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Myiasis: Nursing InterventionMyiasis: Nursing Intervention
By: Bridgette C. Williams, BSN, RNBy: Bridgette C. Williams, BS...
Lesson Plan: Myiasis
• Topic: Myiasis (maggot infestation for nurse clinicians and educators)
• Prerequisites: Undergradua...
Presentation Objectives
• At the end of this presentation learners will be able to:
– Define myiasis.
– Identify one myias...
PART IPART I
ClassificationClassification
Definition
• Myiasis (sounds like my-eye-uh-sis)
– is the infestation of maggots in or on the body
• Nosocomial myiasis
– ...
Myiasis Classification
Classification by type
•Obligate: fly eggs on any host surface
•Facultative: fly eggs on opportunis...
Fly Families
• Oestridae family. This is subdivided into 3 subfamilies:
– Oestridae (sounds like es-trid-ee)
– Calliphorid...
Quiz Question 1
• True of False: The common house fly (Musca domestica) does not cause
myiasis.
December 2011 B. Williams,...
Quiz Question 1 Answer
• Answer: False. The common house fly can
cause myiasis. It is facultative
• (“Facultative myiasis-...
Cutaneous Myiasis
• Cutaneous myiasis is subdivided into 3 types by clinical manifestation:
– Furuncular: Larvae presents ...
Furuncular Myiasis Epidemiology
• Dermatobia hominis, human bot fly
• Obligate parasite
• Found in Mexico and South Americ...
Migratory Myiasis Epidemiology
• Gasterophilus spp., horse bot fly
• Most common parasite to horses
• Obligate parasite
• ...
Wound Myiasis Epidemiology
• Cochliomyia hominivorax, blow fly
• Obligate parasite
• Distributed in warm areas of the Amer...
Quiz Question 2
• True or False: Myiasis is only associated with open areas.
December 2011 B. Williams, BSN, RN, MAMS 14
Quiz Question 2 Answer
• False. Myiasis can occur on intact skin.
• (Robbins & Khachemoune, 2010)
December 2011 B. William...
PART IIPART II
Life CycleLife Cycle
Life Cycle
• Fly lay eggs on an area
1. Eggs are deposited on host
2. Eggs hatch usually within 24 hours
3. Larvae emerge ...
PART IIIPART III
Signs & SymptomsSigns & Symptoms
Signs & Symptoms of Infestation
• Redness, pain, swelling
• Intense itching (pruritus)
• Sensation of movement under skin
...
Quiz Question 3
• Describe 2 signs of infestation.
December 2011 B. Williams, BSN, RN, MAMS 20
Quiz Question 3 Answer
• Redness (locale)
• Pain (locale)
• Itching (locale)
• Swelling (locale)
• Sensation of movement u...
Case Study 1
• A 75-year old woman with venous hypertension and diabetes presented
to the emergency room for an ulcer on t...
Case Study 1 Answer
• Answer: Wound myiasis
• (Victoria, Trujillo, & Barreto, 1999).
December 2011 B. Williams, BSN, RN, M...
Case Study
• A 25 year old man from a rural setting presented to an outpatient clinic
complaining of passing worms in the ...
Case Study 2 Answer
• Accidental myiasis
• (Das et al., 2010).
December 2011 B. Williams, BSN, RN, MAMS 25
PART IVPART IV
Nursing InterventionsNursing Interventions
Risk Factors
1. Patient
– Limited mobile/immobile; poor hygiene of skin and orifices
– Open wounds not covered
– Immune-co...
Nursing Intervention for Myiasis
1. Notify the patient
2. Calm the patient and/or staff
3. Notify the nurse supervisor or ...
Nursing Interventions...continued
6. Larvae (all) in specimen cup. Add 70% isopropyl alcohol in cup.
• Seal cup. Label: wr...
Nursing Interventions...continued
9. Dispose of used dressings in proper receptacle. Apply new dressings
10. Document what...
Critical Reasoning Exercise
• An 83 year old patient with diabetic foot ulcer is diagnosed with
Alzheimer’s and PVD is in ...
Critical Reasoning Exercise Ans.
• Standard precautions and check on the patient to ensure safety.
• Assess vital signs, p...
Myiasis Prevention
• Cover all wounds
• Change wound dressings as ordered and when visibly soiled
• Keep open orifices cle...
PART VPART V
ConclusionConclusion
Conclusion
• Nosocomial myiasis is maggot infestation which occurs in a hospital.
• Common signs/symptoms include redness,...
Reflection
• Constructing science information in the format of a slide presentation is
challenging. Many details must be a...
Evaluation
• Thank you for viewing Myiasis: Nursing Intervention presentation. Below
is a link to Zoomerang© survey evalua...
References
• Das, A., Pandey, A., Madan, M., Asthana, A.K., & Gautam, A. (2010). Accidental intestinal myiasis caused
by
g...
References
• Sherman, R.A., Roselle, G., Bills, C., Danko, L.H., Eldridge, N. (2005). Healthcare-associated myiasis:
preve...
ENDEND
Bridgette C. Williams, BSN, RN, MAMSBridgette C. Williams, BSN, RN, MAMS
williab5@sunyit.eduwilliab5@sunyit.edu
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Myiasis: Nursing Intervention

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PowerPoint slide show presentation about myiasis (maggot infestation) registered nurses.

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Myiasis: Nursing Intervention

  1. 1. Myiasis: Nursing InterventionMyiasis: Nursing Intervention By: Bridgette C. Williams, BSN, RNBy: Bridgette C. Williams, BSN, RN SUNY Institute of TechnologySUNY Institute of Technology
  2. 2. Lesson Plan: Myiasis • Topic: Myiasis (maggot infestation for nurse clinicians and educators) • Prerequisites: Undergraduate nursing degree • Objective: Differentiate types of myiasis in context of the nursing process • Rationale: Myiasis is an occurrence in the health care setting • Part I: Classification—types of myiasis infestation • Part II: Fly Life Cycle—development from egg to fly • Part III: Signs & Symptoms—signs of maggot infestation • Part IV: Nursing Interventions—protocol for maggot removal • Part V: Conclusion December 2011 B. Williams, BSN, RN, MAMS 2
  3. 3. Presentation Objectives • At the end of this presentation learners will be able to: – Define myiasis. – Identify one myiasis classification. – Describe at least 2 signs of infestation. – Explain at least 2 stages of the fly reproductive life cycle. – Differentiate at least 2 risk factors. – Apply at least 2 nursing interventions to care plan for myiasis. December 2011 B. Williams, BSN, RN, MAMS 3
  4. 4. PART IPART I ClassificationClassification
  5. 5. Definition • Myiasis (sounds like my-eye-uh-sis) – is the infestation of maggots in or on the body • Nosocomial myiasis – is the occurrence of maggot infestation in the hospital setting • Myiasis can be classified according to type or clinical presentation • (Robbins & Khachemoune, 2010; Tucker & Goulard, 2008; Merriam-Webster’s collegiate dictionary, 1995). December 2011 B. Williams, BSN, RN, MAMS 5
  6. 6. Myiasis Classification Classification by type •Obligate: fly eggs on any host surface •Facultative: fly eggs on opportunistic areas •Accidental: fly larvae feed on host not of usual source Classification by clinical presentation •Cutaneous •Orifices •Intestinal •Wound •(Trombetta, Oliva, Galache, Bava, & Troncoso, 2009; Werminghaus, Hoffman, Mehlhorn, & Bas, 2008; Robbins & Khachemoune, 2010; .Das, Madan, & Gautam, 2010) December 2011 B. Williams, BSN, RN, MAMS 6
  7. 7. Fly Families • Oestridae family. This is subdivided into 3 subfamilies: – Oestridae (sounds like es-trid-ee) – Calliphoridae (sounds like cal-lif-or-id-ee) – Sarcophagidae (sounds like sar-cof-aj-id-ee) Specie Examples • Dermatobia hominis—bot fly–Oestridae family • Cochliomyia hominivorax—blow fly—Calliphoridae family • Wohlfahrtia vigil—flesh fly—Sarcophagidae family • (Robbins & Khachemoune, 2010). December 2011 B. Williams, BSN, RN, MAMS 7
  8. 8. Quiz Question 1 • True of False: The common house fly (Musca domestica) does not cause myiasis. December 2011 B. Williams, BSN, RN, MAMS 8
  9. 9. Quiz Question 1 Answer • Answer: False. The common house fly can cause myiasis. It is facultative • (“Facultative myiasis-producing flies”, 2011). December 2011 B. Williams, BSN, RN, MAMS 9 ImageSource: http://www.naturephoto-cz.eu/musca-domestica-picture-14134.html Musca domestica
  10. 10. Cutaneous Myiasis • Cutaneous myiasis is subdivided into 3 types by clinical manifestation: – Furuncular: Larvae presents as a boil lesion – Migratory: also known as creeping. Larvae moves under skin layers – Wound: also known as traumatic. Larvae presents in wound bed • (Robbins & Khachemoune, 2010). December 2011 B. Williams, BSN, RN, MAMS 10
  11. 11. Furuncular Myiasis Epidemiology • Dermatobia hominis, human bot fly • Obligate parasite • Found in Mexico and South America • Often affects dogs, cats or cattle • Eggs on surfaces & vectors • Site specific • Invasive; it burrows under the skin to cause a boil • (Trombetta, et al., 2009; Robbins & Khachemoune, 2010; Gingrich, Spickler, & Davis, 2004). December 2011 B. Williams, BSN, RN, MAMS 11 Image Source: http://www.greatapeproject.org/en-US/curiosidade.info/Show/ 1942,have-you-ever-eaten-a-buge Dermatobia hominis
  12. 12. Migratory Myiasis Epidemiology • Gasterophilus spp., horse bot fly • Most common parasite to horses • Obligate parasite • Eggs on the hairs of horses • Distinct serpentine pattern visible under skin • Infestation is by contact with an infected horse • (Robbins & Khachemoune, 2010). December 2011 B. Williams, BSN, RN, MAMS 12 Image Source: http://www.slow-life.co.uk/2010/02/03/the-evil-bee/ Gasterophilus spp.
  13. 13. Wound Myiasis Epidemiology • Cochliomyia hominivorax, blow fly • Obligate parasite • Distributed in warm areas of the Americas • Infestation frequently associated with animals • Female fly lays hundreds of eggs • Larvae of this specie will feed on living tissue (usually larvae feed on dead tissue) • Distinct odor in wound • Death can result if not treated • (Trombetta et al., 2009; Robbins & Khachemoune, 2010; Gingrich, Spickler, & Davis, 2004) December 2011 B. Williams, BSN, RN, MAMS 13 Image Source: http://www.icb.usp.br/~marcelcp/Cochliomyia.htm Cochliomyia hominivorax
  14. 14. Quiz Question 2 • True or False: Myiasis is only associated with open areas. December 2011 B. Williams, BSN, RN, MAMS 14
  15. 15. Quiz Question 2 Answer • False. Myiasis can occur on intact skin. • (Robbins & Khachemoune, 2010) December 2011 B. Williams, BSN, RN, MAMS 15 Image Source: http://www.icb.usp.br/~marcelcp/Dermatobia.htm Dermatobia hominis
  16. 16. PART IIPART II Life CycleLife Cycle
  17. 17. Life Cycle • Fly lay eggs on an area 1. Eggs are deposited on host 2. Eggs hatch usually within 24 hours 3. Larvae emerge from eggs. • instar (usually up to 3) • spiracle 1. Mature larvae leave host to pupa. 2. Within pupa, metamorphosis into reproductive fly • (Sherman, Roselle, Bills, Danko, & Eldridge, 2005). December 2011 B. Williams, BSN, RN, MAMS 17 Image Adapted From: Sherman, R.A., Roselle, G., Bills, C., Danko, L.H., & Eldridge, N. (2005). Healthcare-associated myiasis: Prevention and intervention. Infection Control And Hospital Epidemiology, 26(10), 828-832. Image Adapted From: Nazni, et al. (2011). Nosocomial nasal myiasis in an intensive care unit. Malaysian Journal of Pathology, 33(1), 53-56. Life cycle Spiracle
  18. 18. PART IIIPART III Signs & SymptomsSigns & Symptoms
  19. 19. Signs & Symptoms of Infestation • Redness, pain, swelling • Intense itching (pruritus) • Sensation of movement under skin • Serous or serosanguinous discharge at site • Malodor if affected area is wound bed • *Thread like structure removed • (Sharma, Pai, & Pai, 2008). • *Definitive diagnosis of myiasis is by nurse practitioner or physician if identification of larva removed from area. December 2011 B. Williams, BSN, RN, MAMS 19 Image Source: http://www.langetextbooks.com/_levinson/gallery.php?id=m-n
  20. 20. Quiz Question 3 • Describe 2 signs of infestation. December 2011 B. Williams, BSN, RN, MAMS 20
  21. 21. Quiz Question 3 Answer • Redness (locale) • Pain (locale) • Itching (locale) • Swelling (locale) • Sensation of movement under skin • Discharge at site • Malodor (if in wound bed) December 2011 B. Williams, BSN, RN, MAMS 21
  22. 22. Case Study 1 • A 75-year old woman with venous hypertension and diabetes presented to the emergency room for an ulcer on the right leg. Necrotic tissue and tunneling were present in the wound bed. “Worms” were observed by the nurse assistant. What is the possible clinical presentation? December 2011 B. Williams, BSN, RN, MAMS 22
  23. 23. Case Study 1 Answer • Answer: Wound myiasis • (Victoria, Trujillo, & Barreto, 1999). December 2011 B. Williams, BSN, RN, MAMS 23
  24. 24. Case Study • A 25 year old man from a rural setting presented to an outpatient clinic complaining of passing worms in the stool for the past month. He had no complaints of blood in the stool. Blood pressure was within range. Stool sample collected and lab technician reported 4 active “worms” were microscopically identified. What is the possible clinical presentation? December 2011 B. Williams, BSN, RN, MAMS 24
  25. 25. Case Study 2 Answer • Accidental myiasis • (Das et al., 2010). December 2011 B. Williams, BSN, RN, MAMS 25
  26. 26. PART IVPART IV Nursing InterventionsNursing Interventions
  27. 27. Risk Factors 1. Patient – Limited mobile/immobile; poor hygiene of skin and orifices – Open wounds not covered – Immune-compromised – Cognitively impaired 1. Environment – Warm climate (e.g. tropical or summer weather season) – Food containers left uncovered in room – Overflowing garbage bins in room • (Sherman et al., 2005). December 2011 B. Williams, BSN, RN, MAMS 27
  28. 28. Nursing Intervention for Myiasis 1. Notify the patient 2. Calm the patient and/or staff 3. Notify the nurse supervisor or nurse manager 4. Locate the medical center policy and protocol to control myiasis 5a. Using standard precautions, remove larvae (NP or MD) • Brush the larvae out. DO NOT SMOOSH or SMASH. Put intact larvae aside. 5b. If entire larvae not visible [in skin], apply petroleum jelly •(Department of Veteran Affairs, Policy Memorandum 512-11, 2009; Sherman et al., 2005; Victoria et al., 1999). December 2011 B. Williams, BSN, RN, MAMS 28
  29. 29. Nursing Interventions...continued 6. Larvae (all) in specimen cup. Add 70% isopropyl alcohol in cup. • Seal cup. Label: write patient’s name, date, time, name of clinician who collected specimen and type of solution. • Send to lab IMMEDIATELY (within 24 hours). 7. Wipe infected area; use sterile saline or hydrogen peroxide or Dakin’s solution [0.125% sodium hypochlorite]. 8. Soak infected area using hydrogen peroxide and water mixture (1:3) Soak for approx. 20 minutes. • (Department of Veteran Affairs, Policy Memorandum 512-11, 2009; Sherman et al., 2005; Victoria et al., 1999). December 2011 B. Williams, BSN, RN, MAMS 29
  30. 30. Nursing Interventions...continued 9. Dispose of used dressings in proper receptacle. Apply new dressings 10. Document what was done. • Often, broad-spectrum antibiotic (i.e. Ivermectin) is prescribed •(Department of Veteran Affairs, Policy Memorandum 512-11, 2009; Sherman et al., 2005; Victoria et al., 1999). December 2011 B. Williams, BSN, RN, MAMS 30
  31. 31. Critical Reasoning Exercise • An 83 year old patient with diabetic foot ulcer is diagnosed with Alzheimer’s and PVD is in your care. You are the charge nurse of the 70 bed nursing home facility and the only RN on shift. The doctor is on call. The nurse assistant frantically calls for your assistance. The nurse assistant tells you she was attempting to adjust the sheets in the in the bed and observed the dressing fell off and “white worms” were seen crawling in the wound bed. As the charge nurse, apply 2 nursing interventions for possible myiasis infestation. December 2011 B. Williams, BSN, RN, MAMS 31
  32. 32. Critical Reasoning Exercise Ans. • Standard precautions and check on the patient to ensure safety. • Assess vital signs, pain, wound bed. Offer pain med. • Notify the nurse manager/supervisor. Notify the doctor on call. • Access myiasis policy/protocol/procedure. • Perform myiasis removal. Be sure to preserve the larva in 70% Isopropyl alcohol labeled and sealed in a specimen cup. Clean the wound bed as stated in protocol. • Contact lab; notify technician of pending arrival. Send specimen to lab immediately. • Document what was done. • Look for new orders. December 2011 B. Williams, BSN, RN, MAMS 32
  33. 33. Myiasis Prevention • Cover all wounds • Change wound dressings as ordered and when visibly soiled • Keep open orifices clean, especially if patient has an artificial airway • Establish a turning or repositioning schedule for limited mobile patients • Thorough skin assessment at least 1 time per week • Do not leave open food containers in room • Keep garbage receptacles covered with a lid • (Sherman et al., 2005) December 2011 B. Williams, BSN, RN, MAMS 33
  34. 34. PART VPART V ConclusionConclusion
  35. 35. Conclusion • Nosocomial myiasis is maggot infestation which occurs in a hospital. • Common signs/symptoms include redness, pain, itching. • Risk factors include open wound beds with or without necrotic tissue, bed-ridden patient and unkempt environment. • Nosocomial myiasis is preventable. Additional Information: The Center for Food Security & Public Health, Iowa State University: http://cfsph.iastate.edu/DiseaseInfo/disease.php?name=screwworm-myiasis&lang=en December 2011 B. Williams, BSN, RN, MAMS 35
  36. 36. Reflection • Constructing science information in the format of a slide presentation is challenging. Many details must be abbreviated on slides. • First experience constructing presentation with quiz questions, case studies. • First experience including a synthesis critical reasoning example. • First experience using online survey Zoomerang©. • First presentation using Elluminate Live! V.10©. December 2011 B. Williams, BSN, RN, MAMS 36
  37. 37. Evaluation • Thank you for viewing Myiasis: Nursing Intervention presentation. Below is a link to Zoomerang© survey evaluation. Please take 10 minutes to answer questions. This survey can be completed at any time. If you would like to contact me. Please see contact information on final slide. • http://www.zoomerang.com/Survey/WEB22E58645U4D December 2011 B. Williams, BSN, RN, MAMS 37
  38. 38. References • Das, A., Pandey, A., Madan, M., Asthana, A.K., & Gautam, A. (2010). Accidental intestinal myiasis caused by genus Sarcophaga. Indian Journal of Medical Microbiology, 28(2), 176-178. • Department of Veteran Affairs, A Maryland Health Care System: The Infection Control/Hospital Epidemiology Program (111/MD). (2008). Policy Memorandum (512-11/COS IC-015). Baltimore, MD: Author. • Facultative myiasis-producing flies. (2011). The Merck Veterinary Manual. Retrieved from: http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/71719.htm • Gingrich, E., Spickler, A.R., & Davis, R. (2004). Screwworm myiasis [PowerPoint presentation]. The Center for Food Security & Public Health Iowa State University. Retrieved from: http://cfsph.iastate.edu/DiseaseInfo/disease.php?name=screwworm-myiasis&lang=en • Myiasis. (1995). In Merriam-Webster’s collegiate dictionary (10th ed.). • Robbins, K., & Khachemoune, A. (2010). Cutaneous myiasis: A review of the common types of myiasis. International Journal of Dermatology, 49, 1092-1098. • Sharma, P., Pai, H.S., & Pai, G.S. (2008). Furuncular myiasis mimicking pyoderma [Letters to Editor]. Indian Journal of Dermatology, Venerology and Leprology, 74(6), 679-681. December 2011 B. Williams, BSN, RN, MAMS 38
  39. 39. References • Sherman, R.A., Roselle, G., Bills, C., Danko, L.H., Eldridge, N. (2005). Healthcare-associated myiasis: prevention and intervention. Infectious Control and Hospital Epidemiology, 26(10), 828-832. • Trombetta, L., Oliva, A., Galache, V., Bava, J., Troncoso, A. (2009). Cutaneous myiasis due to Cochliomyia hominovorax in a drug user. Journal of Infection in Developing Countries, 3(11), 873-876. • Tucker, S. –M., & Goulard, S. (2008). More than just a fly on the wall: A case of nosocomial myiasis in the intensive care unit. Canadian Association of Critical Care Nurses, 31. • Victoria, J., Trujillo, R., & Barreto, M. (1999). Myiasis: A successful treatment with topical Ivermectin. International Journal of Dermatology, 38, 142-144. • Wa, N., Jeffery, J., Lee, H.L., Lailatul, A.M., Chew, W., Heo, C.C., Sadiyah, I., Khairul, M, -A., Heah, S.K., Mohd, H.H. (2011). Nosocomial nasal myiasis in an intensive care unit. Malaysian Journal of Pathology, 33(1), 53-56. • Werminghaus, P., Hoffman, T.K., Lehlhorn, H., Bas, M. (2008). Aural myiasis in a patient with Alzheimer’s disease. European Archives of Otorhinolaryngology, 265(7), 851-853. doi: 10.1007/s00405-007- 0535-2 December 2011 B. Williams, BSN, RN, MAMS 39
  40. 40. ENDEND Bridgette C. Williams, BSN, RN, MAMSBridgette C. Williams, BSN, RN, MAMS williab5@sunyit.eduwilliab5@sunyit.edu

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