Pseudomonas aeruginosa is an aerobic, motile, gram negative rod that is slimmer and more pale staining than members of the Enterobacteriaceae. Its most striking bacteriologic feature is the production of colorful water-soluble pigments. It also demonstrate the most consistent resistance to antimicrobial agents of all the medically important bacteria.
Cause of Disease
Pseudomonas aeruginosa is organism that is caused by a bacterium from the genus pseudomonas. Pseudomonas is ubiquitous. Pseudomonas is a gram positive aerobic bacilli that exhibits innate resistance to antibiotics and can develop resistance to antimicrobial treatment after being introduced to the agent. Pseudomonas has many flagella and pilli. Pseudomonas is a opportunistic nosocomial pathogen in immunocompromised individuals. Pseudomonas feeds on organic materials. Pseudomonas infections risks are increased in persons with cystic fibrosis, HIV & AIDS, have burn wounds or receiving chemotherapy. As a result of the ubiquitous characteristic of pseudomonas it is all seen in the blood, ear, lung and skin. Pseudomonas infections in the blood are called bacteremia, while the lung infection is referred to as pneumonia. Infections on the skins are referred to as folliculitis.
Effects of Pseudomonas aeruginosa
The effects of the bacteria Pseudomonas aeruginosa varies based on the type of infection. Bloodstream infections may cause various symptoms including: Fever and chills, Body aches, Lightheadedness Rapid pulse and breathing, Nausea and vomiting Diarrhea, Decreased urination.Pneumonia can cause: Fever and chills, Difficulty breathing, Cough, sometimes with yellow, green, or bloody mucus. Urinary tract infections can cause: strong urge to urinate frequently, painful urination, unpleasant odour in urine and cloudy or bloody urine. Wound infections can cause: inflamed wound site and fluid leakage from wound. Ear infections can cause: Ear pain, Hearing loss Dizziness and disorientation
Mode of Transmission
Pseudomonas aeruginosa is a nosocomial infection that is extremely important and infectious particularly for patients whose immune system has been compromised.
Pseudomonas aeruginosa may be found in a wide range of moist, nutrient-limited environments and as well as in numerous reservoirs within both the household and the hospitals. Pseudomonas aeruginosa may be found in showers, mops, sinks, taps and respiratory equipment found in hospitals.It is constantly reintroduced into the hospital environment on fruits, plants, vegetables and patients transferred from other facilities. The spread may also occur directly from patient to patient on the hands of hospital personnel and also indirectly by patients contact with contaminated surfaces and objects and by ingesting contaminated food and water.
Prevention of Disease
Prevention of the Spread of Pseudomonas Infection
Pseudomonas aeruginosa is one of the most common nosocomial infections in the Intensive Care Unit, (ICU). As a result of the Pseudomonas aeruginosa infection being a multidrug-resistant, gram-negative bacilli (MDR-GNB), it is very important that we prevent it from spreading and causing havoc in our communities. In preventing the spread of the pseudomonas infection, both patient and healthcare personnel have a role to play.
The World Health Organization, WHO, recommends that the following strategies are implemented to prevent the spread of these diseases: proper hand hygiene, environmental cleaning, contact precautions, patient isolation and patient surveillance. (WHO,2017)
Proper Hand Hygiene
This practice was first implemented by Doctor Ignaz Semmelweis in 1842. He proposed to his medical colleagues and students that washing their hands in chlorinated lime solution will prevent the spread of the fatal puerperal sepsis that was going around at the time. Today, Doctor Semmelweis’ proposal is used worldwide by not only medical professionals but all of the human population. In the hospital, health personnel which includes nurses and doctors, are expected to wash their hands with antiseptic soap and water before treating a patient, after treating a patient, after touching surfaces, and after body fluid exposure risk (WHO,2009).
Healthcare personnel must be cautious not to contract the infection when caring for the patient. It is advised that disposable gloves, gowns and surgical nets are worn when around the patient and cleaning their surroundings. Remove and dispose of the protective clothing immediately after leaving the patient’s surroundings and wash hands thoroughly (WHO,2017). These professionals should also be fully immunized before working in the hospital. They should get vaccinated against new strains of diseases before there is an outbreak so that they may be able to ward off these infections.
Frequent cleaning of the surrounding areas and objects of the infected patient has decreased the risk of spreading the pseudomonas infection. It is recommended that the bed surfaces are cleaned with hypochlorite or disinfectants as hydrogen peroxide decreases the lifespan of the bed. The possessions of the patient may be sanitized with disinfectant. Other surfaces such as the floors, bedpans, urinals, windows and tables are to be cleaned with the hypochlorite (WHO,2017).
This form of prevention takes on two forms: isolating and cohorting. Isolation is removing the patient from a common area to a room by themselves, preferably with their own bathroom facilities. Cohorting is removing a patient from a common area into a room with other patients with the same infection with their own restroom facilities. (WHO,2017) This prevents other patients from contracting the pseudomonas infection.
This is keeping a record of the number of patients arriving at the hospital with a disease or infection. Each time a patient is admitted, his illness is documented. Several patients may come in with the same illness and after a period of time a tally is taken. This shows the pattern of the infection – how frequently it occurs and how many persons contracted it. The information can be used to inform the public on how to prevent themselves from acquiring the pseudomonas infection.
Control of Disease
Infection control inhibits the spread of infection in the healthcare environs.
Precautions are needed within the healthcare environment in order to care for patients and to decrease the possible spread of an infection. Pseudomonas aeruginosa in particular can be transmitted through the contamination of drinking or bathing water, contact with wounds, inhalation of water droplets and through other pathways. Medical professionals, therefore, need to be informed of the methods utilized to control opportunistic bacteria.
Proper hand hygiene is necessary to prevent the spread of disease, as well as using the appropriate protective gear/equipment ( eg. surgical masks, apron, latex gloves). Measures should be put in place to protect other workers and patients from respiratory-coughs droplets by putting on masks on coughing patients. The proper placement of patients can greatly reduce the transmission of any infectious bacteria by ensuring patient rooms are not overcrowded. Carefully sanitize and handle instruments or devices used in patient care; likewise, disinfect and clean surroundings thoroughly and appropriately. Frequently clean and handle patients bedding, sheets or any textiles used and discard disposable materials (eg. disposable bed sheets, surgical tape, gauze, medical bandages). Finally, control possible sources of infection especially at an area frequently used by staff members (eg. do not dispose of bodily fluids in wash basin).
Treatment of Disease
Mild, water-related Pseudomonas aeruginosa infections are generally treated easily with certain antibiotics. Treating severe hospital-associated Pseudomonas aeruginosa infections is becoming more difficult because some bacterial strains show resistance to nearly all classes of powerful antibiotics including: Aminoglycosides, Cephalosporins, Fluoroquinolones and Carbapenems (antibiotics of last resort). In fact, about 13 percent of severe healthcare-associated Pseudomonas aeruginosa infections are caused by multidrug-resistant strains. Treating these tough infections requires sending samples to a laboratory to test the bacteria against different antibiotics in hope of finding drugs that are effective against it.
Evidence of Infection in Jamaica Hospital 1
An article published by The Guardian on the 25th of October 2015, declared that there has been unfortunate incidents of hospital infections which has resulted in the death of eighteen babies in three months. It was reported by Dr. Alison Nicholson, a consultant medical microbiologist at The University Hospital of the West Indies, that the ill-fated happening of the death of the eighteen out of forty-two babies was due to two different bacterial infections, namely: Klebsiella and Serratia. A follow up article issued on November 4th of the same year was posted on the Gleaner’s online page, where the resigned Chief of Medical Staff at the University Hospital of the West Indies (UHWI), Professor Trevor McCartney disputed claims made by the Ministry of Health that 12 babies had died at the facility because of bacterial infections. He reported that only eight babies died at the hospital over a period of four months by bacterial infections caused by the Serratia bacteria, Klebsiella bacteria and Pseudomonas bacteria. He highlighted the fact that in previous reports, only two of the three infections were stated. With the deaths being considered, the sanitary guidelines under which the facility operated garnered a lot of attention. McCartney stated that strictly following the sanitary guidelines was hindered due to the lack of water supply to the corporate area. The hospital’s infection control committee took steps to improve the adherence to proper sanitary procedures by providing additional information to staff members to better monitor infection outbreak at the facility. Those within the hospital were faced with other risk factors including the frequent change in medical staff and families of those patients who disregard advice given.