Exam Dec 7 2022

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materials contaminated with radionuclides

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radioactive waste

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discarded solid, liquid and gaseous chemicals

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Chemical waste

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alkylating agents, antimetabolites, mitotic inhibitors, contaminated materials from drug preparation and administration, such as syringes, needles, gauzes, vials, packaging, outdated drugs, excess (leftover) solutions, drugs returned from the wards.

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Cytotoxic waste

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expired, unused, spilt and contaminated pharmaceutical products, prescribed and proprietary drugs, vaccines and sera

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Pharmaceutical waste -

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tissues, organs, body parts, blood, body fluids and other waste from surgery and autopsies on patients with infectious diseases.

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pathologic waste

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waste contaminated with blood or other body fluids, cultures and stocks of infectious agents from laboratory work, waste from infected patients in isolation wards

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infectious waste

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needles, hypodermic needles, scalpels and other blades, knives, infusion sets, saws, broken glass and pipettes

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sharp wastes

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Waste that has not been in contact with infectious agents, hazardous chemicals or radioactive substances and does not pose a sharps hazard

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Non hazardous / General Waste

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Categories of Healthcare Waste

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1. Non-hazardous or general healthcare waste

2. Hazardous healthcare waste

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potentially infectious waste materials generated at health care facilities, such as hospitals, clinics, physician’s offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medicalresearch facilities and laboratories.

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Medical Waste

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Destroys all pathogenic organisms except spores ◦ Used when preparing skin for procedure or cleaning a piece of equipment that does not enter the body

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Disinfection

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Destroys all microbes including spore ◦ Done on equipment that is entering a sterile portion of the body

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Sterilization

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Urinary Tract Infections ◦ Pneumonia ◦ Blood stream infections

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Most Common Hospital Acquired Infections

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Precautions for patients who are infected or colonized by a microorganism that spreads by direct or indirect contact

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Coontact Precautions

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Precaution Used for when patient has an infection that is spread by large-particle droplets

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Droplet Precautions

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For patients who have infections that spread through the air

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Airborne Precautions

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Second tier of precaution • Precautions used in addition to standard precautions for patients will suspected infections that can be transmitted by airborne, droplet or contact routes

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Transmission- based Precautions

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Fit testing essential Protect against small droplets and other airborne particles

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Particulate respirators (N95)

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Cotton, paper Protect against body fluids and large particles

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Surgical masks

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is "specialized clothing or equipment, worn by an employee for protection against infectious materials.”

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Personal Protective Equipment

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OSHA

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Occupational Safety and Health Administration

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Effective if hands not visibly soiled More costly than soap & water

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Alcohol-based Hand Rubs

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the single most important intervention for the prevention of nosocomial infections in hospitalized patients.

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Hand disinfection

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identified that 89% of the hand surface was missed and that the areas of the hands most often missed were the fingertips, finger-webs, the palms and the thumbs.

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Taylor (1978)

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the most effective way to help prevent the spread of organisms

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Hand washing

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Hand washing • Gloves • Face masks • Protective eye wear • protective clothing • instrument sterilization and disinfection

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Preventing Nosocomial Infections

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Those designated for the care of all hospital patients regardless of their diagnosis or presumed infection

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First tier of Precaution

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1. Maintaining/restoring defenses

2. Avoiding spread of infection

3. Reduce/alleviate complications

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Health worker's goals

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Host produces antibodies in response to natural antigens or artificial antigens

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Active Immunity

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Host receives natural or artificial antibodies

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Passive Immunity

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All individuals may be susceptible depending on the exposure andtheir own general health status

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Susceptible Host

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occurs when an individual with an organism/diseasethat is transmitted by the airborne route expels the organism from their respiratory tract by coughing, laughing, singing and sneezing. Once in the air, the organism evaporates until only the core, or nucleus, is left

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Airborne Transmission

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refers to large droplets that are generated from therespiratory tract of infected individual during coughing, sneezing or laughing or during such procedures as suctioning. These droplets are heavier than air and can only travel about two metres (6 feet) before they fall to the ground. Some exa

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Droplet Transmission

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is the most common route of transmission oforganisms in health care settings. It may be direct (e.g contaminated hands) or indirect (e.g. contaminated equipment). Examples

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Contact Transmission

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1. Incubation

2. Prodromal

3. Illness

4. Convalescence

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Stages of Infection

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It describes what happens once a susceptible host has acquired a pathogen.

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Stages of Infection

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1-2 days incubation period

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Common cold

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2-21 days incubation period

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tetanus

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5-7 days incubation period

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Dengue

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5-14 days incubation period

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Covid19

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the interval between the pathogen’s invasion of the body and the appearance of symptoms of infection.

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Incubation Stage

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Pathogen continues to multiply…- This is when general, non-specific signs and symptoms of illness appear.- shorter than the incubation period- malaise, low grade fever, pain, swelling, - CONTAGIOUS!!!

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Prodromal Stage

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infection – specific signs and symptoms appear - microbial replication steadily increases- duration of illness and signs and symptoms vary widely based on the pathogen and infectious disease- HIGHLY CONTAGIOUS!!!

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Illness Stage

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period of recovery from infection- the signs and symptoms disappear, and the person returns to a healthy state - However, depending on the type of infection, there may be a temporary or permanent change in the patient’s previous health state even after the convalescent period.

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Convalescence Stage

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Body DefensesAgainst Infection

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Non specific defenses

Specific Defenses

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Physiologic Barriers

Inflammatory Response

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Non specific defenses

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Immune System

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Specific Defenses

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a local and nonspecific defensive response of the tissues to an injurious or infectious agent

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InflammatoryResponse

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1. Pain

2. Heat

3. Redness

4. Swelling

5. Loss of Function

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5 Cardinal Signs Of Inflammation

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pain

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dolor

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heat

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calor

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redness

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rubor

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swelling

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tumor

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loss of function

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functio laesa

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1. Vascular and Cellular Response

2. Exudate Production

3. Reparative Phase

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Stages of Inflammatory Response

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Fluids, proteins and leukocytes leak into the interstitial space = Swelling and pain

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Vascular and Cellular Responses

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Consist of fluid that escapes from blood vessels, dead phagocytic cells, and dead tissue cells and products that they release.It is cleared away by lymphatic drainage.

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Exudate Production

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Involves repair of injured tissues by regeneration or replacement with fibrous tissue (scar) formation.

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Reparative Phase

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is the replacement of destroyed tissue cells by cells that are identical or similar in structure or function.

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Regeneration

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= fragile, gelatinous tissue, pinkish or reddish because of the newly formed capillaries (early stage)

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Granulation tissue

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is first line of defense, and primarilyinvolves the WBCs (granulocytes and macrophages), which have the ability to ingest foreign particles and destroy the invading agent; eosinophils are only weakly phagocytic. Phagocytes

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phagocytic immune response

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otherwise known as programmed cell death, is the body’s way of destroying worn-out cells such as blood or skin cells or cells that need to be renewed

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Apoptosis

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is the second protective response (sometimes called the antibody response), begins with the B lymphocytes, which can transform themselves into plasma cells that manufacture antibodies

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Humoral Immune Response

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is the third mechanism of defense, involves the T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens.

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Cellular Immune Response

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The structural part of the invading or attacking organism that isresponsible for stimulating antibody production is called

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Antigen

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is the initiating event in any immune response and involves the use of lymph nodes and lymphocytes for surveillance

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Recognition Stage

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The circulating lymphocytes containing the antigenic message return to the nearest lymph node. Once in the node, these sensitized lymphocytes stimulate some of the resident T and B lymphocytes to enlarge, divide, and proliferate

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Proliferation Stage

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In this stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. This stage begins with the production of antibodies by the B lymphocytes in response to a specific antigen. The cellular response stimulates the resident lymphocytes to become cells that attack microbes directly rather than through the action of antibodies. These

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Response Stage

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in this stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader. This initiates activities involving interplay of antibodies (humoral immunity), complement, and action by the cytotoxic T cells (cellular immunity).

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Effector Stage

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are large proteins, called immunoglobulins, that consist of two subunits, each containing a light and a heavy peptide chain held together by a chemical link composed of disulfide bonds. Each subunit has one portion that serves as a binding site for a specific antigen and another portion that allows the antibody molecule to take part in the complement system.

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Antibodies

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One antibody can act as a cross-link between two antigens, causing them to bind or clump together. This clumping effect, referred to as

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Agglutination

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Some antibodies assist in the removal of offending organisms through. In this process, the antigen–antibody molecule is coated with a sticky substance that also facilitates phagocytosis.

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opsonization

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IgA, IgD, IgE, IgG, and IgM

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five different types of immunoglobulin (Ig).

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The portion of the antigen involved in binding with the antibody is referred to as the

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Antigenic determinant

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(75% of Total Immunoglobulin) Appears in serum and tissues (interstitial fluid) Assumes a major role in bloodborne and tissue infections Activates the complement system Enhances phagocytosis Crosses the placenta

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Immunoglobulin G

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(15% of Total Immunoglobulin) Appears in body fluids (blood, saliva, tears, and breast milk, as well as pulmonary, gastrointestinal, prostatic, and vaginal secretions) Protects against respiratory, gastrointestinal, and genitourinary infections Prevents absorption of antigens from food Passes to neonate in breast milk for protection

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Immunoglobulin A

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(10% of Total Immunoglobulin) Appears mostly in intravascular serum Appears as the first immunoglobulin produced in response to bacterial and viral infections Activates the complement system

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Immunoglobulin M

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Appears in small amounts in serum Possibly influences B-lymphocyte differentiation, but role is unclear

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Immunoglobulin D

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(0.004% of Total Immunoglobulin) Appears in serum Takes part in allergic and some hypersensitivity reactions Combats parasitic infections

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Immunoglobulin E

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the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are found throughout the body, including the blood and lymphatic system

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White Blood Cells or Leukocytes (Leucocytes)

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are the most abundant white blood cell, constituting 60-70% of the circulating leukocytes. They defend against bacterial or fungal infection. They are usually first responders to microbial infection; their activity and death in large numbers form pus.

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Neutrophils

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compose about 2-4% of white blood cells in circulating blood. This count fluctuates throughout the day, seasonally, and during menstruation. It rises in response to allergies, parasitic infections, collagen diseases, and disease of the spleen and central nervous system. They are rare in the blood, but numerous in the mucous membranes of the respiratory, digestive, and lower urinary tracts

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Eosinophils

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are chiefly responsible for allergic and antigen response by releasing the chemical histamine causing the dilation of blood vessels. Because they are the rarest of the white blood cells (less than 0.5% of the total count) and share physicochemical properties with other blood cells, they are difficult to study

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Basophils

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much more common in the lymphatic system than in blood. are distinguished by having a deeply staining nucleus that may be eccentric in location, and a relatively small amount of cytoplasm

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Lymphocytes

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the largest type of white blood cell, share the "vacuum cleaner" (phagocytosis) function of neutrophils, but are much longer lived as they have an extra role: they present pieces of pathogens to T cells so that the pathogens may be recognized again and killed

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Monocytes

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Neutrophils

Eosinophils

Basophils

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Types of Granulocytes

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Lymphocytes

Monocytes

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Types of Agranulocytes

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B cells

T cells

Natural Killer Cells

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Types of Lymphocytes

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Agranulocytes

Granulocytes

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Types of Leukocytes