Final Review RRC Polytech Accessible PowerPoint 2025 PDF

Recording alert This session is being recorded and will be available for future RRC Polytech members to follow along with. 2 Land Acknowledgement 3 Microbiology and Infection Control Final Review Learning Outcomes By the end of this course of s...

Recording alert This session is being recorded and will be available for future RRC Polytech members to follow along with. 2 Land Acknowledgement 3 Microbiology and Infection Control Final Review Learning Outcomes By the end of this course of study, you should be able to.... 1. Identify important events in the History of Microbiology. 2. Define microorganisms and list three classifications. 3. Differentiate between normal flora and pathogens. 4. Identify the ideal environment for the growth of microorganisms. 5. Identify the body’s natural defense mechanisms. 6. Describe the chain of infection. 7. Identify portals of entry to the human body. 8. Identify portals of exit from the human body. 9. Describe modes of transmission. 10. Identify factors that increase an individuals’ susceptibility to infection. 11. List the signs and symptoms of infection. 12.Define Health Care Associated Infection (HAI). 13. Differentiate between clean, dirty, and sterile objects. 14. Define medical asepsis. 15. Describe the major Infection Control Strategies. Module 1 Introduction and History of Microbiology Module 1: Objectives 1. Define Microbiology 2. List the techniques used to isolate and culture microorganisms 3. Identify and define different types of microbiological specialties. 4. Identify areas of interest for microbiological fields/work 5. Name and provide the contributions of major historical figures in microbiology. Identify the historical and modern- day impacts. What is Microbiology? Microbiology is the study of microorganisms usually less than 1mm in diameter which requires some form of magnification ( Microscope) to be seen clearly – Examples: Viruses Bacteria Fungi Algae Protozoa What is Microbiology? Microbiology Specialties Microbiology may be interested in specific types of organisms: Virology - viruses Bacteriology - bacteria Phycology - algae Mycology - fungi Protozoology - protozoa What is Microbiology? Microbiology Fields/Work Microbiological work may have a more applied focus: Medical microbiology, including immunology Food and Dairy microbiology Public Health microbiology (Epidemiology) Industrial microbiology  Historical Timeline 1665-1995: Study Example 1839/1855- 1851- 1665- 1700-Spallanzani: Pasteur: 1876-Koch: Schleiden/ Hooke: microbes in air and killed Germ theory Specific organism Schwann/Virchow: Cells by boiling of infections responsible for Cell Theory infection 1667- 1867- 1796- 1850- Van leeunenhoek: Lister: Jenner: Semmelweis: “Animalcules” Carbolic acid to prevent 1ST Vaccine Chlorine wound infection hand wash Student fill in the information 1877 1884 1928 1983 1882 1892 1977 1995 Module 2 Cell Structure of Microorganisms Taxonomy/Morphology Types of Microorganisms Module 2 Objectives Define cell theory 5 characteristics of all cells Identify the basic components of cell structure- cell membrane, cytoplasm, nucleus/nucleoid, organelles, cell wall, spore coat Identify the difference between eukaryotic and prokaryotic cells Define protein and its impact on MDR Characteristics of proteins 15 Module 2 Objectives Define taxonomy and the nomenclature method for bacteria- genus and species Define morphology and the implications of macroscopic and microscopic morphology Define anaerobic, aerobic and facultative anaerobe Describe bacteria shapes and give an example of each. Structural differences between gram+ and gram- bacteria and human impact Understand the significance and procedure for the Gram stain 16 Module 2 Objectives Define bacteria, virus, fungi (molds/yeasts) and prions Provide an example of a fungal infection (Blastomycosis), yeast infection (thrush), mold infection (potato famine) Compare and contrast bacteria and viruses Describe the structure of a virus Describe enveloped and non-enveloped viruses- characteristics and diseases Describe prions, prion associated disease and the impact of prions on Patients/MDR 17 Cell Theory All organisms are formed of one or more cells and all cells are derived from pre-existing cells Cells are the basic units of life and common to all living things Millions of types- some are organisms on their own, while others are part of larger organisms 5 Characteristics of All Cells Self Feeding/Nutrition Self Replication/Growth Differentiation of forming new cell structures Chemical Signalling/Communication Evolution/Changes to show new biological properties Types of Cell Prokaryotic Cell Eukaryotic Cell NO Nucleus or other Has a nucleus as well membrane bound as several complex organelles membrane bound usually unicellular structures (eg, mitochondria)  Differences Between Prokaryotic and Eukaryotic Cells Prokaryotes Eukaryotes Genetic Information DNA is circular, usually free DNA is linear and found in floating in cytoplasm nucleus Organelles NO NUCLEUS or membrane Has nucleus and membrane bound organelles bound organelles Size Small (1-5 micrometers) Larger (10-100 micrometers) Organisms Bacteria/archaea Animals, Plants, Fungi Cell structure ALWAYS unicellular Can be unicellular or multicellular Cell Structure Cell Membrane -The “skin” of the cell -Protection -Regulates movement of water, nutrients and waste into and out of the cell Cytoplasm -Largest part of the cell -Made up of water and proteins. Gel-like consistency. -The nucleus controls the functions of the cell, but all activities for cell function, growth and replication occur in the cytoplasm Nucleus/Nucleoid -The “Brain” of the cell -Contains the genetic information that coordinates how that cell will behave and appear Cell Structure Organelles -Includes the Nucleus and several other structures that have specific roles in the function of the cell -“Little organs” Cell Wall - Most but not all bacteria have a cell wall -**In Plants** -More rigid than cell membrane and helps cells hold their shape. -Does not replace the cell membrane. -Spore Coat -A protective layer formed by many types of micro-organisms - Allows bacteria to go into a resting state and be protected from unfavourable conditions Proteins Proteins are a major component of cytoplasm Cells containing cytoplasm (Protein) make up the human body and waste Tissue(Blood) and body waste are the most common types of soil on items sent to the MDRD Characteristics of Protein  Not soluble in water  May be coagulated by heat, drying, or specific chemicals  Coagulated protein can trap and protect pathogens  Must be removed prior to disinfection or sterilization  Blood: Source of Protein on Instruments By ICSident at German Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=29492562 By A7N8X - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=79564077 Taxonomy: Genus/Species Genus Species Pseudomonas aeruginosa Staphylococcus aureus Mycobacterium tuberculosis Listeria monocytogenes Macroscopic Morphology Public Domain, https://commons.wikimedia.org/w/index.php?curid=1206845 Microscopic Morphology 1.Oxygen Requirement -Aerobes: Require Oxygen -Anaerobes: Don’t Require Oxygen -Facultative Anaerobes: Prefer Oxygen but can live without it 2.Gram Stain 3.Shape and Groupings Microscopic Morphology Cell Wall Thick Thin Cell Wall By Graevemoore at English Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8477969 Gram Stain: Method https://bio.libretexts.org/@api/deki/files/4903/gramstain1.png?revision=1 Microscopic Morphology By Mariana Ruiz LadyofHats - the image i did myself using adobe ilustrator, using the information found on, , ,, ,, and the book "medizinische mikrobiologie" from ernst wiesmann ED. Thieme (1986), Public Domain, https://commons.wikimedia.org/w/index.php?curid=738916 Classification of Microorganisms Bacteria to Prions https://openclipart.org/image/800px/284321 Bacteria  Unicellular organisms  Exist in every habitat on the planet  There are more bacteria cells than human cells in the body  Less than 1% of bacteria are harmful (Pathogenic) Viruses  Smaller than bacteria and cannot grow or replicate apart from a living cell  They must invade a cell and “hijack” the cell’s nucleus/brain  The cell starts to make viral particles, which are then released to spread the infection Fungi Can range in size from single cell to the largest living organism.....3.5 mile wide mushroom! Molds  Microscopic plant organisms  Body is made up of long filaments called hyphae that form a mass called a mycelium  Reproduce by producing spores that are like seeds  Molds can cause disease and create severe allergic reactions Yeasts  Unicellular fungi  Very important in food industry: Bread Prions Are not true cells: Infectious proteinaceous particles Misfolded protein particles that replicate by converting there properly folded counterparts Discovered because of work to find the causes of disease where no virus could be found Viruses: Types Lipophilic -Have an envelope -Are more easily killed by hospital disinfectants -Can be very pathogenic: Hepatitis B, Mumps, Measles, Herpes Hydrophilic -No envelope -Examples: Hepatitis A, Polio, Gastroenteritis virus Bacteria: Interventions  May be susceptible to antibiotics  Immunization is also utilized  Disinfectants may be effective  Sterilization is required to eliminate spore coat forming bacteria Viruses: Interventions  Viruses are not susceptible to antibiotics  Immunization is the best and most effective method of prevention  Disinfectants can reduce the amount and type of viruses Fungi: Interventions  Fungal infections are becoming more common and are predicted to be a major pathogen in the future.  Treatment by topical, oral or IV antifungals Prions: Interventions  Can remain infectious for years  No known cures for disease caused by prions  CANNOT be destroyed by standard sterilization methods, radiation, boiling or alcohol Module 3 Normal and Pathogenic Organisms Symbiotic Relationships Pathogenesis- the Origin of Disease Module 3: Objectives Define human microbiome Define normal flora Describe the advantages/benefits of normal flora Define resident and transient flora List sterile body tissues List locations where normal flora are found  Module 3: Objectives List the factors influencing resident flora List the disadvantages of normal flora Define and give examples of symbiotic relationships: mutualistic, commensalistic, opportunistic/parasitic Define pathogenesis Define contamination vs infection List the main portals of entry Define infection vs disease Module 3: Objectives Define asymptomatic/subclinical infections Define etiology Define pathogenesis vs pathogenicity List and define the factors affecting pathogenicity- virulence, virulence factors Describe the mechanism of pathogenicity: adhesion, biofilm, after infection and spread (extra cellular, intracellular, systemic, tissue injury) List and define 3 causes of tissue injury: exotoxin, endotoxin, specific immunity Human Microbiome: Definition The human microbiome is the aggregate (collection) of microorganisms that reside on the: - surface and in deep layers of skin - the saliva and oral mucosa - conjunctiva -gastrointestinal tract. Normal Flora: Definition Definition: Normal flora is the mixture of microorganisms (bacteria and fungi) that are regularly found at any anatomical site of the human body https://openclipart.org/image/800px/284321 Normal Flora: Advantages Advantages: Provide some nutrients (vit K) Stimulate immune system Prevent colonization by potential pathogens Inhibit some pathogens https://openclipart.org/image/800px/172910 49 Normal Microbial Flora: Types 1. Resident Flora Microbes that are always present 2. Transient Flora Microbes that live in or on your body for a period of time (hours, days, weeks, months) then move on or die off 50 Normal Flora Expected/Normal Not Expected/Abnormal Skin Blood Eyes (ex. conjunctiva) Brain Nose (ex. mucous membrane) Muscle Mouth (ex. saliva) Cerebrospinal fluid (CSF) Ears These are sterile tissues which Urogenital tract/Digestive Tract should be free of microorganisms. 51 Importance of Normal Flora Flora (Advantages) 1. They constitute a protective host defense mechanism by occupying ecological niches. 2. They produce vitamin B and vitamin K in intestine. 3. The normal flora contribute to immunity by inducing low levels of circulating and secretory antibodies that may cross react with pathogens. 4. The normal bacteria flora exert microbial antagonism against nonindigenous species by production of inhibitory fatty acids, peroxides, bacteriocins, etc. 5. The normal flora may antagonize other bacteria through the production of substances which inhibit or kill nonindigenous Importance of The Normal Flora (Disadvantages) 1.They can cause disease in the following: a)When individuals become immunocompromised. b)When they change their usual anatomic location. https://openclipart.org/image/800px/272617 Normal Flora: Influencing Factors Age of person Changes continuously through life Nutrition of person Environment of person Sex of person https://openclipart.org/image/800px/304147 54  The Three Types of Symbiotic Relationships Organism 1 Organism 2 Example Mutualism Benefits Benefits Bacteria in human colon Commensalism Benefits Neither benefits Staphylococcus nor is harmed on skin Parasitism Benefits Is harmed Tuberculosis bacteria in the lung Table Module 3 Normal and Pathogenic Organisms, Relationships Pathogenesis Pathogenesis Definition: The origin and development of disease Contamination Infection Disease Contamination vs Infection Contamination Infection Mere presence of microbes in or Results when the organism has on the body evaded the body’s external defenses, multiplied, and become established in the body 58 Infection vs Disease Infection Disease Invasion and establishment of a Results only if the invading pathogen in a host organism pathogen alters the normal functions of the body Disease is also referred to as morbidity 59 Portals of Entry The body has structures which form a barrier but also those more vulnerable to microbial entry 4 Main Portals: Skin Mucous membranes Placenta Parenteral route 60 Manifestations of Disease Symptoms: subjective characteristics of disease felt only by the patient Signs: objective manifestations of disease that can be observed or measured by others Syndrome: group of symptoms and signs that characterize a disease or abnormal condition 61 Asymptomatic Infection Asymptomatic, or subclinical, infections lack symptoms but may still have signs of infection 62 Etiology: Definition Study of the cause of disease Germ theory of disease – disease caused by infections of pathogenic microorganisms Robert Koch developed a set of postulates one must satisfy to prove a particular pathogen causes a particular disease 63 Pathogenesis vs Pathogenicity Pathogenesis Pathogenicity Origin and development The ability of an organism of disease to cause disease 64 Definitions Pathogenesis Origin and development of disease Virulence Capability of a microorganism to cause disease Virulence Factors Molecules expressed and secreted by pathogens that help in pathogenesis Pathogenicity: Mechanism 1. Adhesion: How the bacteria attach to the tissues Requirements:  Bacterial Adhesins  Host Cell Receptors 2. Biofilm: Formation of a collective of one or more types of microorganisms Requirements:  Formation of polysaccharide web (slime)  Biosensing 66 After Infection- Penetration and Spread 1. Extra Cellular Pathogens Stay on surface of cell. Excrete toxins and cause damage 2. Intra cellular pathogens Pathogens inside cells causing local infection Remains in the epithelial tissue but does not enter bloodstream 3. Systemic Spread Organism enters bloodstream and spreads through body. Bacteria inhibit the body’s ability to remove/kill them. Ex. Inhibiting phagocytosis After Infection- Penetration and Spread Tissue Injury 1. Exotoxin- secreted by bacteria 2. Endotoxin- when bacterial cells lyse 3. Specific Immune System Exotoxins Exotoxin Proteins Secreted by bacteria Can destroy cell membrane Ex. Diptheria Toxin, Cholera Toxin,Tetanus Toxin How to suppress the action of Exotoxins? Antibodies Vaccination Endotoxins Endotoxin Can lead to endotoxic shock-------------SEPSIS Hypotension Fever Intravascular coagulation Organ Failure and Death Specific Immunity Specific Immunity Continuous secretion of antigens stimulates immune system Ex. Rheumatic Fever Muscle damage caused by hypersensitivity reaction Module 4 The Chain of Infection Introduction to Epidemiology Module 4: Objectives Identify and define each link on the Chain of Infection Define epidemiology Describe the role of Public Health: assessment, cause, interventions, reassess Define and describe: distribution(person, place, time), determinants (risk factors) Define inclusion/exclusion criteria Module 4: Objectives Define and describe disease frequency- counts, incidence, prevalence Define epidemic and explain that word’s relationship to epidemiology Describe the purpose of surveillance: early warning, intervention impact, epidemiology Define active vs passive surveillance Define and describe notifiable conditions and methods for same Define Pandemic Chain of Infection Chain of Infection Causative agent:  an infectious dose of a bacteria, virus, fungi Reservoir:  a place where the agent can survive (and thrive)  May be human, animal or environment/ equipment Portal of exit:  A source from which the pathogen can emerge  eg,blood, respiratory tract  Supplies/equipment become contaminated if touch a portal of exit 76 Chain of Infection Mode of transmission:  Means by which organism is transported form portal of exit to portal of entry. Ex- direct contact Portal of Entry to host:  eg, airway or surgical wound  For a specific disease there is usually a specific portal of entry ex. TB is Respiratory tract and HEP B is via blood Susceptible host: aging chronic disease prematurity surgery 77 Introduction to Epidemiology Learning Objectives Define epidemiology Provide examples illustrating each of the 5 parts of the epidemiology definition Describe the way in which epidemiology fits into the overall public health workforce Measures of Disease Frequency: counts, prevalence, incidence Learning Objectives Define epidemic and explain that word’s relationship to epidemiology Define surveillance and explain how surveillance relates to epidemiology overall Define pandemic and explain that word’s relationship to epidemiology Epidemiology and Public Health Introduction to Epidemiology Epidemiology and Public Health Public health deals with the well-being of communities, with a focus on disease prevention. Public health professionals first assess the health status of the population, determine the causes of any health problems, design interventions in an attempt to address those problems, and then reassess the population’s health to evaluate whether the intervention worked. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Epidemiology and Public Health https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Definition of Epidemiology Epidemiology is the study of the distribution and determinants of disease or other health- related outcomes in human populations, and the application of that study to controlling health problems. ii, iii, iv https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Distribution Introduction to Epidemiology Distribution … describing the pattern of an illness in terms of person, place, and time. … first step in any public health initiative. Disease is not randomly distributed https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Distribution Who? Person Where? Place When? Time Controlling Health Problems Introduction to Epidemiology Epidemiology- Controlling Health Problems Epidemiology is the fundamental science of public health, and public health is concerned with preventing disease and improving general wellness in the public. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Determinants Introduction to Epidemiology Epidemiology- Determinants A cause (determinant) is anything that changes the likelihood that an individual will become diseased. Sometimes a determinant increases this chance (e.g., smoking); other times, a determinant decreases this chance (e.g., exercise). Collectively, all determinants of that disease are called the etiology of a disease. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Determinants-Population A population is a group of people with a common characteristic. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Determinants- Population When the target population is too large to include everyone, a sample is selected LBS It is important that the sample be sufficiently representative of the population to ensure statistical validity LBS https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Determinants- Population Inclusion/Exclusion Criteria It usually doesn’t matter whether inclusion or exclusion criteria are used; whichever provides the greatest clarity is generally the best choice. When defining a population, the list of inclusion and exclusion criteria must be sufficiently complete that any given person could look at it and decide whether they were in the population. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Inclusion vs Exclusion Criteria Inclusion criteria are characteristics that the prospective subjects must have if they are to be included in the study. Exclusion criteria are those characteristics that disqualify prospective subjects from inclusion in the study. Inclusion and exclusion criteria may include factors such as age, gender, race, ethnicity, type and stage of disease, the subject’s previous treatment history, and the presence or absence (as in the case of the “healthy” or “control” subject) of other medical, psychosocial, or emotional conditions. 95 Inclusion/Exclusion Example Breast Cancer Study Inclusion criteria; Post menopausal 45-75 Stage 2 diagnosis Exclusion Criteria Abnormal renal function Recent use ( within 1 year) hormone replacement therapy 96 Summary: Determinants A cause (determinant) is anything that changes the likelihood that an individual will become diseased. Collectively, all determinants of that disease are called the etiology of a disease. A population is a group of people with a common characteristic. Target vs Sample Population- Defined inclusion/exclusion criteria sample size must be large enough to be a valid Disease Frequency- Counts, Incidence, Prevalence Introduction to Epidemiology Disease Frequency- Counts(Frequency) A count is just a number—there are no fractions, numerators, or denominators, and the units are always “people.” https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Disease Frequency- Incidence and Prevalence Prevalence:  measure of existing disease  Used for resource allocation Incidence:  measure of new disease  Used to study causes of disease https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Disease Frequency- Prevalence Prevalence is a proportion, meaning that everyone who appears in the numerator must also appear in the denominator. This also means that prevalence ranges from zero (no one has the disease) to one (everyone has the disease), and it is usually expressed as a percent. Prevalence gives us a snapshot of the population-level disease burden at a given time https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Disease Frequency- Prevalence/Incidence Prevalence Equation: # cases present in the specified population at a specified time # people in the population at that time Incidence Equation: # of new cases https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 time period Summary:Disease Frequency Count is just a number—there are no fractions, numerators, or denominators, and the units are always “people.” Prevalence- existing disease, needed for resource allocation Incidence- new disease, used to study causes Prevalence is a proportion Prevalence gives us a snapshot The numerator for incidence is always the number of new cases of a disease observed over some time period. The incidence proportion is interpreted as the average risk (chance) of developing the disease over some time period. Epidemiology- Epidemic The root word for epidemiology is epidemic. An epidemic is “an increase, often sudden, in the number of cases of disease above what is normally expected in that population in that area.” i https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021  Epidemiology- Surveillance Such surveillance can (1) serve as an early warning system for impending public health emergencies (2) document the impact of an intervention, or track progress towards specified goals (3) monitor and clarify the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategies. ii https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Epidemiology-Surveillance: passive Think of this as waiting for disease reports to come to you. Epidemiology- Surveillance: active In active surveillance, on the other hand, epidemiologists actively seek out cases of disease. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Epidemiology- Surveillance: active vs passive Active Surveillance Passive Surveillance Benefit Benefit The benefit of active surveillance is that it Not as resource intensive. generally results in more complete data Disadvantage Disadvantage The downside to active surveillance is that it is more resource-intensive, with increased Passive surveillance relies on others personnel and financial requirements. iv (who have numerous duties other than disease reporting) to report cases. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Epidemiology-Surveillance Notifiable Conditions There is a list of conditions—mostly infectious diseases, but a few chronic diseases and injuries also make the list—that must be reported to the Centers for Disease Control and Prevention (CDC)* whenever they are encountered by clinicians or health department officials. *[designated public health agency] Example: Measles Example: Cancer Registries Cancer registries are somewhat unique compared to other notifiable conditions data because patients are followed over time. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Surveillance: Vital Statistics/Surveys Vital Statistics Birth and death certificates—together called vital statistics —constitute another ongoing surveillance system. Surveys Usually questionnaires: -paper based, telephone, online https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Summary:Surveillance An epidemic is “an increase, often sudden, in the number of cases of disease above what is normally expected in that population in that area.” How do we know how much is “expected”?Surveillance! Passive vs active surveillance Notifiable conditions, vital statistics, surveys Epidemiology-Pandemic A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people” Last JM, editor. A dictionary of epidemiology, 4th edition. New York: Oxford University Press; 2001. https://open.oregonstate.education/epidemiology/chapter/what-is-epidemiology/, retrieved 07 jan 2021 Module5 Pathology- the Disease Process Signs and Symptoms of Disease Stages of Illness The Immune Response Health Care Associated/Acquired Infection (HAI) Module 5: Objectives 1. Define and provide examples of the classification of signs- prognostic, anamnestic, diagnostic, pathognomonic 2. Describe and give examples of the classification of symptoms- remitting, chronic, relapsing 3. Describe the stages of illness- incubation, prodromal, period of illness (acme point), period of decline, period of convalescence 4. Describe physical and chemical immune barriers- skin, tears/mucous, pH/blood proteins/flushing 5. Explain immediate and induced innate immune responses- inflammation, pathogen engulfment, secretion of immune factors and proteins 6. Describe innate immunity 7. Describe pathogen recognition- PAMP’s/PRRs, macrophages, cytokines/cytokine storm 8. Describe phagocytosis and inflammation 9. Define and describe natural killer cells 10. Define and describe the complement system Signs and Symptoms-Review Signs/Objective Observations - Use of the Senses - Measurable Symptom/Subjective Perceptions - Experience of the patient, descriptive - Not measurable Signs- Examples Fever Rash High Blood Pressure/Low Blood Pressure Vomiting Diarrhea Hemoptysis Hematuria Signs- Classifications Prognostic Signs that point to the future. Predict the outcome for the patient Anamnestic Signs that point to parts of a person’s medical history. Eg, Skin scars may be evidence of severe acne in the past. Diagnostic Assist the HCP recognize and identify a current health problem. Eg,high levels of prostate-specific antigen (PSA) in the blood of a male may be a sign of prostate cancer or a prostate problem. Pathognomonic Can link a sign to a condition with full certainty. Eg, presence of a certain microbe in a blood sample can point to a specific bacterial infection. https://www.medicalnewstoday.com/articles/161858 , retrieved 07 Jan 2021 Symptoms- Classifications Remitting Completely resolve Eg, common cold Chronic Long lasting or recurrent Eg, asthma Relapsing Previously resolved and then return Eg, depression Symptoms Feeling hot/cold Pain Fatigue Muscle aches Nausea Signs and Symptoms The foundation of pathology “The Study of Disease”  Stages of Illness Pathology-the Disease Process The Stages of the Disease Process Incubation Period Prodromal period Period of illness—acme point Period of decline Period of convalescence Stages Incubation Microbes infect the body and multiply Individual does not feel sick Microbes may be easily spread Length of incubation period is dependent on the microbe and the individual’s immune system Prodromal Short stage where the individual starts to feel sick The brain knows something is wrong, but not sure of exactly what Stages Period of Illness Individual feels the typical signs and symptoms of a disease The stage where it is most possible to transmit a communicable disease The acme point is the peak of an illness’ intensity where the microbes can be most easily spread Period of Decline Immune system begins to bring microbial replication under control, which leads to the lessening of clinical signs and symptoms associated with the disease. Period of Convalescence Final stage of the disease process Microbial replication is fully stopped and the individual returns to the pre-illness state. Recovery Still possible to transmit disease BUT-In some cases, depending on the disease, the individual may not proceed to the period of convalescence and may die from their disease or be disabled. The Immune Response “Fighting Back” “Fighting Back” Physical and Chemical Barriers Skin Tears/Mucous Secretions pH/blood proteins/flushing Innate Immunity Pathogen Recognition/Responses 125  Conditions that may Overcome Physical/Chemical Barriers skin abrasions or punctures large numbers that overcome the mucus or cilia. evolution of specific mechanisms 126 Innate Immunity When pathogens do enter the body, the innate immune system responds with:  inflammation  pathogen engulfment  secretion of immune factors and proteins https://www.oercommons.org/courseware/lesson/15154/overview, retrieved 07 Jan 2021 Innate Immunity The immune system comprises both innate and adaptive immune responses. Innate immunity occurs naturally because of genetic factors or physiology; it is not induced by infection or vaccination but works to reduce the workload for the adaptive immune response. https://www.oercommons.org/courseware/lesson/15154/overview, retrieved 07 Jan 2021  Pathogen Recognition 1.Blood/ lymph cells recognize specific pathogen-associated molecular patterns (PAMPs) on the pathogen’s surface. 2. Macrophages engulf foreign particles and pathogens 3. Macrophages recognize PAMPS via receptors called PRRS 4. The binding of PAMPS/PRRS releases cytokines https://www.oercommons.org/courseware/lesson/15154/overview, retrieved 07 Jan 2021 Cytokines Cytokines: A chemical messenger that regulates cell differentiation (form and function), proliferation (production), and gene expression to affect immune responses. symptoms of feeling sick, which include lethargy, muscle pain, and nausea. encourage the individual to rest and prevent them from spreading the infection to others. Cytokines Cytokines also increase the core body temperature, causing a fever, which causes the liver to withhold iron from the blood. Without iron, certain pathogens, such as some bacteria, are unable to replicate; this is called nutritional immunity.  Cytokine “Storm” Normally, cytokines are part of the body's immune response to infection, but their sudden release in large quantities can cause multisystem organ failure and death. https://en.wikipedia.org/wiki/Cytokine_storm ,retrieved 07 Jan 2021 Macrophages and Natural Killer Cells Summary: Phagocytosis/Inflammation In response to a cut, Secretion of histamines causes capillary dilation. Neutrophils and monocytes leave the capillaries. Monocytes mature into macrophages. These release chemicals to stimulate the inflammatory response. Phagocytosis by neutrophils and macrophages https://oercommons.s3.amazonaws.com/media/thumbnails/da/ea/daea58fa323125d4417ed0144de1b17e.jpg Natural Killer (NK) Cells NK cells are always active NK cells are constantly patrolling the body and are an effective mechanism for controlling potential infections and preventing cancer progression. Review: Innate Immune System Innate immune system serves as a first responder Utilizes: Inflammation Phagocytosis cytokine release destruction by NK cells, and/or a complement system. When innate mechanisms are insufficient to clear an infection, the adaptive immune response is informed and mobilized. Review: Innate Immune System- Functions/Characteristics Innate Immune System (Functions) Inflammation Pathogen engulfment Secretion of immune factors and proteins Innate Immune System (Characteristics) Natural Developed/evolved early Not induced by infection or vaccination Limited number of targets Review:Pathogen Recognition Viruses- intracellular Bacteria- intracellular or extracellular Must identify which cells have been infected PAMPS (molecules on surface of pathogen) PRRS (Macrophage receptors which recognize PAMPS) Review: Cytokines Cytokine Release Effect =PAMPS + PRRS Cytokines Chemical messengers: Cell differentiation (form and function) Proliferation (production) Gene expression to affect immune response Review: Cytokines Cytokines Create symptoms of feeling sick Increase core body temperature Cytokine Storm Uncontrolled and excessive release of cytokines Multiorgan failure and death Example? Review: Phagocytosis/Inflammation Phagocytosis and Inflammation Release of chemicals from WBC’s Necessary to all cells to gather at infection site Can result in a hypersensitive/allergic response Review: NK’s and Complement System Natural Killer Cells Lymphocytes which are always present, “patrolling” the body to destroy infected and tumour cells. Complement Proteins which assist to destroy extracellular pathogens Compliment the antibody response of the adaptive immune system Module 6 Clinical Applications of MDR MDR Basics:Clean, Disinfected, Sterile Medical and Surgical Asepsis Routine Practices Additional Precautions/Disease Transmission Infection Control Strategies/Breaking the Chain Illness Prevention Antibiotic Resistance HAI’s Module 6: Objectives Define and distinguish between cleaning, disinfection and sterilization. Define asepsis List 3 examples of medial asepsis: respiratory etiquette, environmental cleaning, PPE Define surgical asepsis List and describe the 4 components of surgical asepsis: equipment sterilization, sterile field, sterile workers, sterile technique Provide examples of breaches in sterile technique Define Routine Practices What is PHAC Module 6: Objectives Define and describe: PCRA, Environmental/Engineering Controls, Administrative Controls Define, describe and give examples of additional/transmission based precautions: contact, droplet, droplet/contact, airborne. List one disease associated with each and a method of prevention. Describe methods to break each link of the chain of infection. Describe how sanitation, vaccination and antibiotics have contributed to life expectancy List, define and give an example of each type of vaccine Define antibiotic resistance and the major strategies used by bacteria. Define and describe HAI’s MDR Basics Clean No visible soil Can reduce microbial load Disinfected Reduces number of microorganisms up to 99% Sterility One in a million chance of a viable organism! Asepsis Asepsis- freedom from living pathogenic organisms. Techniques involved in maintaining asepsis don't discriminate between pathogenic and non-pathogenic organisms. They kill or avoid the “good guys as well as the bad”. Basics of Medical Asepsis Medical asepsis:Any number of practices that are designed to prevent the spread of infection. This is sometimes also called the clean technique. Give one example of a clean technique practice. HAND HYGIENE! Examples of Medical Asepsis  Respiratory Etiquette/Hygiene  Environmental Cleaning  Personal Protective Equipment (PPE) Surgical Asepsis What Is Surgical Asepsis? Surgical asepsis is ensuring an environment is completely free from all microorganisms. When is it used? when a foreign object is being introduced into a patient's body, thereby opening a possible route of transmission for an infectious agent Components of Surgical Asepsis Equipment Sterilization Sterile Field Sterile Workers Sterile Technique https://upload.wikimedia.org/wikipedia/commons/2/2e/Cardiac_surgery_operating_room.jpg 152 Breaches in Sterile Technique The sterile field is exposed to air for too long The sterile field is coughed or sneezed upon, or excessive talking occurs over the sterile field A sterile object drops below the waistline of the healthcare worker An unsterile object comes into contact with any part of a sterile object A sterile object touches the edge of the surgical tray (only the tray top is considered sterile) A healthcare worker leans over the surgical field Infection Control Strategies Routine Practices and Hand Hygiene Routine Practices-History 156 Universal Precautions-Routine Practices Universal precautions (1985-88): avoid contact with patients' bodily fluids, by means PPE Associated with the advent of the HIV/AIDs epidemic 1987 saw addition of body substance precautions Standard Precautions(1996) Use of PPE recommended in all settings Routine Practices & Additional Precautions (1999) Additional Precautions Required when dealing with troublesome infectious agents such as Clostridioides difficile or methicillin- resistant staphylococcus aureus (MRSA) Indicated with signage Routine Practices  Point of Care risk assessment (PCRA)  Environmental Controls  Administrative Controls PHAC Public Health Agency of Canada (PHAC) was created in 2004 in response to growing concerns about the capacity of Canada's public health system to anticipate and respond effectively to public health threats. creation also followed recommendations from leading public health experts ― including Dr. David Naylor's report, Learning from SARS: Renewal of Public Health in Canada Additional Precautions Transmission Based Practices Additional Precautions Contact Droplet- >5 microns, within 2 metres Droplet/Contact Airborne- 5 microns, within 2 metres Droplet/Contact Airborne-