Infectious Conjunctivitis: Causes, Mechanism of Action of Gentamicin, Signs, Infection Control Issues, and Transmission

This case study discusses infectious conjunctivitis, the likely microorganism causing the eye infection, the mechanism of action and adverse reactions of gentamicin, the physiological basis of signs, infection control issues, and transmission of the infection. It also explores ways to break the chain of infection. References are provided in APA 6th Ed. referencing style.

This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
Student name (LAST NAME first name):
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1. Background of the case study (Total: 5 marks)
1.1 What is infectious conjunctivitis?
Infectious conjunctivitis is the inflammation in the conjunctiva commonly
caused by the micro-organisms. Conjunctiva is the thin and clear tissues
that present over the white area of t the human eye, and line the inner side
of the eyelid. There are total six type of conjunctivitis: bacterial
conjunctivitis, viral conjunctivitis, gonococcal and chlamydial conjunctivitis,
allergic conjunctivitis, giant papillary conjunctivitis, and non-infectious
conjunctivitis (Garout, Jokhdar, & Abelwadood, 2016).
1.2 Of the four micro-organisms listed below, justify which one is more likely
to be the cause of John’s eye infection. Indicate why the other micro-
organisms from the list are least likely to cause the infection.
Legionella pneumophila
Yes or no, with reason:
No: the infection caused by this microorganism does not occur person to

person
Plasmodium ovale
Yes or no, with reason:
No: it is the species of parasitic protozoa and it causes non-falciparum
malaria, infection in case of John is viral or bacterial as there is purulent
discharge has been reported (Alfonso, Fawley & Lu, 2015).
Adenovirus
Yes or no, with reason:
No: Adenovirus can cause viral conjunctivitis, patient experience
inflammation, pain, and red eye, and blurred vision problems, but John has
no blurry vision.
Staphylococcus aureus
Yes or no, with reason:
Yes: Staphylococcus aureus is more likely to cause conjunctivitis in case of
John he is suffering from acute conjunctivitis and may become chronic can
infect both the eyes of the patient (Alfonso, Fawley & Lu, 2015).
2. Mechanism of action and adverse reactions (Total: 5 marks)
2.1 Describe the mechanism of action of gentamicin?
It is the aminoglycoside type of antibiotic which is prescribed to address the
bacterial eye infections. It can also be used to treat other type of bacterial

infections. Aminoglycosides of gentamicin "irretrievably" attach to
particular 30S-subunit of proteins and the 16S rRNA. Particularly
gentamicin attaches to four different nucleotides of the 16S rRNA and one
amino acid of the protein S12. This impedes with the decoding spot in the
locality of nucleotide 1400 in the 16S rRNA of a 30S subunit (Gografe,
Hansen & Hansen, 2015). This area interrelates with a wobble base in the
tRNA anticodon. This result in intrusion with the start complex, misreading
of the mRNA consequently improper amino acids are introduced into the
polypeptide causes nonfunctional or contaminated peptides and the
disintegration of polysomes into the nonfunctional monosomes. the
secondary mechanism of this drug has been projected based on the crystal
arrangements of the gentamicin drug in a secondary binding site at the
helix 69 of a 23S rRNA, which interrelates with the helix 44 and proteins
that identify stop codons (Bullock & Manias, 2017).
2.2 Name two adverse reactions of this drug?
Difficulty hearing or ringing in the ears, and dizziness.
3. Physiological basis of signs (Total: 10 marks)
3.1 sign 1:
Swollen
Explanation of this phenomenon:
It is because of the discharge of exudate from unusually permeable
capillaries. The outside surface covering seems to have liquid in it. The
conjunctiva turns out to be swollen and gelatinous in appearance.
3.2 sign 2:

Red eye
Explanation of this phenomenon:
As a result of the inflammation and widening of the tiny blood vessels in the
conjunctiva (the thin layer of cells covering the front of the eyes) (Craft &
Gordon, 2019).
3.3 sign 3:
Purulent and sticky discharge
Explanation of this phenomenon:
The conjunctiva comprises thousands of cells that create mucus and small
glands that create tears – inflammation triggers the glands to become
hyperactive, so that they create more water and mucus (Craft & Gordon,
2019).
4. Infection control issues (Total: 5 marks)
4.1 Issue 1:
Bad hygiene
Discussion as to why this is an issue:
Although in aged care facilities the health professional maintain the
hygiene so that the patient do not get infected, but due to the lack of aged
people’s activeness towards their own hygiene it become difficult for
nurses and physician to maintain the hygiene. To prevent the infection
patient form spreading, it is essential to wash hands frequently, do not
touch the eyes with the hands, use of clean towel and washcloth every
day, changing of pillow cases frequently, not sharing eye cosmetics, and

eye care products. In case of older adults, this becomes difficulty to
maintain sometimes. Maintaining the hygiene is quite essential in case of
older people as they age their immunity system is not that strong as it once
was and that indicates bacteria and viruses are additionally harmful for
them (Burchum & Rosenthal, 2019).
4.2 Issue 2:
Low interest of nurses in aged care
Discussion as to why this is an issue:
It has been identified in different research articles that the nurses in the
healthcare setting are not very interested in providing their care to the older
adults as sometime dealing with older people is difficult. This is because
they easily get irritated, angry and rude, their memory loss issues happen
occasionally (Chan, Kapadia & Cheung, 2019).
5. Transmission of infection (Total: 5 marks)
5.1 Describe transmission from John to Mary:
The bacteria responsible for conjunctivitis can cause this eye infection
rapidly; some of those microorganisms are very transmissible. Each of
these kinds of microbes can spread from individual to individual in different
ways. They commonly spread from the infected individual to others and
show their symptoms within 24 hours. As discussed in the cases that marry
is living next to the John’s room, therefore there is probability that the
bacteria transferred by touching the same object or shaking hands.
Bacterial conjunctivitis can spread from individual to individual, form hand
top eye contact, or through eye contact with the contaminated object. The

bacteria could have also transferred through close contacts like hugging
(Peng & Ramanathan, 2018). Coughing and sneezing are the other ways
for transferring the bacteria from person to person. John could have
transferred the bacteria infection by coughing near the room of marries and
she gets the bacterial from the air. Another possibility that the bacteria is
transferred from John to Marry is by health professional. The health
professional like nurses visits the different patients at during their shifts;
therefore they might be the carrier of the bacterial conjunctivitis to Marry.
The proper use of gloves prevents cross-infection between patient and
healthcare worker and vice versa. Despite the risk to self, a study in Nigeria
showed that the main reason for non-compliance in wearing of gloves by
healthcare workers with direct patient contact was because the practice
was considered unnecessary. Gloves should be worn on both hands
whenever there is potential contact with blood and other body
fluids. Another cause of infection that could have infected marry is through
improper management of waste. The waste like eye cleaning swabs,
needles, etc. are thrown in the waste containers, but left open outside the
door of patient room, this enhance the chances of marry infected by the
bacteria (Justel et al., 2015).
6. Breaking the chain of infection (Total: 5 marks)
6.1 Identify procedure 1:
Maintaining personal hygiene
Describe how this effectively breaks the chain of infection:
The chain of infection is starts from the reservoirs or source which can be a

human, or animal, in case of John infection nurse can be the source of
infection to other patients. Therefore by maintaining the personal hygiene
can break the chain. Lack of personal hygiene could be the reason of
conjunctivitis spread as the healthcare providers come in contact with
different patient throughout the day and the can carry the infection. The
nurses or other healthcare providers assigned to provide care to John must
not use the same gloves to different patient as it can carry the bacteria
(Rapp, 2015). Single use gloves can be used to for the patient and after
the use they should be thrown away. They must wash their hands before
and after the administration of the gentamycin eye drop to John (Boustcha
& Nicolle, 1995).
6.2 Identify procedure 2:
Educating patient
Describe how this effectively breaks the chain of infection:
This can break the chain of infection from a mode or means of
transmission, which happen when the patient came in direct contact with
other infected individuals. Patient education is the key method to prevent
the infection from spread to other patient and for fast recovery. Mr. John
should be educated about the washing their hands regularly, using clean
towel, and using mask so that the bacteria cannot transfer to other by
coughing and sneezing. They must also be educated about avoid shaking
hands with other patient, and not sharing his personal items like pillows,
washcloths, eye drops, face masks etc. with other people (Boland, Santall
& Video Education Australasia, 2011).

7. Presentation (Total: 5 marks)
7.1 Referencing in-text and in reference list conforms to APA 6th Ed.
referencing style.
7.2 Critique supported by relevant literature as prescribed.
7.3 Correct sentence structure, paragraph, grammatical construction, spelling,
punctuation and presentation.
References
Alfonso, S. A., Fawley, J. D., & Lu, X. A. (2015). Conjunctivitis. Primary Care: Clinics
in Office Practice, 42(3), 325-345.
Boland, M. (Director), Santall, J. (Presenter), & Video Education Australasia. (2011).
Infection control in healthcare [Videorecording]. Bendigo, Australia: VEA.
Available online
Boustcha, E., & Nicolle, L. E. (1995). Conjunctivitis in a long-term care facility.
Infection Control and Hospital Epidemiology, 16(4), 210-216. Available online
Brinkman, B., & Stelter, K. (2018). In patients with acute bacterial conjunctivitis, what
is the preferred antibiotic?. Evidence-Based Practice, 21(8), 46-47.
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.). Frenchs
Forest, Australia: Pearson Australia.
Burchum, J. R., & Rosenthal, L. (2019). Lehne’s pharmacology for nursing care (10th
ed.). St. Louis, MO: Elsevier/Saunders.
Chan, E. H., Kapadia, M., & Cheung, N. C. (2019). Asymptomatic Follicular
Conjunctivitis in an Elderly Man. JAMA ophthalmology, 137(4), 451-452.

Craft, J., & Gordon, C. (Eds.). (2019). Understanding pathophysiology (3rd,
Australian and New Zealand ed.). St. Louis, MO: Elsevier. Available Online
Garout, M. A., Jokhdar, H. A., & Abelwadood, M. R. (2016). Molecular Epidemiology
of Adenovirus Strains Genotypes among Patients with Acute Follicular
Conjunctivitis. American Journal of Epidemiology, 4(2), 18-21.
Gografe, S. I., Hansen, B. C., & Hansen, K. D. (2015). Deep subconjunctival
injection of gentamicin for the treatment of bacterial conjunctivitis in macaques
(Macaca mulatta and Macaca fascicularis). Lab animal, 44(3), 92.
Justel, M., Alexandre, I., Martínez, P., Sanz, I., Rodriguez-Fernandez, A.,
Fernandez, I., & de Lejarazu, R. O. (2015). Vertical transmission of bacterial
eye infections, Angola, 2011–2012. Emerging infectious diseases, 21(3), 471.
Peng, M. Y., & Ramanathan, S. (2018). Conjunctival and Corneal
Infections. Emergency Management of Infectious Diseases, 258.
Rapp, L. (2015). Acute conjunctivitis. InnovAiT, 8(7), 418-424.