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Management of Varicella Zoster in Skilled Nursing Facilities
Nursing Facilities are usually the home for elder people. It is evident that the global population is aging. It is a natural process that no one can ever stop. Early in the 20th century the life expectancy of most Americans was up only to 47 years old. But as modernization happens along with the discovery of medicinal plants and the building of medical facilities, the American life expectance has raised to about 76-80 years old in the beginning of the 21st century (Lassi et. al., 2014).
However, with the fact that the human body is aging infectious and opportunistic disease attacks it. Given that the human body at old age is presumably low in immunity. Thus, the human body at that time could have multiple infections that are in need of care. One of the recurring infections that attack the human body at the old age is Varicella Zoster.
Herpes zoster, or shingles, is an agonizing disease characterized by rashes created by the recurrence of varicella zoster infection (VZV), the causative operators in chicken pox. Shingles regularly shows in one region on one side of the body or in the dissemination of a nerve. There is generally no fever or other systemic side effects. Itching and tingling in the zone of the shingles may persist after the injuries have been determined (post-herpetic neuralgia). Shingles can be treated with a few antiviral drugs (MDH, 2007).
It can sporadically grow in insusceptible low immunity individuals. Shingles could be easily detected overall and has no occasional variety. It is also evident that the transmission of shingles in the population of old age people is found to be of high frequency.
Diminishing cell-mediated invulnerability (CMI) connected to maturing is thought to be in charge of these expanded rates. Additionally, the loss of CMI among persons with malignancies and HIV disease is thought to be in charge of higher rates of shingles among those populaces. Pretty nearly 20 percent of the overall public will experience shingles amid their lifetime and an expected 500,000 occurrence of shingles happen every year in the U.S. Roughly 4 percent of people will encounter a second scene of shingles. An immunization to counteract shingles in 60 years old and above has been utilized and authorized by the government (Stankus et. al, 2000). It must also be noted that Zoster is contagious and can be mitigated through air or direct skin contact of lesions. Moreover, the quarantine of the patient with this infectious disease shall be prioritized. With these facts, this paper’s main objective is to formulate a conceptual framework on how to manage Varicella Zoster in nursing facilities.
Significance of Varicella Zoster Infection Control:
Infections are imminent in a health care facility mainly because of the old age population. Thus, giving attention to managing the infection and taking control of the epidemic is of high priority. Zoster Varicella is definitely contagious and is very imminent to individuals that have lower immunity and preventing the infections would help the individual cope up with their situation. While it is true that VZV is not benign on healthy adults, it can still cause other complications due to low immunity (weak immune system due to old age). Pneumonia is one of those complications and if it is not attended it could lead to death of immunocompromised patients. Additionally, it could also affect healthcare providers who are pregnant and may result to congenital varicella.
Conceptual Framework of a nursing facility is the basis of performance along with the specific patients to be taken care of. It is the management of the entire task within a facility. Moreover, the conceptual framework governs the overall functionality of the facilities with respect to the employees and patients. In this context the management of Varicella Zoster in Skilled Nursing Facilities will be in focus. The initial idea of dealing with the disease is the main function of the facility. Forming branches for it to have functional employees is a must. Thus, the conceptual framework is a series of interrelated concepts of infection control, research and patient concerns.
The proposed conceptual framework will focus on the management of the disease, clinical trials and clinical treatments, health insurance assessment, research and development department, preventive measures in the facility, discharge interventions (for special case patients) and observational studies among in patient and discharge patients.
Conceptual Framework Chart:
It is very true that nursing homes are considered as one of the most competent facilities that would cater to elderly people. Patients must be screened if they have the zoster virus upon entering the facility. This would make an allowance for the nurses to quarantine the patient so as to not spread the disease. Moreover, the patient can decide if he/she would want to be taken care at home or at the facility. Homecare services are also available at most nursing homes in the US today (Help Guide Org, 2015).
Management of the Disease:
Under the management of the disease are two categories; the management of an elderly patient and the management of healthcare personnel that has contracted the disease:
Management of a Patient with Varicella Zoster (CDC, 2014)
Disease control measures rely on upon whether the patient with herpes zoster is immunocompetent or immunocompromised and on whether the rash is limited or scattered (characterized as appearance of injuries outside the essential or nearby dermatomes). In all cases, standard disease control insurances must be taken after.
If the patient is immunocompetent with confined herpes zoster, then standard insurances shall be taken after the injuries were totally secured. If dispersed herpes zoster is detected, then standard insurances in addition to airborne and contact safeguards shall be taken until the injuries are dry and crusted.
If the patient is immunocompromised with confined herpes zoster, then standard insurances in addition to airborne and contact safeguards must be taken until scattered contamination is discounted. At that point standard administration shall be taken until sores are dry and crusted. If scattered herpes zoster is detected, then standard precautionary measures in addition to airborne and contact insurances ought to be taken after until sores are dry and crusted.
Standard application of VZV immune globulin must be administered to patients that contracted the infection within the premise of the facility.
Standardized diets shall be administered to the infected patients. This is to help the patient in maintaining the strength of his/her immune system. With this, opportunistic disease such as pneumonia can be avoided.
Management of a Healthcare Personnel that has contracted Varicella Zoster (CDC, 2014)
The disease is said to be contagious and can be acquired through direct contact of the lesion or through the air. The following steps are recommended in managing the disease of personnel that has contracted the disease.
Medicinal services faculty who has got 2 measurements of varicella antibody shall be observed on a daily basis amid post exposure days (8–21) for fever, skin sores, and systemic side effects that is characterized by varicella. Social insurance faculty can be observed straightforwardly by the QA or disease control expert. If the manifestations happen, health awareness staff shall be promptly expelled from patient consideration territories and get antiviral medicine. Social insurance work force with varicella and spread herpes zoster shall be allowed with leave from work until all injuries have dried and crusted or, without vesicular sores, until no new injuries have showed up for 24 hours.
A human services work force that has gotten 1 measurement of varicella antibody must get the second measurements at any interim after presentation to somebody with rashes caused by zoster. After inoculation, administration is the same as that of health awareness faculty who have gotten 2 measurements of varicella antibody.
Unvaccinated VZV-helpless nursing facility staff is possibly infected from days 8 to 21 after presentation and must be furloughed or incidentally reassigned to areas remote from patient-care regions amid this period. Uncovered human services work force without confirmation of VZV safety must get postexposure inoculation at the earliest opportunity. Immunization inside 3 to 5 days of presentation to rash may adjust the illness if contamination happened. For unvaccinated VZV-vulnerable nursing staff or nursing aids at danger for extreme malady and for whom varicella inoculation is contraindicated (e.g., pregnant human services faculty), varicella-zoster invulnerable globulin after introduction is prescribed.
Preventive Measures in the Facility:
In order for any personnel that work in the facility to be contracted with the VZV infection personal protective equipment shall be administered. Gloves, masks, and hospital boots are recommended to be used when attending to patients with the VZV infection. Moreover, it is also recommended that antiseptic wash is readily available at the sink. Additionally, routinely immunization of healthcare personnel with varicella vaccine of about 2 dosages can help prevent the spreading of infection.
On the other hand, when certain personnel are identified to have been infected with the disease, it is a standard protocol of the facility to quarantine the individual. The individual is not allowed to be near those patients that are free of the infection (Webber et. al, 2015).
Clinical Trials and Clinical Treatment (Godfrey, 2015):
The management of the disease for both patients and healthcare providers are in connection with the clinical trial and clinical treatment. It is the stage of the conceptual framework by which the gathered samples from patients were analyzed in the lab. It is mainly composed of the individuals that do the analysis of sample blood. Moreover, it could be a trial if the patient to be examined is only suspected to have contracted the zoster virus.
Diagnosis of the infection within the facility
Individual assessment of the medical history and physical examination is enough in diagnosing varicella zoster. Otherwise, not detected, vesicular fluid can be used for another method called direct fluorescent antibody staining. PCR (Polymerase chain reaction) could also be used if and only if it existed in the premise of the laboratory.
Immunization and Treatment
Immunization through VZV vaccine is the only method for old age individuals. For healthcare personnel that have not yet received the immunization due to any valid reason should be administered with Varicella-zoster immune globulin within 96 hours after contracting the infection. It must also be noted that the drug shall be administered in specific dosages within 10 days. Another antiviral drug called oral acyclovir could be administered if the VZ immune globulin does not exist.
Health Insurance Assessment:
The incoming patient should be assessed whether they have the insurance or the proper monetary support for the said nursing facility. Most patients that have Medicaid or Medicare insurance is supported by the US government. If the patient would want to be taken care of at their homes, another method of payment shall be assessed. It is also important for the nursing facility to show the transparent bills to the immediate relative that would receive the important bill details, including the doctor’s bill and the nurse’s bill (professional fee).
Research and Development Department:
Minimal technical support on this context is needed. The development of new drugs to fight VZV is not within the scope of the nursing facility. However, the facility shall do research and development in terms of giving good service to the patients and applying the management of infection control. The research and development department is also responsible in keeping journals related to the study of Zoster infection. Overall, the department governs the scientific research about the disease and its related studies.
Discharge Interventions: This could be attributed to both patient and healthcare personnel.
Patient who are immunocompromised and immunocompetent
It is still highly recommended to administer the preventive methods to help in stopping the infection. This is when the patient opts to be relieved of the facility. If he/she would chose periodic examination, then the nursing facility could still give it to them.
Healthcare personnel who are given Sick leave
Administration of the VZ immune globulin should be given priority. On the off chance that he/she has recovered from the infection the nursing facility will assess it with clinical trials and he/she could go back to work.
Comparative studies among inpatient and home-based patients could be done. Along with the research and development department this concept shall be done in order for the facility to have a better understanding of the infection control. The study could be categorized as behavioral or scientific observation. Behavioral observation can be administered by a resident psychologist within the facility. On the other hand, the scientific observation is going to be worked out in the laboratory.
Outgoing Patients/ Home Care Services (WebMD, 2015):
If the immediate relative or the patient himself would want to be cured at home, the nursing facility shall provide all of the necessary services. This includes the management of the infection control, the doctor’s supervision and the periodic assistance from nurses or nursing aides. The patient also has the rights as to what extent of facilities he/she would need. Most especially if patients are with mobility problems. Moreover, the patient can choose the indicated services pertaining to Varicella Zoster.
Centers for Disease Control and Prevention. (n.d.). Shingles | Preventing VZV in Healthcare Settings | Herpes Zoster | CDC. Retrieved from http://www.cdc.gov/shingles/hcp/hc-settings.html
Cohen, J. I., Brunell, P. A., Straus, S. E., & Krausse, P. R. (1999). Recent Advances in Varicella-Zoster Virus Infection. Annals of Internal Medicine, 130(11), 922-932.
Godfrey, C., & Schouten, J. T. (2014). Infection Control Best Practices in Clinical Research in Resource-Limited Settings. Journal of Acquired Immune Deficiency Syndrome, 65(1), 15-18.
HelpGuide. (2015). A Guide to Nursing Homes: Skilled Nursing Facilities and Convalescent Homes. Retrieved from http://www.helpguide.org/articles/senior-housing/guide-to-nursing-homes.htm
Lassi, Z. S., Salam, R. A., Das, J. K., & Bhutta, Z. A. (2014). The conceptual framework and assessment methodology for the systematic reviews of community-based interventions for the prevention and control of infectious diseases of poverty. Infectious Disease of Poverty, 3(22).
Massachusetts Department of Public Health. (n.d.). Herpes Zoster: Infection Control Guidelines for Long-Term Care Facilities. Retrieved from http://www.mass.gov/eohhs/docs/dph/cdc/infection-control/herpesguide.pdf
Stankus, S. J., Dlugopolski, M., & Packer, D. (2007). Management of Herpes Zoster (Shingles) and Postherpetic Neuralgia. American Family Physician, 15(61), 2437-2444.
Weber, D. J., Rutala, W. A., Hirsch, M. S., & Mitty, J. (2015). Prevention and control of varicella-zoster virus in hospitals. Retrieved from http://www.uptodate.com/contents/prevention-and-control-of-varicella-zoster-virus-in-hospitals#H10
WebMD. (n.d.). What Caregivers Should Know About Nursing Home Care. Retrieved from http://www.webmd.com/health-insurance/nursing-home-care
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