281 Case Study Exercise 33 Isolation and Identification of Streptococci CASE STU

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281 Case Study Exercise 33 Isolation and Identification of Streptococci CASE STUDY the population routinely found in long-term-care facilities GAS outbreaks in such facilities generally have a high mortal s ity rate. When the PDOH reviewed the records of the nurs- c hosts makes for a bad ing facility, it identified a total of 23 cases of GAS over the Of the 23 infections, 13 were invasive, 10 s are a great place to catch an infection. It is where we bring together the sick, the wounded, the immuno- microorganisms. This confluence of combination, and as much as we try to emphasize infec- tion control, we almost always find room for improvement. Sometimes a lot of room. Read the case below and the questions that follow. previous year noninvasive, and 2 resulted in death. The PDOH, along were with the CDC, initiated an investigation to assess risk factors answer and infection control procedures at the facility Invasive Group A Streptococcus in a Skilled Nursing Facility-Pennsylvania, 2009-2010 The length of the outbreak-more than a year-sug- gested that GAS had been introduced into the vulnerable population of the facility on more than one occasion, a theory borne out when molecular characterization of GAS A number of diseases, especially those that are contagious or especially virulent, are deemed reportable. isolates revealed four different strains of the bacterium. When cases of se are encountered, healthcare providers Residents of the facility were screened for GAS carriage by obtaining specimens from the oropharynx, wounds, and the report this information to regional or state health depart skin surrounding various indwelling devices often forward the information to the cheostomies, central lines, etc.) while staff specimens were CDC. This gathering of information allows for epidemiologi- ot cal tracking of individual infections and alerts health officials to outbreaks. In September 2010 a skilled nursing facility in Pennsylvania noted three infections due to invasive Group A obtained from oropharyngeal swabs. Of 436 persons (139 residents and 297 staff members) one resident and four staff members had positive GAS cultures. All five carriers received antibiotic therapy recommended for GAS decolonization in patients of the facility and reported Questioning and observation of staff members revealed this information to the Pennsylvania Department of Health (PDOH). nfection-control deficiencies. Compliance with be 32%, Hand-sanitizing sta- empty, and sinks were not available in centr numerous i proper hand hygiene (hand washing or use of alcohol-based tions were located in every resident's room but were often locations such as nursing stations. Potentially infectious hand sanitizers) was found to Familiar to most of us as the cause of strep throat or noninvasive Group A Streptococcal infections are not thought of as particularly serious; annoying and painful yes, but generally not life-threatening. Invasive GAS, on the tes in the body that are normally sterile, is truly a cause for con- cern. Necrotizing fascitis, often known by the catchier name impetigo, broken or other hand, which occurs when the bacterium enters si material such as biohazard bags containing soiled bandages were routinely moved from room to room. At the time of the investigation, a full-time infection pre- vention st, along with CC state, and local health depart- ment personnel, provided training to staff members on "flesh-eating bacteria, has a mortality rate of 25%, while streptococcal toxic shock syndrome (not to be confused with staphylococcal toxic shock syndrome often connected proper infection control practices. After t ills more than 35% of those affected. The bac- erium is spread through direct contact with mucous from ment of functioning hand-sanitizer dispensers in each room, hand hygiene compliance improved to 70%. Emphasizing to tampons) an infected person or through contact with infected wounds the difficulty of completely eliminating hospital-acquired or sores on the skin. Additionally, many people are carriers of GAS, being able to spread the disease without suffering from infections, two new invasive GAS infections were identified in residents of one unit of the hospital. Rescreening of 59 res- idents and 112 staff members assigned to this unit revealed three residents and four staff members to be colonized with Those most at risk of developing GAS infection are peo- ple with chronic illnesses, surgical wounds, indwelling medi GAS. All seven carriers were treated with antibiotics, a since December 2010 , no additional cases have been seen. cal devices (respirators, catheters), and the elderly, precisely

Explanation / Answer

1. Antibiotic treatment is important and necessary for the GAS carriers because they have infection of GAS and it can be latent as soon as it get the favourable condition. This will result into the severe pathogenicity. So for eradicationg any colony of the GAS is necessary in order to make the patient free of any chance of getting sick at any stage. So the antibiotic will decolonize the GAS. This is why it is compulsory for GAS infected as well as GAS carriers to complete the antibiotic dosage.

2. Due to lack of maintenance of hygienicity related to disposal, sanitation, sampling of the infectious samples there is always a higher risk to the professionals like residents and nurses to get infected with the GAS. It has been seen that there is no proper biosafety measures like sink, sanitizsers, separate disposal room etc. for the hospitals. However the concentration or the bioload of the bacteria is relatively very high in the hospitals comparative to the general places.

3. Detection of Group A Streptococcus can be done traditionally by taking Pharyngeal Swab Samples and doing the Bacterial Culture followed by its identification.

4. Sentinel event is actually the unexpected happening in healthcare organizations resulting in death or serious physical or psychological injury to a patient or patients due to the cause that is not related to the natural course of the patient's illness.

In this case due to improper management of the bacterium GAS it spread from one room to other and consequently those patients and other members who were immunologically compromised or suffering from some other disease easily gets infected with the GAS leading to unawareness of this infection, they didn’t get the proper treatment and hence the consequences are really bad that is severe health challenge and even death. In this way it may lead to the development of epidemiological condition for the disease needs proper investigation.

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