Analysis of Infectious Conjunctivitis: Case Study Evaluation

This case study analyzes a scenario of an 88-year-old resident, John, diagnosed with infectious conjunctivitis. The study begins with defining infectious conjunctivitis and identifying Staphylococcus aureus as the most likely causative organism. It then explores the mechanism of action and adverse reactions of gentamicin, the prescribed medication. The physiological basis of the patient's symptoms, including red eyes, thick discharge, and pain, is explained. The case study further addresses infection control issues within the aged care facility, emphasizing the risks of crowding and immune-compromised patients. It describes the transmission of infection from John to another resident, Mary, and highlights procedures to break the chain of infection, such as educating patients about avoiding rubbing their eyes and maintaining hand hygiene. The study uses the case to illustrate key concepts in healthcare, including pathogen identification, pharmacological interventions, and infection control, providing a comprehensive understanding of managing infectious conjunctivitis in a clinical setting.

This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
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1. Background of the case study (Total: 5 marks)
1.1 What is infectious conjunctivitis?
Infectious conjunctivitis is an infection of the conjunctiva by bacteria or virus resulting in
inflammation of the conjunctiva and characterized by dilation of the blood vessels of the
eye. People affected by infectious conjunctivitis mostly experience symptoms of red and
swollen eyes, thick discharge from the eye and irritation which persists for less than 3
weeks. There are many types of infectious conjunctivitis such as bacterial, viral,
chlamydial, gonococcal conjunctivitis and non-infectious conjunctivitis (O’Callaghan,
2018). In the case study, John, an 88 years old resident experienced the same symptom
as above in his right hand.
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, Legionella pneumophila is not the causative organism for John’s eye infection
because it is responsible for causing Legionnaire’s disease, a severe form of pneumonia
which is transmitted from person to person contact. It never causes any type of
conjunctivitis (Kuroki et al., 2017).
Plasmodium ovale
Yes or no, with reason:
No, Plasmodium ovale is not the cause behind John’s eye infection as Plasmodium is the
causative organism for malaria disease and eye pain is not a usual symptom of malaria.
Hence, possibility of infection by Plasmodium ovale is ruled out (Groger et al., 2017).
Adenovirus
Yes or no, with reason:
No,adenovirus is not the cause behind John’s eye infection. Although infective
conjunctivitis can be viral conjunctivitis, however John’s symptom is not linked to viral
conjunctivitis because watery discharge is main clinical manifestation for viral
conjunctivitis. However, John was found to have sticky and thick discharge which is not

related to viral conjunctivitis. Hence, adenovirus is not the main causative organism
behind John’s eye infection.
Staphylococcus aureus
Yes or no, with reason:
Yes, Staphylococcus aureus has been identified as the main causative organism for
John’s eye infection because it is a bacteria and acute bacterial conjunctivitis is most
commonly caused due to Staphylococcus aureus. In addition, symptoms of bacterial
conjunctivitis include redness, sticky discharge from the eye and itching or discomfort in
the eye (O’Callaghan, 2018). John’s symptoms matched exactly with the above
symptoms.
2. Mechanism of action and adverse reactions (Total: 5 marks)
2.1 Describe the mechanism of action of gentamicin?
Gentamicin is a medication to treat bacterial infections of the eye and the skin around the
eyes. It is a protein synthesis inhibiting antibacterial drug that work by binding to the 30s
ribosomal subunit and blocking the bindings of the tRNAs thereby resulting in disruption
for the anticodon of tRNA. This process results in the formation of an initiation complex
that further disrupts the process of protein synthesis (Abelson et al., 2015). Therefore,
bactericidal effect of the drug is seen because of formation of toxic peptides. It kills the
bacteria by disrupting the pathway leading to protein synthesis
2.2 Name two adverse reactions of this drug?
Two adverse effects of the drug include risk of nephrotoxicity or renal damage and risk of
allergic reactions (Cushnie, O’Driscoll & Lamb, 2016).
3. Physiological basis of signs (Total: 10 marks)
3.1 sign 1:
Red eyes
Explanation of this phenomenon:
Red eye is the main clinical manifestation of bacterial conjunctivitis and it occurs because
of the inflammation of the conjunctiva is response to bacterial infection and dilation of the
blood vessels of the eyes. This dilation manifest in the form of red eyes in patient and the
key cellular mediators linked to the inflammation process includes release of histamines
and other cell mediators involved in the inflammatory process pain (Norris, 2019).

3.2 sign 2:
Thick and sticky purulent discharge from the eye
Explanation of this phenomenon:
Purulent discharge from any area is mainly a sign of infection and the drainage changes
colour because of the number of living and dead germ cells and white blood cells within
the area. Purulent discharge in bacterial conjunctivitis occurs due to release of histamines
in response to infection and inflammation. This is often accompanies by eye swelling and
eye pain (Norris, 2019).
3.3 sign 3:
Painful eye
Explanation of this phenomenon:
Painful eye was another clinical symptom for John and this was mostly of the activation of
the normal flora of the eyes in response to infection. The process of inflammation of the
inner lining of the eyes activates the normal defense systems and results in dilation of the
blood vessels. Severe discharge is accompanied with painful eyes too (Gulati & Jain,
2016).
4. Infection control issues (Total: 5 marks)
4.1 Issue 1:
Risk of crowding and presence of other staffs and patients in aged care facility
Discussion as to why this is an issue:
As John is residing at a high dependency care facility, crowding and presence of other
staffs and patient can be a major infection control issue because John cannot be kept
completely isolated from staffs. For his treatment, the aged care staffs will engage in his
care and person to person contact can increase risk of infection for other people in the
residential care patient. Evidence shows that risk of infection is high in clinical setting
because continuous exchange between patient and staffs take place increasing the
possibility of transfer of infection from one person to the other (Khan, Baig & Mehboob,
2017). Hence, the approach to prevent the issue can be isolate the patient or
promote proper hygiene culture in the hospital.
4.2 Issue 2:
Presence of immune-compromised patients

Discussion as to why this is an issue:
High dependency aged care unit is a setting where many elderly patients with frailty and
immunodeficiency resides in one place. Ageing and frailty issues due to presence of many
morbidity and ageing related changes make them vulnerable to infection. As frailty and
immunodeficiency is a major risk factor of bacterial conjunctivitis, it can lead to infection
control issues as other elderly residents may acquire the infection because of poor
immune reaction to foreign objects (Wakefield et al., 2017).
5. Transmission of infection (Total: 5 marks)
5.1 Describe transmission from John to Mary:
The case study analysis revealed that Mary who resides next door has been infected by
bacterial conjunctivitis 4 days later. There is a possibility that infection might have
transmitted to Mary from John by means of person to person contact. This might have
occurred when John touched his eyes due to irritation and used the same hands to touch
his bed and linens. The nurse visiting John during treatment would have touched those
objects and transferred the infection from hand to that of Mary (Sun et al., 2017). Hence,
it can be said that John’s eye is the main source of infection and the reservoir of infection
is Mary. The mode of transmission of infection is the patient’s clothes and towels which
have been transferred to Mary from the visiting nurse at the residential care facility.
6. Breaking the chain of infection (Total: 5 marks)
6.1 Identify procedure 1:
Educating John to avoid rubbing his eyes
Describe how this effectively breaks the chain of infection:
As discharge from the eye was the main source of infection, it is necessary to avoid
rubbing the eyes to break the chain of infection. Hence, education to John regarding not
rubbing eyes might have reduced the transfer of infection from eyes to patient’s clothes
and other staffs in the residential care facility (Farrer, 2018). This gives the
implication that while providing care, educating patients about risk factors of
infection is important to control negative behaviour and break the chain of
infection. This will prevent any infective disease from becoming an epidemic in
hospital setting. For nurse, effective communication with patient throughout
the care process is essential to promote recovery and avoid any negative
health behaviour that can increase risk for individuals or other patients during
hospital stay.

6.2 Identify procedure 2:
Maintaining hand washing technique before and after touching patients
Describe how this effectively breaks the chain of infection:
The second factor that increased risk of transmission of infection from John to Mary was
that the staffs at the hospital did not engage in hand hygiene before and after touching
patients. If the staffs had engaged in appropriate hand hygiene technique, then the
infection would not have transmitted to Mary. Hence, nurses can adapt the technique of
hand hygiene by washing hands rigorously with water and soap and then providing any
nursing intervention to patient. The same procedure must be followed after completing any
procedure too. This can ensure that there is no chance of transmission of infection from
one person to another (Mathur, 2011). Hence, the above strategy can effectively break
the chain of infection.

References:
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pharmacotherapy for allergic conjunctivitis. Expert opinion on pharmacotherapy, 16(8), 1219-
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