Fighting infectious disease, the very heart of public health and the genesis of contemporary nursing, is about more than hand washing and immunizations. Its about screening and early detection, identifying risk and protective factors, and educating clinicians, facilities and the public. But it all begins with research, like that underway by nurse researchers at the Johns Hopkins University School of Nursing (JHUSON). Their work is more important now than it has been in nearly the past century. Infectious disease rates, stable since the 1918 influenza pandemic, have been on the rise since the mid-1980s. The battle against these illnesses from HIV/AIDS to MRSA and from STDs to resurgent tuberculosis (TB), and others has been escalating, and long before the recent emergence of the H1N1 influenza virus earlier this year.
For JHUSON nurse researchers, the communities around the corner and around the world are their infectious disease laboratories. JHUSON faculty research, for example, is shedding light on curbing sexually transmitted infections and their physical and emotional repercussions on college campuses. It also is exploring best practices to curtail the spread of resurgent diseases like tuberculosis and reducing the impact of treatment resistant infections like MRSA both within and beyond the hospital setting. The community-based inquiry not only is yielding new knowledge but also, when coupled with its translation into clinical education and practice, is helping to save lives today and to be better prepared to save them in an uncertain future.
Infection Detective at Work in High-Risk Environments
JHUSON researcher, assistant professor and self-professed infection control preventionist Jason Farley, PhD, MPH, ARNP, is working to give nurse colleagues and other health care professionals the research-based tools they need to identify, prevent, and destroy drug-resistant infections in hospitals and in communities from Maryland to South Africa. Growing rates of drug-resistant infections like tuberculosis and methicillin-resistant staphylococcus aureus (MRSA), coupled with recent H1N1 pandemic concerns, make his work most timely. His MRSA-related research not only has documented its evolution from a hospital problem into a community and public health concern, but also has given health providers
Farley's work is as much about transmitting knowledge as it is about curbing infection transmission. In new work supported by the JHU's Center on Global Health, he is evaluating current tuberculosis infection control practices and strategies in TB hospitals throughout South Africa. With highly drug-resistant TB adding to the significant toll taken by HIV/AIDS in that country, the need to improve infection control is marked. Yet, Farley has found considerable inattention to such issues as segregated care for TB-infected patients, lack of evaluation and testing of health care workers for the disease, and limited use of respirators to combat the spread of this airborne disease. Farley notes, "Infection control needs to be paramount in our thoughts about patient safety and also in how we avoid infection in health care workers." His work in South Africa seeks to determine if a trained infection control nurse can help reduce or eliminate these and other gaps in infection control. From a public health perspective, Farley says, "No one knows about infection control better than nurses. Its where our professions evidence-based roots began; nurses will continue to be on the front lines of infection prevention and public education tomorrow."
Breaking through the Sound of Silence: When the Infection is Sexual
Most sexually transmitted diseases (STDs) can be readily treated and cured; all can be prevented. Yet, in the U.S. alone, as many as 19 million new cases of a sexually transmitted disease (STD) are diagnosed each year, almost half of which are among sexually active teens and young adults. Many are symptom-free, don't even know they have an STD, and, as a result, don't get treated. Others whose STD symptoms are evident, may lack access to care or may be too ashamed, afraid or upset to discuss the illness, much less get treatment for it. In either case, continuing infection and ongoing transmission are likely. Whether well-known STDs like gonorrhea, syphilis and HIV/AIDS or less familiar ones like chlamydia and herpes, the physical repercussions of untreated STDs can be significant, ranging from pelvic disease to infertility, cervical cancer, even death, with attendant health care costs and lost productivity. The emotional toll can be equally or even more devastating, particularly since so many affected and infected are between the ages of 15 and 24. JHUSON assistant professor, Hayley D. Mark, PhD, MPH, RN doesn't think that's good for the public health and has been working to change the situation through research.
Drawn to the field of STD research because "It affects the human condition as a whole health, psychology and social environment," she noted that certain STDs tend to be passed around within specific closed communities, such as a college campus, the nightclub scene or the correctional facility. While it is well known that screening reduces the likelihood of transmitting HIV and bacterial STDs, Mark wondered whether wide-scale, voluntary screening also could help reduce the incidence of the transmission of genital herpes, HSV-2, a viral, often silent STD that puts people at greater risk for HIV infection. She began her inquiry on a college campus, assessing how to motivate student participation in STD screening and the performance characteristics of the HSV test in college students , reported in the Journal of American College Health and Sexually Transmitted Disease, respectively. Results suggested that to be successful, information about the availability of screening for HSV-2 should be neutral in tone and informative, transmitted broadly by a trusted source such as a student health center. Further, Mark's finding that a diagnosis of HVS-2 often causes significant emotional and social difficulty (social break-ups, depression, and anxiety) led her to recommend the value of both immediate and follow-up counseling to address both the medical and psychological aspects of infection.
Mark believes nurses are ideally poised to break through the silence that so often surrounds STDs. She notes, "Because we are trained to help people feel comfortable in an uncomfortable medical environment, we can help open the door to STD prevention as well as to screening and treatment. Part of what we do is help people talk about difficult health topics by providing a nonjudgmental environment in which knowledge can be shared. Its a great model of how nurses work to promote the public health."