1. Control of Growth

2. Lister “ Saved more lives by introduction of his system than all the wars of the 19th century together had sacrificed” Revolutionized surgery

3. Definitions Sterilization Disinfection Cide vs stasis Sepsis Asepsis

4. Rate of Microbial Death Factors that influence effectiveness –# of microbes –Presence of organic material interferes with action of disinfectant –Temperature –Time of exposure –Characteristic of organism

5. Potential Risk of Infection Critical items-direct contact with body tissues Semi critical- contact with mucous membranes but do not penetrate body tissue Non critical-contact with intact skin

6. Actions of Agents Damage to membrane-leakage Damage to proteins & nucleic acids –Enzymes –Nucleic acids -lethal

7. Daily Life Soaps and detergents Hand cleansing

8. Physical Methods of Control Heat –Denatures enzymes Moist heat coagulates proteins –Boiling kills vegetative forms of pathogens

9. Autoclave Uses temperature above boiling water Steam under pressure Preferred method unless material is damaged Higher the pressure, higher the temperature Need direct contact with steam All air is evacuated from chamber 15 psi at 121 C for 15 mins

10. Autoclave Prions- protein only –134 C for 18 mins –Soak in 1N NaOH for 1 hour Flash sterilization-at 134 C for 3min –Used for individual instruments Packaging Use of indicators –Biological indicators-endospores

11. Physical Methods of Control Pasteurization for heat sensitive products –Mild heating to kill pathogens Dry heat –Kills by oxidation – Flaming or hot air

12. Filtration Passage of liquid through screen device Pores small enough to retain microbes Sterilize heat sensitive materials Negative-uses vacuum Positive uses pressure HEPA hoods & TB rooms

13. High Pressure Can alter structure of proteins Kill vegetative forms Endospores relatively resistant Osmotic pressure reduces availability of water

14. Radiation Ionizing radiation-less than 1nm –Gamma rays-cobalt or electron beams –X rays Principle-ionization of water

15. Radiation Nonionizng radiation –UV light –Causes pyrimidine dimers T-T, T-C

16. Chemicals Considered pesticides Regulated by EPA Sterilants-sterilize in 6-10 hrs High level disinfection do not kill all endospores Intermediate level kill bacteria and some viruses Low level – general purpose

17. Microbial Characteristics Gram negatives more resistant –External layer of lipopolysaccharide –Porins –holes in cell wall, selective Mycobacterium-lipids in cell wall Viruses without a lipid layer more resistant

18. Antimicrobial Chemotherapy

19. History Paul Ehrlich- magic bullets Chemotherapeutic agent Antimicrobial Antibiotic Synthetic drugs produced in lab

20. History Sulfa drugs- wide spread use in 1935 Fleming-penicillin in 1928 Waksman- bacteria from soil- Streptomyces griseus-streptomycin

21. Selective Toxicity Harm microbe without causing significant damage to host Penicillin Streptomycin to tx TB

22. Drug Administration Effective concentration of abx to site of infection- route Topical-infection at body surface –Athlete’s feet Systemic-IV fastest but need hospitalization IM intra muscular- peak levels in BS within 15 mins

23. Drug Administration PO- enters GI then into BS –Painless, but slower and not as effective –Only fraction enters BS –Must follow directions –Great for outpts

24. Drug Distribution Barriers to fast distribution: cell membrane & proteins –Prevent entry or bind drug CM of cells around BS can prevent free passage into tissues from blood vessels

25. Drug Distribution Drug binding proteins Penicillin: about 65% reversible bound to albumin Race between distribution of drug and elimination

26. Elimination of Drugs Converted metabolically to another compound: liver Excreted Penicillin excreted rapidly via kidneys Within 90 minutes, most in urine Take regularly and often or Resistance can develop

27. Drug Resistance Natural or acquired resistance Species lacks target: penicillin attacks peptidoglycan in cell wall Many can’t enter gram negative cell wall

28. Spectrum of Activity Range of microbes the agent acts against Broad –gram positive & negative Narrow –small number of microbes Prevents destruction of normal flora

29. Acquired Resistance Broad spectrum antibiotic changes normal flora: Mutations and genetic exchange among bacteria Antibiotics favor resistant strains but do not cause genetic changes

30. Mechanisms Alteration of target of drug action Alteration of membrane permeability Efflux or pumps out the drug

31. Mechanism Development of enzymes: most common –Destroy or inactivate drug –B-lactamase-several

32. Genetics Mutations on chromosome Develop gradually over years of antibiotic usage Need higher & higher concentrations of drug Eventually becomes useless

33. Plasmid Borne Genes Occurs almost immediate via genetic recombination R plasmids or factors Penicillin resistance from beta- lactamase is an example

34. Slowing Use of Antibiotics 3/4 of all hospital pts receive several courses of abxs-over kill 50 million of 150 million outpatient antibiotics are unneeded Maintain high levels in body long enough to kill all pathogens

35. Slow Resistance Limit use of antibiotics in animals Transmission of drug resistant organisms from animals to humans Some countries drugs sold over the counter

36. Drug Dosage Depends upon route of administration, drug distribution, drug elimination Effective concentration depends upon susceptibility of organism to drug Kirby-Bauer method –MIC: minimum inhibitory concentration –Microbial sensitivities

37. Kirby Bauer Method Disk diffusion method-standardized Agent spread over MH plate Disks impregnated with antibiotic Agent diffuse out, lower MW faster Zones of inhibition-clear areas around disk Standardized for S, R I

38. Targets of Antimicrobial Drugs Bactericidal-kills Bacteriostatic-inhibits growth –Phagocytosis & antibodies kill organisms Inhibition of cell wall synthesis

39. Cell Membrane Membrane of bacteria & fungi differ somewhat from animal cell membranes –Some selective toxicity but not ideal

40. Inhibition of Protein Synthesis Selective toxicity depends upon difference between ribosomes Bacteria-70S (30S & 50S) & animals -80S –Human 40S & 60S but mitochondria have 70S –Side effects do occur

41. Inhibition of Nucleic Acid Synthesis Rifampin binds to bacterial RNA polymerase –inhibits RNA synthesis- TB –Colors urine and contacts orange