing. Aliquots of the iodophor were transferred from stock bottles to small in-use bottles. Cultures from the dialysate concentrate and the internal areas of the dialysis machines were negative; iodophor from a small in-use plastic container yielded a pure culture of P. aeruginosa. What improper technique led to this infection? and List the microbial targets of disinfecting chemicals & provide one example of a chemical agent that affects that structure.

Answer 1

PSEUDOMONAS AERUGINOSA HAS BECOME AN IMPORTANT CAUSE OF GRAM NEGATIVE INFECTION,ESPECIALLY IN PATIENT WITH COMPROMISED HOST DEFESE MECHANISMS.ITBIS THE MOST COMMON PATHOGEN ISOLATED FROM PATIENTS WHO HAVE BEEN HOSPITALIZED LONGER THAN 1 WEEK,AND IT IS A FREQUENT CAUSE OF NOSOCOMIAL INFECTIONS.

PSEUDOMONAL INFECTIONS ARE COMPLICATED AND CAN BE LIFE THREATENING.

PERITONITIS =REPRESENTS A MAJOR COMPLICATION OF PERITONEAL DIALYSIS

VALID RISK FACTORS FOR PERITONITIS :MALNUTRITION ,OVERWEIGHT,SMOKING,ETC

PERITONITIS IS A COMPLICATION OF PERITONEAL DIALYSIS AND IS A LEADING CAUSE OF =HOSPITALIZATION

=CATHETER LOSS

=TECHNIQUE FAILURE

SKIN INFECTION =ONE OF THE MOST SERIOUS COMPLICATIONS OF PERITONEAL DIALYSIS IS INFECTION ,WHICH CAN DEVELOP IN THE SKIN AROUND THE CATHETER.

CATHETER CARE IS A STERILE PROCESS;ALWAYS WASH BEFORE AND AFTER CATHETER CARE.

PERITONITS OR EXIT SITE INFECTIONS DUE TO PSEUDOMONAS SPECIES IS A SERIOUS COMPLICATION IN CAPD (CONTINOUS AMBULATORY PERITONEAL DIALYSIS.THESE ORGANISMS HAVE TRADITIONALLY PROVEN DIFFICULT TO ERADIACTE,AND THE STANDARD REGIMEN HAS CARRIED THE POTENTIAL FOR NEPHROTOXICITY.

THE NURESE TAKE THE ALIQUOTS OF IDOPHOR TRANSFERRED TO SMALL IN USE BOTTLES THAT IS THE IMPROPER TECHNIQUE LEAD INFECTION.THE EXTENT OF CONTAMINATION AND FACTORS PERMITTING THE SURVIVALOF P.aeruginosa IN THE BOTTLE THAT WERE USED PSEUDO INFECTION.

CATHTER CARE ; A STERILE GAUZE BANDAGE IS USUALLY TAPED OVER THE EXIT SITE TO STOP THE CATHETER FROM MOVING AND TO KEEP THE AREA CLEAN.THE BANDAGE IS FIRST CHANGED BY A PD NURSE UNDER STERILE CONDITIONS.THE CATHETER SHOULD NOT BE MOVED OR TOUCHED A LOT,BECAUSE THIS CAN INCREASE THE CHANCE FOR INFECTION.

THE NURSE DIDNOT FOLLOW THE STERILE TECHNIQUE ,SHE USE THE SMALL IN USE BOTTLES FOR ALL PATIENTS SO THE COMPLICATIONS AFFECTED THE ALL PATIENTS.

MICROBIAL TARGET OF DISINFECTING CHEMICALS

IN ADDITION TO PHYSICAL METHODS OF MICROBIAL CONTROL ,CHEMICALS ARE ALSO USED TO CONTROL MICROBIAL GROWTH.IT IS IMPORTANT TO CONSIDERED THE TYPE OF MICROBE TARGETED;

THE CHEMICALS ARE; =PHENOLICS

= HEAVY METALS

MERCURY

COPPER ,NICKEL AND ZINC

= HALOGENS

=ALCOHOLS

=SURFACTANTS

MERCURY IS AN EXAMPLE OF A HEAVY METALS THAT HAS BEEN USED FOR MANY YEARS TO CONTROL MICROBIAL GROWTH

SILVER HAS LONG BEEN USED AS AN ANTISEPTIC

COPPER ,NICKEL AND ZINC .SEVERAL OTHER HEAVY METALS ALSO EXHIBIT MICROBIAL ACTIVITY.

NATURAL CHEMICAL FOOD PRESERVATIVES ALSO INHIBIT MICROBIAL ATIVITY

CHEMICAL CONTROL REFERS TO THE USE OF DISINFECTANT,ANTISEPTICS ,ANTIBIOTICS AND CHEMOTHERAPEUTIC ANTIMICROBIAL CHEMICALS.

DISINFECTANTS WORK BY DESTROYING THE CELL WALL OF MICROBES OR INTERFERING WITH THEIR METABOLISM.

ANTISEPTICS ARE ANTIMICROBIAL SUBSTANCES THAT AREAPPLIED TO LIVING TISSUE OR SKIN TO REDUCE THE POSSIBILITY OF INFECTION,SPESIS OR PUTREFACTION.

PHENOLICS SUCH AS THYMOL AND EUCALYPTOL OCCUR NATURALLY IN PLANTS.OTHER PHENOLICS CAN BE DERIVED FROM CREOSOTE ,A COMPONENT OF COAL TAR.PHENOLICS TEND TO BE STABLE ,PERSISTENT ON SURFACES AND LESS TOXIC THAN PHENOL.THEY INHIBIT MICROBIAL GROWTH BY DENATURING PROTEINS AND DISRUPTING MEMBRANES.

=HYDROGEN PEROXIDE AND SODIUM HYPOCHLORITE DISINFECTANT ARE MORE EFFECTIVE AGAINST PSUDOMONAS AERUGINOSA BIOFILMS THAN QUATERNARY AMMONIUM COMPOUNDS.HYDROGEN PEROXIDE AND SODIUM HYPOCHLORITE DISINFECTANTS HAVE BEEN REPORTED TO DESTROY BOTHTHE BIOFILM MATRIX AND THE BACTERIA CELL WITHIN,MAKING THEM BETTER ANTIBIOFILM AGENTS.

NOTE:

THESE PROBLEMS WERE TREATED WITH AN ANTIBIOTIC COMBIANTION OF INTRAPERITONEAL CEFTAZIDIME AND ORAL CIPROFLOXACIN.RECURRENT EXIT SITE INFECTIONS WERE TREATED WITH A REPEATED COURSE OF THE ANTIBIOTICS,AND WITH SURGICAL DEBRIDEMENT AND SUBSEQUENT SHAVING OF THE EXTERNAL CUFF OF DOUBLE -CUFFED CATHETERS.