Download Running head: PREVENING TOXIC SHOCK SYNDROM

Running head: PREVENING TOXIC SHOCK SYNDROM
Preventing Toxic Shock Syndrome in School Age and Adolescent Girls
Devyn Gravley
Lamar University
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Preventing Toxic Shock Syndrome in School Age and Adolescent Girls
Puberty is a time of numerous changes in a child’s body. For females, this includes
beginning menstruation and, as a result, the use of feminine hygiene products. Often, a brief
presentation is given to fifth or sixth grade students by teachers to explain puberty (M. Guidry,
personal communication, March 7, 2016). Many parents rely solely on the school system to
educate their children on the eminent changes which will occur in their bodies during puberty.
Because the teachers educating the students about puberty are not sex education teachers,
children may not receive important information, which can potentially be detrimental to their
health. A school nurse, M. Guidry, identifies the need for education on toxic shock syndrome
resulting from the use of tampons (personal communication, March 7, 2016). Lack of
knowledge about toxic shock syndrome and tampon use contribute to preteen girls risk of
developing the condition.
Pathophysiology
Toxic Shock Syndrome is a systemic infection, primarily caused by Staphylococcus
aureus and group A streptococcus bacteria (Mayo Clinic, 2016, p. 1). The bacteria “can induce
massive activation of T cells” causing an inflammatory cascade within the body, “which mediate
shock” (Li, Pian, Hao, Zheng, Zang, H. Jiang and Y.Q. Jiang, 2016, p. 527). The systemic
symptoms include pain, hypotension, vomiting, diarrhea, red rash, desquamation on the palms of
hands and soles of the feet, confusion, muscle aches, headaches, and seizures (Mayo Clinic,
2016, p. 2). Localized symptoms include redness and edema at the primary site of infection.
Toxic shock syndrome requires urgent medical treatment as systemic “shock is apparent at the
time of hospitalization or within 4-8 hours for all patients” (Venataraman, Sharma, 2015, p. 5).
Hypotension occurs as a result of systemic shock and is often not responsive to intravenous
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fluids. Over half of patients experiencing toxic shock syndrome must be mechanically ventilated
to combat respiratory distress (Venataraman, Sharma, 2015, p. 5). Females are at the greatest
risk for developing toxic shock syndrome. The use of “highly absorbent tampons, using tampons
for more days of their cycle, and keeping a single tampon in place for a longer period of time”
drastically increases females’ risk (Venataraman, Sharma, 2015, p. 1). Those diagnosed with
chronic diseases, particularly HIV, diabetes mellitus, and cancer, use nonsteroidal antiinflammatory medications, and “a recent history of varicella infection” are also at increased risk
for developing toxic shock syndrome (Venataraman, Sharma, 2015, p. 5). As toxic shock
syndrome is a life-threatening condition, complex interventions must be implemented to treat the
patient. Antibiotics to treat the underlying infection and hypotensive medications and fluids are
given as well as medications to combat individual symptoms. “The toxins produced by the staph
or strep bacteria and accompanying hypotension may result in kidney failure” (Mayo Clinic,
2016, p. 8). If kidney failure occurs, dialysis is necessary. Patients may undergo surgery to
remove necrotic tissue and drain the infection. By knowing how toxic shock syndrome occurs,
who is at risk and what the signs and symptoms are, prevention and early detection can decrease
the incidences of fatal toxic shock syndrome.
What Is Being Done
Healthy People 2020 set the goal to “increase the proportion of schools that require newly
hired staff who teach required health instruction to be certified, licensed, or endorsed by the State
in health education” (2014, p. 2). This goal can be extended to encompass the “puberty talk”
students receive in school, not included in a health education class. By requiring teachers to be
educated by the State, a more in depth explanation of puberty can be explained, as well as risks
that accompany puberty such as toxic shock syndrome related to tampon usage.
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The U.S. Food and Drug Administration (FDA) has had a significant role in decreasing
the risk of menstruating women developing toxic shock syndrome by regulating tampon products
and setting guidelines for safe usage. “Manufacturers pulled certain types of tampons off the
market,” including super absorbent tampons and tampons made out of particular materials as a
result of pressure from the FDA (Mayo Clinic, 2016, p. 1). In addition, information pamphlets
or sections on the box are required to be included with tampon packages warning of toxic shock
syndrome associated with tampon usage. The FDA also developed guidelines to reduce
menstruating females’ risk for developing toxic shock syndrome. These guidelines include using
the lowest absorbance possible to control flow, change tampons at least every eight hours, do not
use tampons overnight, read the pamphlet included in tampon packages, store tampons in a
sanitary and dry environment, wash hands before and after inserting or removing a tampon, and
be knowledgeable of symptoms of toxic shock syndrome (Brown, 2013, para 21). Because
approximately half of those diagnosed with toxic shock syndrome are associated with tampon
use, easily accessible information included with a purchase of the product is a convenient
resource in preventing toxic shock syndrome.
As technology progresses, children and adolescents utilize the internet as an
informational source. A variety of web pages have been designed particularly for girls and
female adolescents educate them on the use of tampons and toxic shock syndrome.
Kidshealth.org has a section devoted to adolescence titled Teens Health, which compiles
information related to safe tampon usage and toxic shock syndrome in an easy to navigate web
page. The web page includes the FDA tips for preventing toxic shock syndrome in a manner that
is geared towards adolescents, the cause of toxic shock syndrome, and its signs and symptoms.
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By marketing the information specifically to adolescences, the information provided is
appropriate for their educational level and specific to the adolescent’s needs.
What needs to be done
There is a significant knowledge deficit in reference to toxic shock syndrome,
particularly in school and adolescent girls. Even among those informed of the correlation
between tampon use and toxic shock syndrome, most have not been educated on the signs and
symptoms of the condition. Knowing the signs and symptoms is critical to the early diagnosis
and treatment. The formal education provided in schools often does not educate girls on toxic
shock syndrome. A revision of materials and specially certified teachers will promote a more in
depth education in female health. Most information on toxic shock syndrome emphasizes the
rarity of developing the condition. Although this is true, young females are at the highest risk for
contracting toxic shock syndrome. The emphasis on rarity can give young females a false sense
of security causing them to develop a not-me mentality. This decreases the likelihood of
implementing simple, yet effective preventative interventions in developing toxic shock
syndrome. Although informational resources are available, many young females are not aware
of these resources. Simply typing in “toxic shock syndrome” into a search engine brings up
countless web pages, however the majority of these resources are above a middle school
education level. Valuable information aimed at decreasing the risk of the condition can easily be
over looked because it is presented at a more advanced level than the young girls are able to
comprehend. The school nurse can be a valuable resource to school age girls. School nurses
posses the knowledge and resources to aid young females in preventing the development of toxic
shock syndrome.
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Conclusion
Toxic shock syndrome, a medical emergency, presents with characteristic signs and
symptoms. Those most at risk, such as young females, should be educated on these issues.
Although federal programs and independent organizations have released information on the signs
and symptoms as well as intervention to prevent the development of toxic shock syndrome, a gap
exists between producers and consumers of the information. The school nurse can aid in closing
this gap by providing students with the information.
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References
Healthy People 2020. (2014). Early and Middle Childhood. Retrieved from
https://www.healthypeople.gov/2020/ topics-objectives/topic/early-and-middlechildhood/objectives
L. Li, Y.Y. Pian, H.J. Hao, Y.L. Zheng, Y.T. Zang, H. Jiang and Y.Q. Jiang (2016). "Findings
from Institute of Microbiology in Toxic Shock Syndrome Reported. Obesity, Fitness &
Wellness Week 30 Apr. 2016, 527. Retrieved from http://go.galegroup.com.libproxy.
lamar.edu
Mayo Clinic. (2016). Toxic Shock Syndrom. Retrieved from http://www.mayoclinic.org/diseasesconditions/toxic-shock-syndrome/basics/definition/con-20021326
Nemorus. (2016). Toxic Shock Syndrome. Teen Health. Retrieved from
http://kidshealth.org/en/teens/tss.html#
Venkataraman, R., & Sharma, S., (2015) Toxic Shock Syndrome. Medscape. Retrieved from
http://emedicine.medscape.com/article/169177-overview#a6
Winters, L., (2013). Female Health Topics. Sutter Health: Palo Alto Medical Foundation.
Retrieved from http://www.pamf.org/teen/health/femalehealth/periods/tampons.html
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U.S. Food and Drug Administration (FDA) recommends the following to lower your risk of
TSS:
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Use the tampon with the lowest absorbency you need, e.g. don't use a bigger or more
absorbent tampon for a small blood flow.
Change your tampon at least every four to eight hours.
Avoid using tampons overnight when sleeping.
Follow the manufacturer's instructions.
Store tampons in a clean, dry place.
Wash hands with soap and water before and after inserting or removing a tampon.
Try a less absorbent variety if a tampon is irritating or difficult to remove.
Stay informed of TSS by reading the package information included in the tampon box
and asking about TSS when you have a medical checkup.
Stay aware of TSS symptoms because early diagnosis and speedy treatment are
crucial in avoiding the most serious effects of TSS.
Brown, N., (2013). Female Health Topics. Sutter Health: Palo Alto Medical Foundation.
Retrieved from http://www.pamf.org/teen/health/femalehealth/periods/tampons.html
A few specific tampon designs and high absorbency tampon materials were also found to have
some association with increased risk of TSS. These products and materials are no longer used
in tampons sold in the U.S. Tampons made with rayon do not appear to have a higher risk of
TSS than cotton tampons of similar absorbency. (Food and Drug Administration, 2015, para 11)
Food and Drug Administration. (2015). Tampons and Asbestos, Dioxin, & Toxic Shock
Syndrome. U.S. Food and Drug Administration. Retrieved from
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm070003.h
tm
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