Infectious Conjunctivitis Case Study: Patient Care and Management

This case study analyzes a scenario involving infectious conjunctivitis, focusing on a patient named John and the potential spread of the infection to Mary. The assignment begins by defining infectious conjunctivitis and identifying the most likely causative microorganism from a list, justifying the selection based on the characteristics of each organism. It then delves into the mechanism of action and adverse reactions of gentamicin, a common antibiotic used to treat bacterial infections. The study explores the physiological basis of the signs and symptoms of conjunctivitis, such as redness, swelling, pain, and discharge. It also addresses infection control issues within an aged care facility, highlighting the impact of nursing staff shortages and a lack of awareness among patients and staff. The case study further examines the transmission of the infection from John to Mary, detailing the various modes of transmission. Finally, it proposes and explains procedures for breaking the chain of infection, including maintaining personal hygiene, proper handling and sterilization of ophthalmic care equipment, and the importance of staff training. The case study uses references to support the answers provided.

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1. Background of the case study (Total: 5 marks)
1.1 What is infectious conjunctivitis?
Infectious conjunctivitis can be described as the inflammation of the conjunctive in an
individual caused due to infection of viruses or bacteria. It can be identified by the redness
in the eyes as well as the sticky discharge releasing from the eyes of the infected person.
In the case of conjunctivitis, the doctors prescribe antibiotic eye drops to the patients
(Boustcha & Nicolle, 2011).
1.2 Of the fourmicro-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. This is a bacterial strain which is responsible for causing legionnaires disease, which
occurs due to consumption of contaminated water. An organism passing through
consumption of contaminated water is less likely to cause eye infection.
Plasmodium ovale
Yes or no, with reason:
Plasmodium ovale is a class of protozoa, which are responsible for causing malaria and is
very less likely to cause Conjunctivitis or any other eye infection. The life cycle of this
protozoan completes in liver and RBCs and thus, has nothing to do with eye and its
membrane.
Adenovirus
Yes or no, with reason:
Yes, this is the largest class of viruses which are responsible for causing conjunctivitis.
The disease caused by these viruses is highly communicable and severe and might result
into permanent blindness if not treated well (BenEzra, 2006).
Staphylococcus aureus
Yes or no, with reason:
Yes, these bacteria are responsible for causing acute bacterial conjunctivitis. The bacterial
conjunctivitis is less frequent than the viral one. However, it is also highly contagious. The
infection due to these bacteria is treated using the antibiotic eye drops (Tabbara, El-Asrar,
& Khairallah, 2014).
2. Mechanism of action and adverse reactions (Total: 5 marks)
2.1 Describe the mechanism of action of gentamicin?
Gentamicin is an aminoglycoside antibiotic. It is a broad-spectrum antibiotic and
bactericidal in nature. The mechanism of action of this antibiotic involves the inhibition of
the process of protein synthesis in the bacterial species causing conjunctivitis by binding

to the 30s ribosomal unit. This antibiotic is highly effective against the gram-negative
bacteria (Bartlett & Jaanus, 2013).
2.2 Name two adverse reactions of this drug?
However, Gentamicin is considered to be highly effective drug against gram negative
bacteria, there are certain side effects of this drug as well. They are:
 It may cause damage to the kidney if taken in concentration higher than 2 mg/L
 It may also cause neurotoxicity and can result into loss of control of bodily
movements, vertigo and such others (Hahn & Sarre, 2010).
3. Physiological basis of signs (Total: 10 marks)
3.1 Sign 1:
Redness and swelling in eyes
Explanation of this phenomenon:
The reddening and swelling in the eyes occur as a result of dilation of the blood vessels
due to infection. Itching in the eyes can lead to an allergy-like response in the eyes, which
leads to dilation of the tiny blood vessels (Craft, Gordon, Huether, McCance, & Brashers,
2018).
3.2 Sign 2:
Pain in the eyes
Explanation of this phenomenon:
The pain in the eyes occurs when the optic nerve situated at the back of the eyeball,
connecting it to the brain, becomes inflamed as a result of the bacterial or viral infection.
3.3 Sign 3:
Sticky discharge from eyes
Explanation of this phenomenon:
It is actually the mucus which is secreted by the eyes in the case of inflammation due to
infection and due to an effort of the eye glands to keep the eyes lubricated and moistened
(Craft, Gordon, Huether, McCance, & Brashers, 2018).
4. Infection control issues (Total: 5 marks)
4.1 Issue 1:
Lack of nursing staff
Discussion as to why this is an issue:
This is a major issue because the nursing staff needs to be available at the aged care
facilities to take care of the aged people, as they are incapable of doing so. They need to
be available for the aged patients in the case of conjunctivitis to wipe the regular
secretions of mucus, to put the eye drops in given time intervals and to make sure that
they wear required safety gears to prevent the infection from spreading to other healthy
people in the aged-care facility (Lee & Bishop, 2012).
4.2 Issue 2:
Less awareness and training among the patients as well as nursing staff about the
disease
Discussion as to why this is an issue:
The patients need to be well informed about the disease, its causes, its effects and the

ways in which it can be transmitted from one person to another. There is a probability that
the old people might not be aware of all these specifications related to the disease and
hence, they do not pay much attention to wearing the safety gadgets and putting the eye
drops on time. For making sure that it does not happen, the nursing staff must be well
trained regarding the signs, symptoms and the negative impacts of this disease. The
patients must also be made aware that if they do not take precautions, their relatives or
other people in the room might also get infected from the disease (Burchum, Rosenthal, &
Yeager, 2016).
5. Transmission of infection (Total: 5 marks)
5.1 Describe transmission from John to Mary:
As mentioned above, conjunctivitis is a communicable disease and has a very high
frequency of spreading from one person to another. Mary resides in the room near John
and has got the infection in her eye. There are different means through which the
conjunctivitis virus or bacteria spread from one person to another. They usually spread
from one infected person to the others through:
 The air or air droplets developed while sneezing or coughing
 Close personal contact with the infected person such as shaking hands or
touching
 Touching any surface or object with the germs on it and then touching back the
eyes before washing the hands might cause the infection to the healthy person or
transmit the infection (Lee & Bishop, 2012).
Mary must have undergone any of the above situations in order to develop the infection.
The hospital staff must take care of the fact that the patients must be well informed about
the precautionary measures one must take while approaching a person with the infection.
6. Breaking the chain of infection (Total: 5 marks)
6.1 Identify procedure 1:
Maintaining personal hygiene and clothing
Describe how this effectively breaks the chain of infection:
As mentioned above, it is difficult for the healthcare patients in the aged-care facilities to
take care of themselves in the case of infection and making sure that the transmission of
their infection does not occur to the patients admitted nearby. In this case, the role of the
nurses becomes highly relevant as they have the responsibility to control the infection and
maintain the personal hygiene of the infected patients. The nurses must avoid any direct
patient contact and must make sure that any infected or potentially infected lesions must
be covered with occlusive dressing. Clothing must be changed regularly. Jewelleries, wrist
watches must be avoided to be worn by the nurses and they must also take care of their
personal hygiene. Hand washing must be ensured prior to changing the dressing, putting
the eye drops, handling the patient utilities and such others. Proper use of gloves must be
done by the healthcare staff to prevent any cross contamination. The gloves and other
surgical instruments used by the nurses must be sterilized from time to time (Boland,
Wilson, & Santall, 2011).
6.2 Identify procedure 2:
Skilful handling and usage of equipment used in ophthalmic care and their sterilization
from time to time.
Describe how this effectively breaks the chain of infection:
The areas of the slit lamp biomicroscope or tonometer prisms must be wiped or washed
properly using the soap and water or the effective sterilizing agents like ethanol or 1%
sodium hypochlorite. The eye drops administered to each and every patient must be taken
from the personal bottle of the patient and must not be retrieved from some other patient’s
medicine box. The contact of the eye dropper directly with the eyelashes, eyelids of facial
skin must be avoided and the expiry dates must be checked for each medicine or eye
drops. The nurses must be well trained for the use of the equipment and they must be

ensured to have all the requited knowledge to handle the patients with conjunctivitis
properly and check the spread of infection from one person to another. It will also be
helpful for them to prevent themselves from infections (Seewoodhary & Stevens, 2010).
References
Bartlett, J. D., & Jaanus, S. D. (2013). Clinical Ocular Pharmacology. Stoneham, MA: Butterworth-
Heinemann.
BenEzra, D. (2006). Blepharitis and Conjunctivitis. Guidelines for diagnosis and treatment. Barcelona,
Spain: Editorial Glosa.
Boland, M., Wilson, J., & Santall, J. (2011). Infection control in healthcare. Bendigo, VIC: VEA.
Boustcha, E., & Nicolle, L. E. (2011). Conjunctivitis in a Long-Term Care Facility. Infection Control &
Hospital Epidemiology, 16(4), 210-216.
Burchum, J., Rosenthal, L., & Yeager, J. J. (2016). Study Guide for Lehne's Pharmacology for
Nursing Care (9th ed.). St. Louis, Missouri: Elsevier Health Sciences.
Craft, J., Gordon, C., Huether, S., McCance, K. L., & Brashers, V. L. (2018). Understanding
Pathophysiology 3e Australia New Zealand. Elsevier Health Sciences.
Hahn, F. E., & Sarre, S. G. (2010). Mechanism of Action of Gentamicin. The Journal of Infectious
Diseases, 119(4-5), 364-369.
Lee, G., & Bishop, P. (2012). Microbiology and Infection Control for Health Professionals. Australia:
Pearson Higher Education.
Seewoodhary, R., & Stevens, S. (2010). Transmission and Control of Infection in Ophthalmic Practice.
Community Eye Health, 12(30), 25-28.
Tabbara, K. F., El-Asrar, A. M., & Khairallah, M. (2014). Ocular Infections. New York: Springer.