The aim of this assessment is to increase students' understanding of how microorganisms can cause health breakdown, and the role of relevant pharmacological interventions in the recovery processes. Students will explore various modes of transmission, relevant characteristics of pathogens and the importance of breaking the chain of infection. This assessment facilitates the development of the following skills: critical appraisal of the nurse's role in infection control, literature searching, and academic writing and referencing.

1. Physiological basis of the wound observations (Total: 10 marks)

Wound infection is a result of an active interplay between the pathogen and the immune system of the host. The broken skin with plenty of microorganisms often serves as the best medium of infection growth due to the body temperature and the availability of nutrients beneath the skin. An infection is caused when the host immune system cannot control the growth of the pathogens, leading to immunological reactions and certain manifestations (International Wound Infection Institute (IWII), 2016). There are four stages of wound infection, which describes the pathogenic activities of the microorganisms in the body with the development of the symptoms. Wound contamination is the presence of the pathogens on the wound surface. The organisms do not multiply or cause any immune response in this stage, causing no impairment in wound healing. In the colonization stage, the multiplication of the microorganisms take place without causing a host reaction. It may also be considered that the host immune system keeps a check on the proliferation of the microorganisms. The organisms do not interfere with the healing process, cause a damage to the wound tissue or cause an immune response. The critical colonization or local infection occurs when the microorganisms pass into the deeper tissues and cause proliferation at a high rate causing host immune reaction. The infection is localised in one place, a tissue or structure (Cook & Ousey, 2015). Local infection cause covert signs such as hypergranulation, bleeding, friable granulation, epithelial bridging and pocketing in granulation tissue, wound breakdown, excessive damage to the wound, delayed wound healing, increase in pain and excessive odour. The covert signs often progress to overt signs if treatment is delayed, causing erythema, warmth, swelling, tenderness, pain, delayed wound healing and malodour.  Spreading infection does not remain localised at a place rather invades the surrounding tissues, muscle fascia, organs or body cavities. The signs and symptoms extend beyond the wound (IWII, 2016). 

In the present case, Mary had developed a lacerated wound, which had progressed to stage three with the symptoms of pain, swelling, redness, warmth and purulent discharge. The infection causes the blood vessels to dilate causing warmth and tenderness to facilitate wound healing. The microorganisms and dead cells causes the drainage o become purulent (IWII, 2016).

2. Possible sources of contamination and modes of transmission (Total: 10 marks)

2.1 Name one endogenous source of contamination and discuss the mode of transmission from the source to the new host. (5 marks)

An endogenous source of infection is the natural flora. The organisms of the natural flora may become invasive and cause infections after the breakdown of the skin. Most of the carriage sites include the nostrils and throat, which causes the spread in the skin (Negi, Juyal, Pal, Sharma, & Sharma, 2015). The presence of the infection in the nostrils is about six times more susceptible to wound infection.  The risk factors include surgical site infection. Insertion of a central line catheter, contact with the carriage (Gould, 2012). Treatment with broad spectrum antibiotics may damage the natural flora of the susceptible flora, which causes colonization  of the part with resistant organisms. This colonization may possibly be the cause of infection (Kolmos, 2012). The endogenous source of infection for Mary is Staphylococcus aureus.

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