 Short note

1. Infection prevention
 The transmission and endurance of a problem pathogen in a healthcare
institution depends on the patient base, selective pressure from
antimicrobial use, and the number of patients colonized (the act of or
process of establishing colony or coloninies.) or infected with the
pathogen.
 A combination of interventions may need to be employed to prevent and
control the spread of pathogens.
 Types of interventions used by institutions may vary depending on the
types and significance of pathogens, the population of the institution, and
available resources.
 In addition to following Standard Precautions for all patient encounters,
the following are some recommended strategies:
 Improvements in hand hygiene
 Use of Contact Precautions in patients with a multidrug-resistant
organism until patient is culture-negative.
 Active surveillance cultures.
 Education.
 Enhanced environmental cleaning.
 Cohorting of patients.
 Decolonization.
 Improvements in communication regarding patients with
multidrug-resistant organisms between healthcare institutions.
 Prevent infection
o vaccinate (protect)
o remove indwelling lines
 Diagnose and treat infection effectively
o target the pathogen
o consult with the experts
 Use antimicrobials wisely
o Practice antimicrobial control.
o use local data
o Treat infection not colonization.
o Treat infection not contamination.
o Know when to say “no” to vancomycin.
o Stop treatment when infection is cured or unlikely.
 Prevent transmission
 o isolate the pathogen
o Break the chain of contagion

2. Hand hygiene

 The objective of hand hygiene is to remove dirt/ or reduce the level of

organisms present on the hand and also to prevent hospital acquired
infections.
 Hand washing technique should be adhere to
a. Prior to and after handling patient, particularly those infected or
colonized with highly resistance bacteria.
b. Prior to and after performing aseptic techniques or any nursing
procedures.
c. After handling contaminated material /substances such as
secretions/ excretions and blood and body fluids.
d. On arrival and prior to departure from duty.
e. Before and after using the toilet/bathroom, before going to
cafeteria and after completing duty.
f. Before and after touching wounds and dressing of any type.
g. Before preparing and serving food.
h. After touching hair, nose, mouth or handkerchief.
i. Before and after wearing gloves.
 Appropriate hand hygiene is considered the leading measure to reduce the
transmission of nosocomial pathogens in healthcare settings. Its impact
on infectious and resistant organisms’ cross-transmission risk is largely
recognized in hospitals, schools and day care centers, as well as in
community settings.
 Inappropriate hand hygiene practice has been recognized as a significant
contributor to numerous outbreaks.
 Several studies have shown the impact of improved hand hygiene on the
risk of nosocomial infection and multi-resistant pathogen cross-
transmission.
 Normal human skin is colonized with bacteria and harbors mainly two
types of bacteria, resident and transient flora.
 Transient flora colonizes the superficial layers of the skin. It has a short-
term survival rate on the skin, but a high pathogenic potential. It is
 usually acquired by healthcare workers (HCWs) during direct contact
with patients or contaminated environmental surfaces adjacent to the
patient, and is responsible for most nosocomial infections and spread of
antimicrobial resistance resulting from cross-transmission. Hand hygiene
decreases colonization with transient flora and can be achieved either
through hand washing or hand antisepsis.
 The ideal technique for hand hygiene should be quick to perform, reduce
hand contamination to the lowest possible level, and be free from
significant side-effects on the HCWs’ skin.
 Definitions to be used. Hand hygiene defines either
a. Hand washing: Hand washing refers to the action of washing hands
with plain (non-antimicrobial) soap and water.
b. Hand antisepsis: Hand antisepsis refers to either antiseptic hand
wash or antiseptic hand rub.
o Antiseptic hand wash: Antiseptic hand wash refers to the
action of washing hands with water and soap or other
detergents containing an antiseptic agent.
o Antiseptic hands rub: Antiseptic hand rub refers to the
application of a waterless antiseptic (mostly an alcohol-
based product) agent to the hands to reduce the number
of microorganisms present.

c. Hand disinfection: Hand disinfection refers to any action where an

antiseptic solution is used to clean hands, either with medicated
soap or alcohol.

 5 moments of Hand Hygiene by WHO-

1) Before touching a patient.
2) Before clean/aseptic procedures.
3) After touching a patient.
4) After body fluid exposure.
5) After touching a patient surroundings.

 Six steps of hand washing

1) Palm to palm
 2) Right palm over left dorsum and left palm over right dorsum
3) Palm to palm fingers interlaced
4) Back of finger to opposing palm with fingers interlock
5) Rotational rubbing of right thumb clasped in left palm and vice
versa
6) Rotational rubbing, backwards and forwards with clasped fingers
of right hand in left palm and vice versa

3. ETO sterilization
 Ethylene Oxide gas was introduced in the 1950’s, and it is an
effective, low temperature chemical sterilization method.
 It also takes longer than steam sterilization, typically, 16-18 hours
for a complete cycle. Temperatures reached during sterilization
are usually in the 50-60°C range.
 Ethylene oxide (ETO) is a chemical agent that kills
microorganisms, including spores. ETO gas must have direct
contact with microorganisms on the items to be sterilized.
 Due to ETO being highly flammable and explosive in air, it must
be used in an explosion-proof sterilizing chamber in a controlled
environment.
 Items sterilized by this process must be packaged with wraps and
be aerated.
 The aeration time may be long and is needed to make sterilized
items safe for handling and patient use.
 ETO is used to sterilize items that are heat or moisture sensitive.
 Disadvantages of ETO gas are that it can leave toxic residues on
sterilized items and it possesses several physical and health
hazards to personnel and patients that merit special attention.
 Since ETO poses several health hazards, there are currently two
alternative technologies that are currently available: 1. a plasma
phase hydrogen 2. Peroxide-based sterilizing agent and Steris, a
per acetic acid based technology.

4. Differentiate between mutation & transferable drug resistance

Mutational Transferable
 • One drug at a time • Multiple drugs
• Low degree of resistance • High degree
• Can be overcome by high drug • High dose ineffective
dose
• Can be prevented by drug • Cannot be prevented by drug
combinations combinations
• Mutants may be defective • Spreads to same or different
species
• Virulence may be low • Not defective
• One drug at a time • Virulence not decreased.

5. Barrier nursing
 Barrier nursing is a set of stringent infection control techniques
used in nursing. The aim of the barrier nursing is to protect medical
staff against infection by patients, particularly those with highly
infectious diseases.
 It is a term sometimes used to describe the use of barriers to carry
out the appropriate infection control protocol for the particular
infection.
 Nurses and other health care professionals use appropriate infection
control precautions to prevent transmission of a microorganism
from:
o Infected patient to other patients and vice-versa.
o Infected patient to visitors and vice-versa.
o Infected patient to general hospital environment and vice-
versa.
o Infected patient to health care worker and vice-versa .
 It is a method for administering patient care while preventing the
transmission of highly contagious diseases.
 This is done for two reasons:
 o A patient can be isolated to prevent the spread of disease to
others;
o Isolation is imposed to protect a patient with a compromised
immune system.
 Barrier nursing entails the wearing of special protective equipment,
such as impermeable gown or a respirator, to prevent the
transmission of infectious material.
 Why do we need to Isolate/barrier nurse?
o To reduce the risk of spread of certain infections or antibiotic
resistant germs to other patients and staff.
o To protect patients from infection if they have a weak
immune system due to disease or taking certain drugs.
 Barrier Techniques include Aseptic technique, hand hygiene,
Isolation, Safer Handling of Sharps, Linen handling and disposal,
Waste disposal. Handling Biological Spills, Environmental
cleaning, Risk assessment, Staff health.

6. Sterilization of various scopes

1. Prevention of Growth of Diseases-

a. One of the most important reasons why the disinfection of medical
devices is so important is to prevent the buildup of bacteria and
various other diseases.
b. When any medical tool is used, bacteria come onto the device. If
left unchecked or not disinfected properly, then it is highly likely
that bacteria will grow.

2. Prevention of Spread of Diseases-

a. One of the biggest reasons why the disinfection of medical devices is
so important is to prevent the spread of diseases.
b. If surgical equipment is not properly sterilized, there are chances
that the next patient the equipment is used on can be exposed to a
disease the previous patient had.
c. The disinfection of medical devices ensures that many
compromising and debilitating diseases, such as AIDS, are
prevented.
 d. If the blood of a patient comes into contact with another patient,
then there is a chance that the other patient can contract AIDS.
e. Many deadly bacteria can grow on unsterilized medical equipment.
If those bacteria were to somehow gain entry into a patient’s body,
it could kill them rather quickly.

3. Prevention of Double Surgeries-

a. Many medical devices are used in a surgical operation. If
unsterilized equipment is used, it can cause an infection which may
not appear until much later.
b. When it does, surgery may have to be performed again in order to
remove it. This is costly and can cause many life-threatening
complications.
c. The disinfection of medical devices is an important practice. If
proper medical sterilization was not practiced, a number of medical
problems can occur.
d. As evident, these problems can be simple or complex in nature.
However, they are simple to prevent. The growth and spread of
diseases are just two of the most important reasons why medical
equipment must be sterilized after every use.

7. Cleaning protocol in OT

 All bins and sterile sets must be ensured that they are sterilized.
Certify from the CSSD that each pack has passed the process
challenge device test.
 After use, each instrument must be cleaned at ones thoroughly in
warm /hot water with a detergents &sent for sterilization.
 All sharps must be disposed off in the puncture proof bean only. No
sharps must put into the buckets.
 Nurse assisting must ensure that blood drops /spills are curved with
1% sodium hydro chloride &clean before leaving theatre after a
case.
 Nurse must supervise the proper disposal of gauze, human body
parts & OT suction apparatus contains.
 Dry mopping and wet mopping have been done many times in a
day mostly after every use. The walls were cleaned once every day
and disinfected.
  Restricted entry of personnel. Only the concerned people must be
allowed to work area. Prior permission must be obtained from
nurse in charge/ DMS if visitors are to enter OT
 0nly personnel in OT dress cap and mask to be allowed inside
sterile zone.
 Slipper must be earmarked and used for the area. The slipper for
bathroom must be marked.
 No person must go out with OT dress and come back into OT in the
same dress. Dress must be changed if person re-enter.
 No septic cases must be posted in main complex. Minor OT should
be used. The sister in charge must inform by doctor if any septic
cases are being done prior to posting in minor OT.
 Due precautions must be adhered to if seropositive patients for
HIV/HbsAg /HCV is posted for surgery. The doctor must be
informed about the patient’s status prior to posting. Must inform
the theater personnel.
 Half an hour must be given between cases to clean up the room
after each surgery.
 Terminal cleaning must be done of each theater at the end of the
day.
 The nurses who are assisting must ensure proper disposal of sharps,
blood stain, linen gauge pieces and body parts at the each case.
 During surgery the nurse assisting must ensure that minimal
spillage blood, body fluids occurs. The gauze pieces must be
accounted for in the stand for gauze counting.
 Weekend cleaning and mechanical scrubbing of the OT must be
done. Only minor OT to be used for emergency cases on Sunday.
No elective cases must be posted on Sunday.
 One senior nurse must supervise the weekly cleaning and scrubbing
as per the critical care room cleaning guidelines.

8. Plasma sterilizer
 Plasma is a fourth state of matter (solid, liquid, and gas) produced from
hydrogen peroxide as a reactive cloud of ions, electrons and neutral
atomic particles by a strong electric or magnetic field.
  The sterilization cycle 1-4 hours is short, no aeration required.
 Plasma sterilization is fast evolving into a promising alternative to
standard sterilizing techniques.
 Research on plasma sterilization started way back in 1960. Since then,
extensive research has been performed in plasma sterilization.
 There are numerous parameters involved such as the pressure or the
type of gas used etc. In an effort to arrive at the optimal mix of
parameters, numerous experiments have been performed.
 The components required for plasma sterilization
o Hydrogen Peroxide Cartridge
o Vacuum Pump
o Radio Frequency (RF) Generator
o A/C Enclosure
o Main PC
o UV Light
o Vaporizer Plate
 Methods of Plasma Sterilization
o Dielectric discharge barrier (DBD).
o Inductively Coupled Plasmas (ICP).
o Atmospheric Pressure Plasma Jet (AAPJ).
o Microwave (MW) Plasmas.

 Advantages of plasma sterilization

o The process is usually at room temperature and hence poses no
dangers associated with high temperatures (unlike autoclaves).
o Doesn’t involve any chemicals and hence is non-toxic (unlike
EtOH).
o Time of treatment is fast and of the order of 1 min or less.
o Before Sterilization after Plasma Treatment.
o Is versatile and can sterilize almost any material and any shape
with nooks and crannies.
o It presents an effective alternative to conventional methods such as
heat, chemical, or radiation sterilization.
 Disadvantages are :-
o The main disadvantage of this method is its low penetrability.
o It is cost effective method of sterilization.
 9. Post exposure prophylaxis
 Preventive measures taken to protect a person or community from harm
after contact with disease causing chemicals, germs, or physical agent.
 Simply it means a defense or protection.


10. What is carriers and describe types of carriers.

 Carrier
o Hosts that carry pathogenic organisms that produce no symptoms,
but are capable of transmission. (Typhoid Mary)
Condition is called "carrier state.
 As a rule, carriers are less infectious than cases, but epidemiologically
they are more dangerous than cases. E.g. Typhoid Mary.
 The elements of carrier state are

a) The presence in the body of the disease agent

b) The absence of recognizable symptoms and signs of disease, and

c) The shedding of the disease agent in the discharges or excretions.

 Types of carriers as below:

1. Incubatory carrier-
 Incubatory carriers are those who shed the infectious agent
during the incubation period of disease.
 That is they are capable of infecting other before the onset of
illness.
 This usually occurs during the last few days of the incubation
period, e.g. measles, mumps, polio, influenza diphtheria and
hepatitis B.
2. Convalescent carriers-
  That is those who continue to shed disease agent during the
period of Convalescence, e.g. Typhoid fever. Dysentery.
 A Convalescent carrier can pose a serious threat to the
unprotected household members and those in the immediate
environment.
3. Healthy carriers-
 Healthy carrier emerge from subclinical cases.
 They are victims of the subclinical infections who have
developed carrier state without suffering from overt disease, but
are nevertheless shedding disease agent, e.g. poliomyelitis,
cholera, meningococcal meningitis, salmonellosis and diphtheria.
 It is well to remember that a person whose infection remains
subclinical may or may not be a carrier.
4. Temporary carrier-
 Temporary carrier are those who shed the infectious agent for
short period of the time.
 In this category may be included the incubatory, Convalescent,
Healthy carriers.
5. Chronic carriers-
 A Chronic carriers is one who excretes the infectious agents for
indefinite periods. chronic carrier state occurs in a number of
diseases,e.g. typhoid fever, hepatitis B, dysentery, malaria.
 Chronic carrier are far more important sources of infection than
cases.
 The longer the carrier state, the greater the risk to the
community.
 Chronic carriers are known to reintroduce disease into areas
which are otherwise free of infection (malaria).
 Therefore their early detection and treatment are essential to
limit the spread of infection. Carrier of a virulent organism are
called pseudo carrier. Pseudo carriers are not important
epidemiologically.
11. Polymerase chain reaction and uses.

 PCR is a means to amplify a particular piece of DNA (Amplify= making

numerous copies of a segment of DNA).
 In-vitro technique.
 PCR can make billions of copies of a target sequence of DNA in a few
hours. PCR was invented in the 1984 as a way to make numerous copies
of DNA fragments in the laboratory. Its applications are vast and PCR is
now an integral part of Molecular Biology.
 The three main steps of PCR:-
• Denature DNA (At 95C, the DNA is denatured, i.e. the two strands
are separated)
• Primers Anneal (At 40C- 65C, the primers anneal or bind to their
complementary sequences on the single strands of DNA).
• DNA polymerase Extends the DNA chain (At 72C, DNA
polymerase extends the DNA chain by adding nucleotides to the 3’
ends of the primers).
 Application of PCR:-
o Genome mapping and gene function determination.
o Biodiversity studies ( e.g. evolution studies).
o Diagnostics (prenatal testing of genetic diseases, early detection of
cancer, viral infections...).
o Detection of drug resistance genes.
o Forensic (DNA fingerprinting).
 Advantages of PCR:-
o Automated, fast, reliable (reproducible) results.
o Contained :( less chances of contamination).
o High output.
o Sensitive.
o Broad uses.
 o Defined, easy to follow protocols.
 Disadvantages of PCR:-
o Need for equipment.
o False reactions.
o Internal control.
o Cross-reaction.
o Capacity building needed.
o Unspecific amplification.

12. Notifiable diseases (Rabies vaccine)

 A notifiable disease is any disease that is required by law to be reported to

government authorities. The collation of information allows the authorities to
monitor the disease, and provides early warning of possible outbreaks.
 The primary purpose of notification is to effect prevention and/or control of the
disease.
 It is a valuable source of morbidity data i.e. the incidence and distribution of
certain specified diseases which are notifiable.
 List of notifiable disease vary from country to country, and also within the
country between the state and between urban and rural areas.
 Usually diseases which are considered to be serious meanaces to public healthcare
included in the list of notifiable disease.
 At the international level, the following diseases are notifiable to WHO in
Geneva under the international health regulation (IHR), viz. cholera, plague and
yellow fever. A few others are polio, Influenza, Malaria, Rabies and salmonellosis
are subject to international surveillance.
 Although notification is an important source of health information, it is common
knowledge that is suffer from serious limitations:
o Notification covers only a small part of the total sickness in the community
o The system suffers from a good deal of under-reporting.
 It provides valuable information about the fluctuations in disease frequency. It
also provides early warning about new occurrences or outbreak of disease.
13. ELISA
 Enzyme-Linked Immunosorbent Assay (ELISA) is biochemical assay technique
used mainly in immunology. It is plate-based assays designed for detecting and
quantifying substances such as peptides, proteins, antibodies and hormones. First
and most basic test to determine if an individual is positive for a selected
pathogen, such as HIV.
 The term ELISA was first used by Engvall & Perlma in 1971.
 Principle of ELISA
o A sensitive immunoassay that uses an enzyme linked to an antibody or antigen
as a marker for the detection of a specific protein, especially an antigen or
antibody.
o ELISA involves detection of “analyze” in a liquid sample using liquid reagent
(wet lab) or dry strips (dry lab).
o In dry analysis, strip can be read in reflectometry. The quantitative reading
usually based on detection of intensity of transmitted light by
spectrophotometry at specific wavelength.
 The sensitivity of detection depends on amplification of signal during the
analytic reaction. In some enzymatic reaction, the signal generated by
enzyme which are linked to the detection reagents in fixed proportions to
allow accurate quantification (enzyme linked).
 There are two main variations on ELISA method is
o It can be used to test for antibodies that recognize an antigen.
ELISA can be used to detect the presence of antigens that are
recognized by an antibody or
o It can be used to test for antibodies that recognize an antigen
 ELISA results:
o The ELISA assay yields three different types of data output:
 Quantitative: ELISA data can be interpreted in comparison to a standard
curve in order to precisely calculate the concentrations of antigen in
various samples.
 Qualitative: ELISAs can also be used to achieve a yes or no answer
indicating whether a particular antigen is present in a sample, as
 compared to a blank well containing no antigen or an unrelated control
antigen.
 Semi-Quantitative: ELISAs can be used to compare the relative levels of
antigen in assay samples, since the intensity of signal will vary directly
with antigen concentration. .
 Applications –
o Serum Antibody Concentrations.
o Detecting potential food allergens.
o Disease outbreaks- tracking the spread of disease.
o Detections of antigens.
o Detection of antibodies in blood sample for past exposure to disease
e.g. Lyme Disease, trichinosis, HIV, bird flu.

 The other uses of ELISA include:

o Detection of Mycobacterium antibodies in tuberculosis
o Detection of rotavirus in feces
o Detection of hepatitis B markers in serum
o Detection of enterotoxin of E. Coli in feces
o Detection of HIV antibodies in blood sample.

14. Candida (_Rabies ppt)

 Candida is a genus of yeasts and is the most common cause of fungal

infections worldwide. Candida albicans is the most commonly isolated
species, and can cause infections (candidiasis or thrush) in humans and
other animals.
 It is grown in the laboratory, appears as large, round, white or cream
colonies with a yeasty odor on agar plates at room temperature.
 It causes superficial and deep infection, Caused by Candida sp. Especially
Candida albicans.
 It is a part of normal flora of humans, commonly found on skin and in
GIT and female GUT and the Infection usually endogenous.
 Predisposing factors
a. Infancy and old age.
b. Prolonged antibiotic therapy.
 c. Immuno deficiency.
d. Diabetes mellitus.
e. Moisture of skin.

 Infections caused by Candidiasis-

o Mucocutaneous infections : Oral thrush and vaginitis
o Cutaneous infection – Intertriginous and Paronychia.
o GIT candidiasis
o UTI
o CVS infection
o Respiratory system
o CNS
 Lab diagnosis- Samples collected, Gram stain – gram positive budding
yeast cells with pseudo hyphae.
 Culture on Sabarauds agar (creamy white colonies), CHROM agar.
 For the confirmation of the species techniques are used as follows-
o Germ tube test.
o Chlamydospore formation.
 Treatment-
15. Influenza vaccine. (for reference ppt rabies vaccine).
a) Killed Vaccines
 Most influenza vaccination programmes make use of inactivated
vaccines.
 The recommended vaccine strains (injury) for vaccine production
are grown in the allantoic cavity.
 The vaccine is conventionally formulated in aqueous or saline
suspension. One dose of the vaccine contains approximately 15
micrograms of Ha. The vaccine is administered by the
subcutaneous or intramuscular route.
 A single inoculatuion (0.5 ml for adults and childrenover 3 years
and 0.25 ml for children fron 6 months to 36 months of age) is
usually given.
  However, in persons with no previous immunological experience, 2
doses of the vaccine, separated by an interval of 3 to 4 weeks are
considered necessary to include satisfactory antibody levels.
 Proactive value of the vaccine varies between 70-90 per cent and
immunity lasts for only 6-12 months. Revaccination on an annual
basis is recommended.
 The killed vaccination can produce fever, local inflammation at the
site of injection, and very rarely an ascending paralysis. Since the
vaccine strains are grown in eggs may develop symptoms and sings
of hypersensitivity.

b) Live- attenuated vaccines-

 A trivalent, live-attenuated influenza vaccine administered as a
single dose intranasal spray is as effective as inactivated vaccine in
preventing the disease. It is approved for use in otherwise healthy
individuals between age of 2 years and 49 years.
 Because the risk of transmission of the live- attenuated vaccine
virus to immunocompromised individuals is unknown, it should not
be used n household members of immunosuppresed individuals,
healthcare workers, or others with close contact with
immunosuppresed persons.
 Effectiveness of influenza vaccine
 Vaccine effectiveness depends on the similarity between vaccine
strains and the strains in circulation during influenza season.
 With a good "match," influenza immunization prevents disease in
70 to 90% of healthy individuals.
 This drops to 30 to 40% in the frail and elderly.
 It does, however, prevent death in 85% of the frail and elderly.
 It prevents hospitalization in 50 to 60% of individuals immunized.
 Even with an imperfect match, Canadian studies show the vaccine
still reduces the overall risk of infection by about 40-60%.
 A vaccine that is not perfectly matched can still offer.
16. Malaria etiology and lab diagnosis

 Malaria is a life-threatening disease. It is typically transmitted

through the bite of an infected Anophelesmosquito. Infected
mosquitoes carry the Plasmodium parasite. When this mosquito
bites any person, the parasite is released into his bloodstream.
 Once the parasites are inside in a body, they travel to the liver,
where they mature. After several days, the mature parasites enter
the bloodstream and begin to infect red blood cells.
 Within 48 to 72 hours, the parasites inside the red blood cells
multiply, causing the infected cells to burst open.
 The parasites continue to infect red blood cells, resulting in
symptoms that occur in two-to-three-day cycles.
 Malaria is typically found in tropical and subtropical climates (e.g.,
Africa) where the parasites can live. The World Health
Organization estimates there were 198 million cases of malaria
diagnosed in 2013. The disease killed more than half a million
people in 2013. In the United States, the Centers for Disease
Control and Prevention report 1,500 cases of malaria annually.
Most cases of malaria develop in people who travel to countries
where malaria is more common.
 Malaria can occur if a mosquito infected with
the Plasmodium parasite bites you. In addition, an infected mother
can pass the disease to her baby at birth. This is known as
congenital malaria. Because malaria is transmitted by blood, it can
also be transmitted through:

 an organ transplant

 a transfusion

 shared use of needles or syringes

 Laboratory diagnosis of malaria

 o The diagnosis of malaria is dependent on demonstration of
the parasite in the blood.
a) Microscopy- two types of blood films are useful in
searching for and identification of malaria parasite.the
thin film and the thick film. It is recommended the both
types of film be prepared on a single microscope glass
slide. The thick film is more reliable in searchimg for
parasite as large volume of blood ie examine under each
microscop when scaternity parasite may be found about
20 times more rapidely in thick slide than in thin slide.the
thin slide is valuable for identifying the species of malaria
parasite present. In it they are seen more clearly .
17. Prevention of CA-UTI
 Urinary catheter: Indwelling catheter-A drainage tube that is
inserted into the urinary bladder through the urethra, is left in
place and is connected to a drainage tube( Foley’s catheter ).
 A UTI where an indwelling urinary catheter was in place for more
than 48 hrs.
 Following signs:
o Fever
o Suprapubic tenderness
o Costovertibral angle pain
o Urinary urgency
o Urinary frequency
o Dysuria
o Isolation of organisms from urine
 Prevention of CA-UTI
o Hand hygiene
o Aseptic technique
o Selection of size of the catheter
o Sterile closed drainage system with drainage bag below the
level of bladder
o Empty urinary drainage system regularly
 o Catheter to be fixed to the thigh
o Clean the srea with soap and water regularly
o Daily evaluation for the need of catheter
o Antibiotic prophylaxis in not needed.
o No bladder washes
o Operator
o Skin flora
o Contamination of catheter hub and lumen
o Contamination of infusate

18. Gas gangrene.

 Gangrene is the death of body tissue. Gas gangrene, also known as
clostridial myonecrosis, is a fast-spreading and potentially life-
threatening form of gangrene caused by a bacterial infection. The
infection causes toxins to release gas, which leads to tissue death.
 Symptoms include swelling, blisters that contain gas bubbles near the
area of infection, increased heart rate, and high fever. Skin in the
affected area often turns from pale to brownish-red. Symptoms
progress at a very rapid rate. Treatment may include antibiotics and
surgery to remove the dead tissue.
 Causes of Gas Gangrene
o Gas gangrene is caused by bacteria called Clostridium
perfringens (C. perfringens). In some cases, it can be caused
by Group A Streptococcus.
 Gas gangrene generally occurs at a recent surgical or injury site.
Rarely, it happens spontaneously, without apparent cause. In either
case, it comes on suddenly and spreads quickly.
 Signs and symptoms of gas gangrene include-
o air under the skin
o pain
o swelling
o pale skin that turns gray, brownish-red, or black
 o blisters with foul-smelling discharge
o a crackly sensation when you touch your skin in the affected
area
o fever
o perspiration
o anxiety
o increased heart rate
o vomiting
o Yellow skin and eyes (jaundice).

Treatment for Gas Gangrene

 Treatment must begin immediately. For advanced cases, it may be
necessary to begin treatment before test results are in. Dead or
infected tissue must be surgically removed (debridement), and high
doses of antibiotics will be administered.

 In severe cases, amputation of a limb must be performed to prevent

the infection from spreading to the rest of your body.

 Some physicians and hospitals use high-pressure oxygen (hyperbaric

oxygen) to increase the amount of oxygen in your blood. This
therapy is used to help wounds — especially infected wounds—heals
faster.

 Prevention of gas gangrene

 Healthcare providers routinely give antibiotics before and after surgery
to help lower risk of developing an infection. Be sure to take all
medications as directed by doctor.
19. Infection prevention methods in ICU

1. Supervisors to ensure that daily cleaning is done. Hands on training have

to be given for reconstitution of disinfectants. (Measuring cylinder to be
used). A logbook for this has to be maintained.

2. Periodically supervisors have to check by housekeeping Incharge that

this is done. Log book to be checked.

3. Morning and evening wet mopping of the area has to be done with a
disinfectant. once a week vacuum to be done –no brooms must be used in
the ICU.

4. Weekend disinfectant to be done for all equipments and beds in the ward.
No area must be visibly dirty

5. Restriction of visitors to ICU.

6. Wearing gloves and mask by staff is essential hand washing with the
soup and water is compulsory

7. All Equipment used on a patient i.e. the ventilation tubing; suction

tubing must be disposed of.

8. All spills to be covered with disinfectant for 10 minutes with groveled

hands (by 4% of sodium hypochlorite )

20. Leptospyrosis

 Leptospirosis is essentially animal infection by several serotypes of

leptospira and transmitted to man under certain environmental
conditions.
 The disease manifestation are many and varied, ranging in severity from
I mild febrile illness to severe, and sometimes fatal disease with liver and
 kidney involvement. Leptospirosis is considered to be the most wide
spread of the disease transmissible from animal to man.
 It has high prevalence in worm humid tropical countries.
 Out breaks mostly occur in as a result of heavy rain fall and consequent
flooding.
 It has known to occur in India since long. Reports indicates that it is
fairly widespread throughout India
 There was an outbreak of leptospirosis in Orissa after the super cyclone of
29 oct 1999 and in the month of august 2000 there was a cases of
leptospirosis in Gujarat, Maharashtra, Kerala.
 Mode of transmission
o Direct contact – leptospira can enter the body through skin
abrasions or through infect mucus membrane by direct contact
with urine or tissue of infected animal.
o Indirect contact – through the contact of the broken skin with soil,
water or vegetation contaminated by urine of infected animals or
through ingestion of food or water contaminated with laptospiriae
o Droplet infection – infection may also occur through inhalation as
well milking infected cows or goats by breathing air polluted with
droplets of urine.
 Incubation period
o Usually 10 days with the range of 4 to 20 day.
 Diagnosis
o It is not possible to diagnose leptospirosis with certainty on clinical
ground
o The diagnosis is made by isolation of laptospires from blood during
the acute illness and from urine after first week
o Early in the disease, the organism may be identified by dark-field
examination of the patient blood or by culture on a semisolid
medium. Culture takes one to six weeks to become positive.
o The organism may also be grown from the urine from 10th day to 6
weeks.
o Diagnosis is usually made by means of serological test.
 o Agglutination test positive after 7 to 10 days after illness and peek
at 3 to 4 weeks.
o In direct haemagglutination, ammuno fluorescent antibody ELISA
test also available
o The IgM ELISA Is particularly used full I making and early
diagnosis , as it is positive as early as two days in to illness
 Control
o Antibiotics – Penicilin is the drug of choice but other antibiotics(
tetracycline or doxycycline) are also effective. The dosage of
penicillin is 6 millions units daily intravenously.
o Environmental measures- this includes ore venting exposure to
potentially contaminated water, reducing contamination by rodent
control and protection of workers in hazardous occupation.
Measures should be taken to control rodents, proper disposal of
wastes and health education etc.
 Vaccination
o Immunization of farmers and pets prevent disease.
o In some countries for instance Italy, USSR and china whre certain
occupations carry a high risk of infection, vaccines are available.

21. Entamoeba Histolytica

 Entamoeba histolytica is an anaerobic parasitic protozoan that infects

the digestive tract of predominantly humans and other primates.
 It is a parasite that infects an estimated 50 million people around the
world and is a significant cause of morbidity and mortality in developing
countries.
 Analysis of the genome allows new insight into the workings and genome
evolution of a human pathogen.
 Transmission of the parasite occurs when a person ingests food/water that
has been contaminated with infected feces.
 The infection E. histolytica is called Amebiasis (or Amoebiasis). Cysts of
the parasite are the viable form outside the host. They can survive weeks
in water, soils and on foods under moist conditions.
 Once inside the host, cysts divide into four trophozoites in the small
intestines.
 Mode of infection:
o Eating raw vegetables (salad)
o Drinking water
o Flies and food handlers
o Faeco-oral (Autoinfection)
 Animal reservoir host include monkeys, dogs and pigs.
 Entamoeba histolytica causes Amebiasis, Amebic dysentery, Amebic
hepatitis.
 Diagnosis:
o Clinical diagnosis.
o Direct method: Identification of the parasite in feces or tissue.
o Laboratory diagnosis:
 Stool Examination : the most relied upon single method for
Lab. Diagnosis is the examination of fresh stool.
 Serological: a wide variety of excellent serological test exist
for the serodignosis of amebiasis,regardless of whether the
disease is confined to the intestinal tract. These test include
the indirect heamaglutination test,ELISA
 Assay for Amebic antigen in stool.
 Treatment:
o Tissue amoebicide (Metronidazole, Tinidazole).
 Very effective in killing amoebas in the wall of the intestine,
in blood and in liver abscesses.
o Luminal amoebicide (Diluxanide furoate).
 kills trophozoites and cysts in the lumen of the intestine.
 Control :
o Treatment of patients.
o Examination and treatment of food handlers.
 o Environmental sanitation.
o Personal prophylaxis.
o Human faeces should not be used as fertilizers.

22. Pulse Polio Program

Ppt of malaria (hospital adnmin)

23. Cryptococosis

24. Prevention of CLABSI

25. Rabies vaccine

26. Lab Diagnosis of Cholera

27. Recent techniques in diagnosis of TB

28. Prevention of VAP

 Prevention of VAP involves limiting exposure to resistant bacteria,

discontinuing mechanical ventilation as soon as possible, and a variety
of strategies to limit infection while intubated.
 Resistant bacteria are spread in much the same ways as any
communicable disease.
 Proper hand washing, sterile technique for invasive procedures, and
isolation of individuals with known resistant organisms are all
mandatory for effective infection control.
 A variety of aggressive weaning protocols to limit the amount of time a
person spends intubation have been proposed. One important aspect is
limiting the amount of sedation that a ventilated person receives.
 Other recommendations for preventing VAP include raising the head of
the bed to at least 45 degrees and placement of feeding tubes beyond
the pylorus of the stomach. Antiseptic mouth washes such as
chlorhexidine may also reduce the incidence of VAP. One study also
suggests that using heat and moisture exchangers instead of heated
humidifiers may also reduce the incidence of VAP.
 VAP occurs in up to 25% of all people who require mechanical
ventilation. VAP can develop at any time during ventilation, but occurs
more often in the first few days after intubation. This is because the
intubation process itself contributes to the development of VAP. VAP
occurring early after intubation typically involves fewer resistant
organisms and is thus associated with a more favorable outcome.
Because respiratory failure requiring mechanical ventilation is itself
associated with a high mortality, determination of the exact
contribution of VAP to mortality has been difficult.
 Mortality is more likely when VAP is associated with certain
microorganisms (Pseudomonas, Acinetobacter), blood stream infections,
 and ineffective initial antibiotics. VAP is especially common in people
who have acute respiratory distress syndrome.

29. Parasite causing Diarrhoea in Immuno compromised individuals