Mrs.

Santhya Sam
Asepsis
.absence of germs or micro organisms
Medical asepsis.
technique or procedure which reduces the number of
micro organisms and thus prevents the spread of disease
Surgical asepsis.
Protection against infection before, during and after a
surgical procedure.
Infection
Invasion of the body by pathogens
Medical asepsis:
A state of cleanliness that decreases the potential for
the spread of infections
Promoted through:
Maintaining a clean environment
Maintaining clean hands
Following Centers for Disease Control (CDC) guidelines
Medical asepsis
Practice which reduces the number, growth and spread
of micro organisms
Referred to as clean technique
Handwashing 2 min-15 sec
Surgical asepsis
Total elimination of all micro organisms, spores
Sterile field (OR, L&D, etc), gown and glove
Methods:
Steam, radiation, chemicals, or gas
Chemical agents
Pesticides, food additives, medications, industrial

Physical agents
Heat, noise, radiation, and machines
Inflammation
Innate immunity and the initial response to
infection
Cytokines that induce inflammation and direct
inflammatory cells
Recognition of microbes by Toll-like receptors
(TLRs) and other innate recognition elements
Inflammation and recruitment of phagocytes
Uptake and killing of bacteria by phagocytes
Innate immunity against fungi, helminths, at
mucosal epithelium

rubor et tumor cum calore et dolore
(redness and swelling with heat and pain)
--Cornelius Celsus in De Medicina, 1st century
A.D.
later functio laesa (disturbance of function)
was added

rubor et tumor cum calore et dolore
(redness and swelling with heat and pain)
--Cornelius Celsus in De Medicina, 1st century
A.D.
later functio laesa (disturbance of function)
was added

Inflammation is an adaptive response to noxious conditions
(infection and tissue injury)--an attempt to restore
homeostasis

Inflammation can be induced by immune recognition of infection
or tissue damage (usually good)
Inflammation can be induced by immune recognition that is
hypersensitive to environmental components or autoinflammatory
or autoimmune (=disease)


Inflammation can be induced by immune recognition of infection
or tissue damage (usually good)
Inflammation can be induced by immune recognition that is
hypersensitive to environmental components or autoinflammatory
or autoimmune (=disease)
Acute inflammation: influx of white blood cells and fluid from
blood to fight infection and aid tissue repair
Chronic inflammation: inducer of inflammation is not removed
Leads to tissue damage and loss of tissue function (joint
destruction, lung fibrosis, etc.)
Current view: aggressively fight inflammation in certain chronic
diseases to decrease/delay progressive loss of function



Inflammation can be induced by immune recognition of infection or tissue
damage (usually good)
Inflammation can be induced by immune recognition that is hypersensitive
to environmental components or autoinflammatory or autoimmune
(=disease)
Acute inflammation: influx of white blood cells and fluid from blood to
fight infection and aid tissue repair
Chronic inflammation: inducer of inflammation is not removed
Leads to tissue damage and loss of tissue function (joint destruction,
lung fibrosis, etc.)
Current view: aggressively fight inflammation in certain chronic
diseases to decrease/delay progressive loss of function
Current research suggests that inflammation may play an important role
in common chronic diseases including atherosclerosis, type 2 diabetes,
neurodegeneration, and cancer


A. Definitions
B. The Normal Flora of Humans
C. Generalized Stages of Infection
D. Virulence Factors and Toxins

Disease and Infectious Disease
Disease
Any deviation from a condition of good
health and well-being
Infectious Disease
A disease condition caused by the presence
or growth of infectious microorganisms or
parasites

Pathogenicity and Virulence
Pathogenicity
The ability of a microbe to cause disease
This term is often used to describe or
compare species
Virulence
The degree of pathogenicity in a
microorganism
This term is often used to describe or
compare strains within a species
Acute infection vs. chronic infection
Acute Infection
An infection characterized by sudden
onset, rapid progression, and often with
severe symptoms
Chronic Infection
An infection characterized by delayed
onset and slow progression

Primary infection vs. secondary infection
Primary Infection
An infection that develops in an otherwise
healthy individual
Secondary Infection
An infection that develops in an individual
who is already infected with a different
pathogen

Localized infection vs. systemic infection
Localized Infection
An infection that is restricted to a specific
location or region within the body of the
host
Systemic Infection
An infection that has spread to several
regions or areas in the body of the host

Clinical infection vs. subclinical infection
Clinical Infection
An infection with obvious observable or
detectable symptoms
Subclinical Infection
An infection with few or no obvious
symptoms

Opportunistic infection
An infection caused by microorganisms that are
commonly found in the hosts environment This
term is often used to refer to infections caused by
organisms in the normal flora
The suffix -emia
A suffix meaning presence of an infectious agent
Bacteremia = Presence of infectious bacteria
Viremia = Presence of infectious virus
Fungemia = Presence of infectious fungus
Septicemia = Presence of an infectious agent in
the bloodstream
The suffix -itis
A suffix meaning inflammation of
Examples:
Pharyngitis = Inflammation of the pharynx
Endocarditis = Inflammation of the heart
chambers
Gastroenteritis = Inflammation of the
gastointestinal tract


Epidemiology
The study of the transmission of disease
Communicable Disease
A disease that can be transmitted from one individual to
another
Contagious Disease
A communicable disease that is easily spread from one
individual to another
Noncommunicable Disease
A disease that is not transmitted from one individual to
another
Endemic Disease
A disease condition that is normally found in a certain
percentage of a population
Epidemic Disease
A disease condition present in a greater than usual
percentage of a specific population
Pandemic Disease
An epidemic affecting a large geographical area; often
on a global scale



Reservoir of Infection
The source of an infectious agent
Carrier
An individual who carries an infectious agent without
manifesting symptoms, yet who can transmit the agent
to another individual
Fomites
Any inanimate object capable of being an intermediate
in the indirect transmission of an infectious agent
Animal Vectors
An animal (nonhuman) that can transmit an infectious
agent to humans
Two types: mechanical and biological
Biological animal vectors: The infectious agent must
incubate in the animal host as part of the agents
developmental cycle; eg, the transmission of malaria by
infected mosquitoes
Mechanical animal vectors: The infectious agent is
physically transmitted by the animal vector, but the agent
does not incubate or grow in the animal; eg, the
transmission of bacteria sticking to the feet of flies


Direct Mechanisms of Disease Transmission
Directly From Person to Person
Examples:
Direct Skin Contact
Airborne (Aerosols)


Indirect Mechanisms of Disease Transmission
Examples:
Food & Waterborne Transmission
Fomites
Animal Vectors



Causative Agent
Susceptible Host
Portal of Entry
Mode of
Transmission
Portal of Exit
Reservoir
Bacteria
Viruses
Fungi
Protozoa
Helminthes

People
Equipment
Water
Secretions
Excretions
Droplets
Skin
Direct-Indirect Contact/Fomite
Injection/Ingestion
Airborne/Aerosols
Broken Skin/Mucous Membrane
Gastrointestinal/Respiratory/
Urinary Tract
Neonates
Diabetics
Immunosuppressed
Cardiopulmonary Disease
Chain of
Infection
Microorganisms
Bacteria
Fungi
Viruses
Protozoa


Moisture
Organic matter
Warmth
Darkness
Oxygen
Alkaline ph
Infectious agents
Pathogens
Normal flora that become pathogenic

Reservoir
Where pathogens live and multiply
May be living
Humans, animals, insects
May be nonliving
Food, floors, equipment, contaminated water
Portal of Exit:
Via
Bodily fluids
Coughing, sneezing,
diarrhea
Seeping wounds
Tubes, IV lines
Mode of Transmission:
Contact
Direct touching, kissing,
sexual contact
Indirect contact with a
fomite
Droplet: Cough, sneeze
Airborne: Via air
conditioning, sweeping
Portal of Entry:
Eye, nares, mouth, vagina,
cuts, scrapes
Wounds, surgical sites, IV
or drainage tube sites
Bite from a vector

Susceptible Host:
Person with inadequate
defense
Three determining factors:
Virulence
Number of organisms
Hosts defenses
Incubation: From time of infection until manifestation
of symptoms; can infect others
Prodromal: Appearance of vague symptoms; not all
diseases have this stage
Illness: Signs and symptoms present
Decline: Number of pathogens decline
Convalescence: Tissue repair, return to health
Vascular
Aterioles dilate, blood and WBC go to area
s/s= redness and warmth
Inflammation
Tissue dies causing release of chemicals (histamine and
prostaglandins) which allow blood vessel permeability.
Cells, proteins, fluids enter the tissue spaces blocking
lymphatics to create a wall against infection
Phagocytosis
WBC enter the tissues causing release of pyrogens
(fever); exudates form discharge; healing occurs

An infection acquired in a health-care facility
Leading cause of death
Preventable with use of aseptic principles/ techniques
Exogenous Nosocomial Infection: Pathogen acquired from
health-care environment
Endogenous Nosocomial Infection: Normal flora multiply
and cause infection as a result of treatment
Iatrogenic
Infection from a procedure
ex: UTI from foley insertion
exogenous
Infection from non-normal flora
ex: clostridium
Endogenous
Infection when normal flora altered
ex: yeast infection



UTI
Insertion, contamination of drainage system, improper
cleansing
Surgical site
Improper technique for handwashing or dressing change
URI
Improper handwashing or suctioning technique
IV
Improper handwashing or site care
Extended LOS in hospital

Multiple care givers

Antibiotic choices and over use

Improper medical or surgical asepsis
Age
Very young and very old
Poor nutritional status
Smoker ,use
Existing co-morbid conditions
Chronic illnesses, chemo, radiation
Clients with invasive procedures
Clients with prolonged stress
Containing nosocomial infections
CLEAN, DISINFECT, STERILIZE
Controlling/eliminating reservoirs
Bathing, dressing changes, patent drainage systems
Controlling the portal of exit
Cover mouth/nose, wear mask, client teaching
Controlling transmission
Do not share equipment, proper handling of linens,
HANDWASHING
Controlling portal of entry
Maintain skin integrity, position changes, proper wiping
techniques, maintain drainage integrity
Protecting susceptible host
Protect natural defenses-skin, mucous membranes,
fluid intake
Encourage cough and deep breathing
Change position
Oral hygiene
Promote rest and sleep
Reduce client stress
Primary Defenses:
Anatomical features, limit pathogen entry
Intact skin
Mucous membranes
Tears
Normal flora in GI tract
Normal flora in urinary tract
Secondary Defenses:
Biochemical processes activated by chemicals released
by pathogens
Phagocytosis
Complement cascade
Inflammation
Fever
Tertiary Defenses:
Humoral immunity
B-cell production of antibodies in response to an antigen
Cell-mediated immunity
Direct destruction of infected cells by T cells
Developmental stage
Breaks in the skin
Illness/injury, chronic disease
Smoking, substance abuse
Multiple sex partners
Medications that inhibit/decrease immune response
Nursing/medical procedures


Adequate nutrition
To manufacture cells of the immune system
Balanced hygiene
Sufficient to decrease skin bacterial count
Not overzealous; causes skin cracking
Rest/exercise
Reducing stress
Immunization
Benefits of the normal flora
Nutrient production/processing
eg Vitamin K production by E. coli
Competition with pathogenic microbes
Normal development of the immune system
Normal flora and opportunistic infections
Types of Symbiosis (cont.)
Parasitism
A symbiotic relationship in which one
species benefits, and the other species is
harmed
Generally, the species that benefits (the
parasite) is much smaller than the species
that is harmed (the host)


Normal flora is present in
skin
upper respiratory tract
oral cavity
intestine, especially large intestine
vaginal tract
Very little normal flora in eyes & stomach
Notably absent in most all internal organs
Absent in:
lower respiratory tract
muscle tissue
blood & tissue fluid
cerebrospinal fluid
peritoneum
pericardium
meninges
1. Entry of Pathogen
Portal of Entry
2. Colonization
Usually at the site of entry
3. Incubation Period
Asymptomatic period
Between the initial contact with the microbe and
the appearance of the first symptoms
4. Prodromal Symptoms
Initial Symptoms
5. Invasive period
Increasing Severity of Symptoms
Fever
Inflammation and Swelling
Tissue Damage
Infection May Spread to Other Sites
Acme (Fastigium)

6. Decline of Infection

5. Convalescence
State of the Host Immune System

Number of Pathogenic Cells
encountered by the Host
Infectious Dose

Enzymatic Virulence Factors
Examples:
Coagluase (Staphylococcus aureus)
Streptokinase (Streptococcus pyogenes)
Hyaluronidase (Many pathogens)
Collagenase (Many pathogens)
Leucocidin (Many pathogens)
Hemolysin (Many pathogens)
Adhesion Factors
Examples:
Protein A (Staphylococcus aureus)
Protein M (Streptococcus pyogenes)
Exotoxins
A type of bacterial toxin with the following
properties:
May be produced by either gram-positive or gram-
negative bacteria
Is secreted by the bacteria
The action of the exotoxin does not necessarily require
the presence of the bacteria in the host
Most exotoxins are peptide or protein
Most exotoxins are heat sensitive (exception: enterotoxin
of Staphylococcus aureus)
Exotoxins (cont.)
Classes of exotoxins: Neurotoxic, cytotoxic, or
enterotoxic exotoxins
Neurotoxins: Interfere with proper synaptic
transmissions in neurons
Cytotoxins: Inhibit specific cellular activities, such as
protein synthesis
Enterotoxins: Interfere with water reabsorption in the
large intestine; irritate the lining of the gastrointestinal
tract

Endotoxins
A type of bacterial toxin having the following
properties:
Produced only by gram-negative bacteria
Endotoxins are a component of the gram-negative cell
wall
The action of endotoxin requires the presence of the
bacteria in the host. The endotoxin may be released from
the cell wall as the cells die and disintegrate
Endotoxins (cont.)
Endotoxin is composed of Lipid A: Part of the
lipopolysaccharide layer
Mode of action: Irritation/inflammation of epithelium,
GI irritation, capillary/blood vessel inflammation,
hemorrhaging