Biom111 Microbiology Workbook

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PART A QUESTION 1 Infection control in a health care setting Chickenpox in a Health Care Worker – Total 13 marks A registered nurse working in an HDU (High Dependency Unit) notified the Infection Control Nurse that her daughter had chickenpox. The daughter’s skin lesions had appeared five days prior to the notification. The staff member did not have a history of having had the disease and was in the second trimester of her second pregnancy. Blood tests on the RN for antibody to Varicella zoster virus (VZV) were negative. She was rostered off work and given varicella zoster specific immunoglobulin by her obstetrician. A few days later she developed chickenpox. She subsequently gave birth to a normal infant weighing 3050 g. a) Why was the immunoglobulin injection not effective in preventing chickenpox in this case? The nurse's daughter had already presented with symptoms (skin lesions) for too long prior to her notification for the varicella zoster specific immunoglobulin to be of effect, as it should be administered within 96 hours of contact with the infection (South Australian Perinatal Practice Guidelines Workgroup 2010). After the first trimester of pregnancy the risk of congenital deformation drops to 2% (McCrary, ML, Severson, J, Tyring, SK 1999). The obstetrician would have recommended the immunoglobulin due to the fact that the pregnant woman had never developed the virus and so would not have been immune, as well as being in close contact with her infectious daughter. b) What are the risks to the baby if chickenpox is contracted during pregnancy? Chicken pox during pregnancy causes issues in 3 out of every 1,000 pregnancies (Ács, N, Bánhidy, FG Czeizel, AE 2010). If chickenpox is developed prior to 20 weeks, it is very difficult to treat and there is a larger chance that the newborn will suffer from Foetal Varicella Syndrome. This condition causes

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