1. Host-Parasite relationship
1- Pathogenic bacteria: bacteria which capable of causing disease. Pathogenicity: it’s the capability of the organism to cause disease. 2-Virulence : it’s the degree of pathogenicity. The Virulence factors of bacteria are:

2. 1- Adherence factors: certain bacteria have specialized structure e. g
1- Adherence factors: certain bacteria have specialized structure e.g. fimbria ,allows them to adhere to human cell causing the disease.
2- Invasion factors: Bacteria invade the tissue followed by inflammation, then it can cause a disease. This invasion is helped by:
Enzymes secreted by bacteria e.g. collagenase& lecithinase.
Antiphagocytic factors: e.g. capsule of pneumococci.
3- Toxin production.

3. Toxigenicity: it’s the ability of the organism to produce toxins whether exotoxin or endotoxin.

4. Difference between exotoxins & endotoxins
1- Secreted by the living organisms mainly gram positive
2- protein
3- Very highly toxic
4- Every individual extoxin has specific action.
5- Can be converted to toxoid.
6- Highly antigenic.
7- Unstable to temperature above 60 ċ
Endotoxin
1- It’s the integral part of the cell wall of gram negative organism liberated upon cell disintegration
2- lipopolysaccharide
3- Low toxigenicity
4- All endotoxins give fever & shock.
5- Cannot converted to toxoid.
6- Poorly antigenic.
7- Stable to temperature above 60 ċ

5. . Toxoid:
Is the treatment of exotoxin by formalin(one month) to remove toxicity & keep antigenicity.
E.g. Corynebacterium diphtheria & Clostridium tetani are toxigenic bacteria.

6. Types of infectious diseases
1- Acute infection: Rapid onset and short duration of illness.
2- Chronic infection: Slow onset with long duration.
3- Latent infections: Never completely eliminated, become reactivated when immune response is decreased.
Carriers: individuals harboring infectious agents for long period of time (months or years) spread the pathogen continually even though no signs or symptoms of the disease.

7. Sterilization And Disinfection

8. article (+ spores)whether pathogenic or
Sterilization:
Is complete destruction of all living
microorganisms that contaminating an
article (+ spores)whether pathogenic or
non pathogenic.

9. Sepsis: Is the presence of pathogenic microbes in living tissues.
Disinfection:-Elimination of pathogenic microorganisms from the surfaces (_ spores) but too toxic & irritant to be applied directly on living tissues.
Sepsis: Is the presence of pathogenic microbes in living tissues.
Antiseptic: A chemical substance less toxic or irritant than disinfectant & can be safely applied locally against pathogenic microbes on living tissues.

10. Cleaning :- is the removal of organic materials and dust that interfere with sterilization and disinfection process, using soap and water.

11. Methods of Sterilization:- Five main methods are used:
1- HEAT
2- Filtration
3- Ionizing Irradiation
4- Sterilant gases
5- Sterilant Liquids

12. 1- HEAT
a- Dry heat
Incineration: It is a burning process to destroy contaminated materials in hospitals.
Direct flame: To direct the flame to the tip of the forceps, scalpels, bacterial -loops and mouth of test tube.
Hot air oven: Metal chamber that operated at temperature of 160C– 180 C for 1 – 2 hours. Used for materials not denaturized by high temperature such as glassware ,metallic instruments, oil and powders. (E.g. talcum powder ).

13. b-Moist Heat at 100 C :
Boiling:
Boiling the articles in water for 20 min, all non sporing and some spores will be killed ( metallic syringes& forceps).Add Na bicarbonate 2%.
Steaming: by Koch Steamer (tyndallization).
Metallic chamber with conical led.
Water is allowed to boil in bottom at normal atmospheric pressure The steam temperature is 100 C will replace the air
Used to sterilize culture media e.g. media containing gelatin or carbohydrates that might be destroyed by exposure to higher temperature.

14. Tyndallization
Materials on the perforated tray. This method is known as intermittent steaming it
occurs at three successive days each sterilization time is min. On the first occasion vegetative bacteria are killed, any spores that remain survive, will germinate at 37 C after 24 hours. Then vegetative forms will be killed by the second occasion and so on ,at third steaming occasion.

15. C- Moist heat above 100C (steam under pressure):The autoclave
It is a metal chamber with a closely fitting lid which is connected to (1) a steam discharge tap, (2) a safety valve and (3) a manometer.
To sterilize articles in the autoclave these direction will be followed:
1- Water is placed in the bottom and the articles to be sterilized are placed on the top of the perforated tray above the level of water.

17. The sterilization time is calculated (20 min) at
121C under double atmospheric pressure The heater is turned off and the autoclave is allowed to cool down before opening the lid.
.The autoclave is used to sterilize : surgical instruments , bed linen, surgical dressing, gowns , cotton , gauze and any culture media not destroyed by heat.
N.B : 134 C under 3 atmospheric pressure 3-6 minutes.

18. PRECAUTIONS
Do not overloads the autoclave for better penetration of steam and more contact of steam with the articles.
Make sure that, there is no air left inside before closing the steam tap( continuous jet).
Start timing from the moment the manometer read 2 atmospheric pressure.
Do not open the lid before the pressure goes down to normal atmospheric pressure, otherwise the articles will be blown up and accident will happen.

19. To test the efficiency of the autoclave
Chemical method: A glass tube contains a red indicator solution that turns green when an adequate temperature had been maintained for a sufficient period of time.
Biological method: A preparation of dried bacterial spores( Bacillus stearothermophilus) is placed within the load and at the end of sterilization time they are tested for viability because, this spores are killed at 120 C in about 10 – 20 min.

20. 2- STERILIZATION by IRRADIATION
Gamma rays: which are emitted by radioactive elements such as cobalt-60.
High energy electrons (B-rays): which are produced by electron accelerators. Ionizing radiation has a high penetrating power used for sterilization of prepacked disposable items such as plastic syringes, gloves, catheters and I.V. infusion sets.

21. 3- STERILIZATION BY FILTRATION
For antibiotics, hormones and vitamins that don’t stand heat . The most reliable filter is membrane filter.
The membrane filters with a pore size of less than o.45 um .
They filter rapidly
Do not affect the filtrate in any way
Adsorb very little of the substance being filtered.

22. Air Filtration
HEPA ( High Efficiency Particulate Air )Filters .Can produce sterile air at filter face Acheive % arrestance of particles of 0.5um.

23. 4- sterilent gases
ETHYLENE OXIDE: It is a highly penetrative, non corrosive, and microbicidal gas which is used for sterilization of heat-sensitive medical devices such as plastic syringes and catheters.
FORMALDEHYDE GAS & LOW TEMPERATURE STEAM under sub atmospheric pressure:

24. It is very effective although it kill spores but requires excess safety measures which make this process not suitable for routine hospital use.
5- Sterilant liquids:
e.g. glutaraldehyde.

25. METHODS OF DISINFECTION
1- Cleaning:-By Soap and water
Thorough cleaning is a successful disinfection method reduces the microbial load.

26. 2- Disinfection by moist heat:
Washing or rinsing laundry or eating utensils in water at 70-80C for few minutes.
Boiling water (100C) for 20 minutes +add of sodium bicarbonate 2%.
Pasteurization of milk by heating at 63 C for 30 min. or at 72C for 20 sec, then sudden cooling, destroys pathogenic organisms transmitted from diseased animals e.g. M.bovis, brucella and Salmonella.

27. 3- Disinfection by Ultraviolet irradiation:-
Is a low-energy, non-ionizing radiation with poor penetration power. It is produced by mercury lamps.
e.g. laminar flow and small operation rooms.

28. 4- Disinfection by chemicals
Alcohols: ethyl alcohol (70 %) is used as skin disinfectants.
Aldehydes: formaldehyde and glutaraldehyde for endoscopes.

29. Biguanides: E.g. Chlorhexidine for skin and mouth wash.
It is often combined with compatible detergents for hand washing or with alcohol as a hand rub.

30. Halogens Hypochlorite disinfectants to surfaces .
Chlorine water supply & swimming pools.
Iodophores They are widely used in preoperative preparation of the skin.

31. Phenolics: are preferable for tuberculous material and for non-enveloped viruses, and where much organic matter is present. e.g. floors.
Oxidizing agents: as potassium permanganate and hydrogen peroxide which has limited application for the cleaning of wounds

32. Assignment
Compare and contrast:
Exotoxin and Endotoxin