Otic Medications

ANTIINFECTIVE EAR MEDICATIONS

·         Kills or inhibits the growth of susceptible bacteria

·         Indication:

o    To dry the ear and kill susceptible bacteria

o    Acetic acid may be used to dry the ear.

Example:

acetic acid and aluminum acetate (Otic Domebro®)

amoxicillin (Amoxil®)

ampicillin trihydrate (Polycillin®)

cefaclor (Ceclor®)

chloramphenicol (Chloromycetin® otic)

clarithromycin (Biaxin®)

clindamycin hydrochloride (Cleocin®)

erythromycn (Ilotycin®, E-Mycin®)

gentamicin sulfate otic solution (Garamyin®)

loracarbef (Lorabid®)

penicillin V potassium (Pen-V®)

polymyxin B sulfate (Aerosporin®)

tetracycline hydrochloride (Achromycin®)

trimehoprim and sulfamethoxasole (Bactrim®, Cotri®, and Septra®)

Side Effects:

·         Mild diarrhea

·         Headache

·         Superinfection in patients with overgrowth of nonsusceptible organisms

ANTIHISTAMINES AND DECONGESTANTS

·         Stimulate adrenergic receptors of respiratory mucosa, producing vasoconstriction and reducing respiratory tissue hyperemia to open Eustachian tube

·         Indication:

o    Adjunctive therapy for otitis media; to reduce respiratory congestion or open obstructed Eustachian tube

Example:

brompheniramine (Bromphen®,Dimetane®)

cetirizine (Zyrtec®)

chlorpheniramine (Chlor-Trimeton®, Teldrin®)

clemastine (Tavist®)

naphazoline hydrochloride (Allerest®, Albalon®)

tripolidine and pseudoephedrine (Actifed®)

Side Effects:

·         Drowsiness ·         Blurred vision

·         Dry mucus membranes

LOCAL ANESTHETICS

·         Block nerve conduction at or near application site to control pain associated with ear infections.

·         Indication:

o    To treat pain associated with ear infection

Example:

antipyrene and benzocaine combination (Auralgan® otic solution)

benzocaine (Tympagesic®)

Side Effects:

·         Irritation

·         Allergic reactions

·         May mask the symptoms of middle ear infection

CERUMINOLYTICS

·         Emulsify and loosen cerumen deposits

·         Indication:

o    To remove excess cerumen

Example:

carbamide peroxide (Debrox®)

boric Acid (Ear Dry®)

trolamine polypeptide oleate-condensate (Cerumenex®)

Side Effects:

·         Irritation, redness or swelling of the ear canal

General Contraindications and Precautions for Otic Medications:

o    Hypersensitivity reactions

§  Redness

§  Burning

§  Itching

§  Stinging

§  Vesicular or maculopapular dermatitis

§  Swelling and mild irritation

o    Perforated eardrums

General Nursing Interventions:

ü  Assess the patient for hearing loss, pain and ear drainage.

ü  Use the correct method to instill medications:

Ear drops:

o    Use clean technique; if tympanic membrane is damaged, use sterile technique.

o    Assist patient to side-lying position, ear being medicated uppermost.

o    Clean the pinna of the ear and the opening of the external ear canal with solution and cotton-tipped applicators as needed.

o    Warm the medication container with your hand or in warm water for comfort; partially fill the ear dropper with medication.

o    Straighten the auditory canal by:

§  For the child younger than age 3: pull the pinna/auricle down and back

§  For the adult and older child: pull the pinna up and back

o    Hold the bottle or dropper ½ inch above the ear canal and instill the correct number of drops along the side of the ear canal.

o    Apply gentle pressure with fingers to the tragus of the ear (to enhance the flow of medication to the ear canal).

o    Have the patient maintain side-lying position for 2-5 minutes for even dispersion.

o    Before the patient arises, loosely place a cotton ball at the meatus and leave in place for 30 mins. to prevent mediation loss.

Otic irrigation:

o    Assist the patient to a sitting or lying position with the head tilted toward the affected ear ; place water-proof pad and drainage receptacle under the affected ear.

o    Check that the temperature of the irrigant is 98ºF.

o    Determine that the tympanic membrane is intact before beginning the otic irrigation.

o    Straighten the ear canal and gently insert the syringe tip into the auditory meatus; direct the solution slowly and steadily along the wall of the canal (*to avoid damaging the tympanic membrane).

o    Use no more than 50 to 70 ml at one time.

o    Dry the outside of the ear with cotton balls after the solution drains. Place a dry cotton ball in the auditory meatus lightly to absorb remaining excess fluid.

o    Assist the patient to a side-lying position on the affected side for further drainage.

o    Assess for discomfort.

Administration of Ceruminolytics:

o    Moisten a cotton ball with medication before insertion. Do not use a swab because it might cause trauma to the inner ear.

o    Avoid touching ear with dropper.

o    Flush ear gently with warm water, using a soft rubber bulb ear syringe within 30 mins. after instillation to remove cerumen.

o    Keep container tightly closed and away from moisture.

ü  Assess the patient for hypersensitivity reactions. 

Infection Control

Nosocomial Infections (Hospital Acquired Infections)

·         Infections that are acquired in the hospital or other health care facility that was not present or incubating at the time of a client's admission.

Transmission of infectious agent within a healthcare setting requires three elements:

1.        A source of infectious agent

2.        A susceptible host with a portal of entry receptive to agent

3.        A mode of transmission for the agent

 Standard Precautions:

Hand Washing

·   The single most important practice to reduce the transmission of infectious agents in health care settings.

·   Wash hands after touching blood, body fluids, secretions, excretions and contaminated items, whether or not gloves are worn.

·   Wash hands immediately after removing gloves, between patient contacts, and when otherwise indicated to reduce transmission of microorganisms.

·   Wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

·   Use plain nonantimicrobial soaps for routine handwashing.

·   An antimicrobial agent or waterless antiseptic agent may be used for specific circumstances (hyperendemic infections) as defined by infection control.

Gloves

·   Is indicated when:

o Anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin and other potentially infectious material

o Having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route e.g., VRE, MRSA, RSV 559

o Handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces

Gown

·   When applying Standard Precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated.

Masks

·   Are used for three primary purposes in healthcare settings:

o Placed on healthcare personnel to protect them from contact with infectious material from patients e.g., respiratory secretions and sprays of blood or body fluids, consistent with Standard Precautions and Droplet Precautions

o Placed on healthcare personnel when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a healthcare worker’s mouth or nose.

o Placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others (i.e., Respiratory Hygiene/Cough Etiquette).

 Masks should not be confused with particulate respirators that are used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route.

Goggles / Face Shields

·   Should be worn if patient care activities may generate splashes or sprays of blood, body fluids, secretions and excretions.

Patient-Care Equipment

·   Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing and transfer of microorganisms to other patients or environment.

Environmental Control

·   Follow hospital procedures for the routine care, cleaning and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces.

Occupational Health & Blood-Borne Pathogens

·   Never recap used needles, or otherwise manipulate them using both hands, or use any other technique that involves directing the point of the needle toward any part of the body; rather, use either a one-handed "scoop" technique or a mechanical device designed for holding the needle sheath.

·   Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand.

·   Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation.

. Modes of Transmission .

. Transmission-Based Precautions .

Contact Transmission - most common mode of transmission

Direct Contract Transmission

·         Occurs when microorganisms transferred from infected person to another person without a contaminated intermediate object or person.

Indirect Contact Transmission

·         Involves the transfer of an infectious agent through a contaminated intermediate object or person.

Examples of common pathogens that are transmitted via contact transmission:

o    Clostridium difficile

o    Herpex Simplex Virus

o    Respiratory Syncytial Virus

o    Staphylococcus Aureus

o    Multi-Drug Resistant Organisms e.g Methicillin-resistant Staphylococcus aureus (MRSA)

o    Sarcoptes scabiei var hominis (scabies), & other skin infections

o    Bacillus anthracis ("Anthrax"). [or inhaled]

o    Clostridium botulinum

C. difficile - a spore-forming gram positive anaerobic bacillus that is the major cause of healthcare-associated diarrhea.

Control of Multi-Drug Resistant Organism (MDRO)

1.        Administrative support (e.g adherence to infection control guidelines)

2.        Judicious use of antimicrobials

3.        Surveillance (routine and enhanced)

4.        Standard and Contact Precautions

5.        Environmental measures

6.        Education  

7.        Decolonization

Examples of MDRO: Methycillin Resistant Staphyloccus Aureus [MRSA], vancomycin resistant enterococcus [VRE]

Contact Precautions:

§  Isolation room.

§  Wear gloves when in contact with the patient or when entering the room.

§  Wear gown when entering the room when you anticipate your clothing will have substantial contact with the patient, environmental surfaces or if the patient is incontinent or has any drainage that is not contained by dressing.

§  After glove and gown removal and handwashing, ensure that hands do not touch contaminated environment items.

§  Limit movement and transport of patient.

Droplet Transmission

·         Is a form of contact transmission in which respiratory droplets carrying infectious pathogens transmit infection when they travel directly from the respiratory tract of the infectious individual, through coughing, sneezing, talking or during endotracheal intubation, to susceptible mucosal surfaces of the recipient.

·         It may be prudent to don a mask when within 6 to 10 feet (> 3 feet) of the patient or upon entry into the patient's room, especially when exposure to emerging or highly virulent pathogens is likely.

Examples of infectious agent that travel via the droplet route:

o    Bordetella pertussis

o    Influenza virus

o    Adenovirus

o    Rhinovirus

o    Mycoplasma pneumoniae

o    SARS-asscoaited coronavirus

o    Group A streptococcus

o    Neisseria meningitidis

Droplet Precautions:

§  Isolation room

§  Wear mask when entering room

§  Limit movement and transport of patient to essential purposes only

§  Mask patient when transporting out of area

Airborne Transmission

·         Occurs by dissemination of either airborne droplet nucei or small particles in the respirable size range containing infectious agent that remain infective over time and long distances.

Example:

o    Spores of Aspergillus spp

o    Mycobacterium tuberculosis

o    Rubeola virus (measles)

o    Varicella-zoster virus (chickenpox)

o    Variola virus (smallpox)

Airborne Precautions:

·         Patient must be placed in Airborne Infection Isolation Rooms (AIIRs). Room under negative pressure.

·         Nurse must use wear respiratory protection when entering AIIRs (e.g N95 respirator, NIOSH-approved Particulate Respirator "air purifying respirators")

·         Limit movement and transport of patient to essential purposes only.

·         Mask patient when transporting out of area.

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