Pharmacology and

Venipuncture
Janine Claire D. Buco, RRT
Clinical Instructor
Microorganisms and
Infections
Nosocomial Infection

 Infections acquired in the course of medical care

 This term is most often applied to infections contracted
in an acute care hospital; however, it also applies to
infections patients receive while in extended care
facilities, outpatient clinics, and behavioral health
institutions
 Infections contracted at birth by infants of infected
mothers are also classified as nosocomial
 Iatrogenic infection
 A nosocomial infection that results from a particular treatment or
therapeutic procedure
Normal Flora
 are the microorganisms that live on another living
organism (human or animal) or inanimate object
without causing disease. The human body is not
sterile; we become colonised by bacteria from the
moment we are born.
 normal flora of humans is consists of >200 species
of bacteria
 consists of communities of bacteria that function as
microbial ecosystems
 exogenous nosocomial infections
 Infections that are caused by microorganisms that are not
normal flora
 endogenous nosocomial infection.
 Occurs when a person acquires an infection in the health care
setting as a result of an overgrowth of normal flora
 are often the result of the alteration in the number of
normal flora present in the body or the alteration in
placement of normal flora into another body cavity
 may also be the result of treatment with a broad-
spectrum antimicrobial drug that alters the number of
normal flora
Factors that Encourage
Nosocomial Infection
Environment
 Air contaminated with infectious agents;
 other patients who have infectious diseases;
 visitors;
 contaminated food;
 contaminated instruments;
 hospital personnel
Therapeutic regimen

 Immunosuppressive and cytotoxic drugs used to

treat malignant or chronic diseases,
 which decrease the patient’s resistance to infection;
 Antimicrobial therapy,
 which may alter the normal flora of the body and
 encourage growth of resistant strains of microbes
sometimes called hospital bacteria
Equipment
 Instruments that have not been adequately
cleaned and sterilized such as:
 catheters,

 intravenous tubing,

 cannulas,

 respiratory therapy equipment, and

 gastrointestinal tubes
Contamination During Medical Procedure

 Microbes transmitted during

 dressing changes,
 catheter insertion, or any invasive procedure may
introduce infective organisms if correct technique is
not used
Factors That Increase the
Potential for
Nosocomial Infection
Reasons for Susceptibility
 Age
 Heredity
 The very young have
immature immune systems  Congenital and
and are more susceptible to genetic factors
 nosocomial infections.
passed on from
birth make
 Also, as one ages, the individuals more or
immune system becomes
less resistant to
less efficient and organ
function declines, making
disease.
infections more difficult to
resist
 Nutritional status  Stress
 Inadequate nutritional  Work-related or other
stress factors increase
intake, obesity, or
potential for infection as
malnourishment as a levels of cortisone in the
result of illness render body increase related to
one increasingly constant tension.
susceptible to
nosocomial infections
 Inadequate rest and  Personal habits
exercise  Smoking,
 Efficient elimination and  excessive use of drugs
circulation decline as a and alcohol, and/or
result of inadequate rest
 dangerous sexual
or exercise. practices

 contribute tolowering
the body’s defenses
against nosocomial
infections.
 Health history
 Inadequate defenses
 Persons with a history of poor health  Broken skin;
such as
 burns or trauma;
 diabetes,
 or immunocompromised
 heart disease, or persons related to a
 chronic lung disease, or medical regimen

 children who have not been immunized

against diseases of childhood  are at increased risk of
acquiring a nosocomial
 are at increased risk for acquiring a infection.
nosocomial infection.
Common Sites for Nosocomial Infection
 The bloodstream and the urinary tract are common sites
of nosocomial infections.
 These are often the result of long-term use of vascular
access devices (VAD) and retention urinary catheters
 Infections in wounds following surgical procedures and
respiratory tract infections also occur frequently
 Early removal of urinary catheters, intravenous catheters,
and other types of invasive treatment devices is
recommended whenever possible to reduce the
incidence of nosocomial infections.
MICROORGANISMS
Microorganisms
 Do not fit into the plant or animal kingdom;
 therefore, a third kingdom was formulated by Haeckel, named
 the Protista kingdom.
This kingdom includes
 bacteria,

 fungi,

 protozoa,

 helminths,

 viruses, and

 prions.
 Microorganisms are used in a variety of
ways:
 in
food and drug processing to destroy waste
and,
 frequently, as
a means of effecting a positive
change in the environment.
 Prions
 are present in brain cells and may mutate to become infectious
disease.
 If a microorganism is known to produce disease, it is
called a
pathogenic microorganism, or a
pathogen.
 There are also believed to be unidentified pathogens that
produce newly recognized diseases.
 Some microorganisms that are natural flora in one area of the body produce
infection if they are accidentally relocated to a site other than their natural
habitat.
 For example,
 Escherichia coli (E. coli),
 which normally inhabits the human intestinal tract, do not cause
disease there;
 however, if it gains entrance to the urinary bladder, it can cause a
urinary tract infection.
 enterotoxigenic strain
 strains
of E. coli that are extremely virulent and are not considered
normal flora.
 may cause a severe cholera-like infectious disease.
 This disease has been linked to the E. coli from cattle and is spread
by introduction into beef or contamination from irrigation of
vegetables with contaminated water.
Factors that determines the pathogenicity of a
microorganism
 Quantity of microorganisms in an area that produces infection.
 A small number of a particular bacterium in the body may be harmless; however, if
the number increases, it may produce an infection.
 There are few areas of the human body that are considered sterile. These are the
 brain,
 blood,
 bone,
 heart, and
 the vascular system.
 its ability to find susceptible body tissue to invade.
 For example,
 the skin is a normal habitat for staphylococci; however, if this microorganism enters the lungs, it
can cause an infection.
 Some microorganisms are more virulent than others. This means that some microbes are more
certain than others to cause disease if they enter the human body.
resident flora
 The human body houses resident flora.
 That is, there are colonies of bacteria living on the
skin that do not result in infections. This means that
there are microbes that live in the body at all times
in a quantity that is usually stable.
 When the quantity of resident flora increases, the
flora may become pathogenic.
 Staphylococci are resident flora on the superficial layers of
the skin that, in large numbers, may cause a serious
infection.
 Resident flora requires firm friction and an effective soap
and quantities of water to remove them from the skin.
Transient Flora
 Flora that are acquired by contact with an object on
which they are present.
 Transient flora is more easily removed from the dermal
layers of the skin because they are not firmly adherent.
 For an infection to occur,
 the microorganism must be able to survive and multiply in the
body of the host, whether the host is human, plant, or animal.
 Moreover, the microorganism must be able to produce a
disease, and
 the host must be unable to mobilize its defenses against the
infectious microbes.
Four major groups of microorganisms are
known to produce diseases:

 bacteria,
 fungi,
 viruses,
 parasites.
Bacteria
Bacteria
 Bacteria are colorless, minute, one-celled organisms with a typical nucleus.
 They contain both
 deoxyribonucleic acid (DNA)
 carries the inherited characteristics of a cell
 ribonucleic acid (RNA)
 constructs cell protein in response to the direction of DNA.
 Bacteria are classified according to
 their shape, which may be
 spherical (cocci),
 oblong (bacilli),
 spiral (spirilla), or
 pleomorphic (lacking a definitive shape).
 Short rods are called coccobacilli.
 according to their divisional grouping as
 diplococci (groups of two),
 streptococci (chains), or
 staphylococci (grapelike bunches).
 Bacteria must be stained to be seen under a microscope
and are classified according to their reaction to various
staining processes in the laboratory.
 gram-positive,
 which means that they take the stain;
 gram-negative,
 which means that they do not take the stain; or
 acid-fast,
 which means that the bacteria are resistant to colorization by acid
alcohol.

 Bacteria may also be classified according to their

immunologic or genetic characteristics (Gladwin and
Tattler, 2000).
 Rickettsias, chlamydias, and mycoplasmas
 are gramnegative bacteria-like microbes that are smaller than bacteria and
 do not have all of the characteristics of bacteria.
 They used to be considered viruses because they are too small to be seen under
normal microscopic conditions.
 Rickettsias and chlamydias
 usually live as parasites inside another cell.
 Rickettsias
 are transmitted from animal to animal by the bite of an infected arthropod vector
such as a tick or flea.
 Typhus and Rocky Mountain spotted fever are caused by rickettsias.
 Chlamydia
 is transferred by direct contact between hosts often during sexual contact.
 It causes infections of the urethra, bladder, or sexual organs of the host.
 Mycoplasmas
 may be parasitic or free-living and cause pneumonia and genitourinary
infections in humans.
Endospores
 Some forms of bacteria are able to form a protective coat or
spore when conditions are unfavorable for survival.
 Bacterial spores are called endospores.
 Endospores encase the genetic material in the cell and may
protect it for many years.
 When conditions for survival are again favorable, the
endospore germinates and the bacterial cell again grows and
replicates.
 Endospores are more difficult to destroy than are vegetating
bacteria;
 therefore, many methods of destroying pathogenic bacteria do not
affect their endospores
 Aerobes
 bacteria that survive and thrive only in an oxygen environment.
 Anaerobes
 unable to live in the presence of oxygen
 Many bacteria are opportunists and learn to adapt or thrive in any
condition.
 They may also learn to live in the presence of antimicrobial drugs or
disinfectants.
 Some diseases caused by bacteria include
 tuberculosis,
 streptococcal infections of the throat,
 staphylococcal infections of many parts of the body,
 Salmonella poisoning,
 Lyme disease,
 gonorrhea,
 syphilis, and
 tetanus
FUNGI
 Fungi
 are cells that require an aerobic environment to live and
reproduce.
 Fungi exist in two forms—
 yeasts and
 molds.
 Yeasts
 are one-celled forms of fungi that reproduce by budding.
 Molds (also called mycelia)
 form multicellular colonies and reproduce by spore formation.
 dimorphic fungus
 is a form of fungi that can grow as either a yeast or a mold
depending on temperature and environment.
 saprophytes
 Another variety of fungi live in and utilize organic matter such as
 rotting vegetation as a source of energy
 Yeasts and molds can be harmful and cause a number of infectious diseases.
 On the other hand, molds are often extremely useful.
 primary source of material for the production of antibiotic drugs;
 produce enzymes for medical use and
 used in the production of foods to flavor various cheeses.
 Yeasts
 are used commercially to produce beer and wine and to leaven bread.
 They are also a source of vitamins and minerals;
 however, some yeasts are pathogens that produce diseases in
humans and animals.
 A commonly seen disease caused by yeast infection is
 Candida albicans (thrush).
 Diseases caused by dimorphic fungi are
 histoplasmosis,
 blastomycosis, and
 coccidioidomycosis.
Parasites
 Parasites are organisms that live on or in other
organisms at the expense of the host organ.
 Parasites may be plant or animal, but animal
parasites are those that are pathogenic to
humans.
 A large number of parasites produce disease,
and they are roughly classified as
 protozoa and
 helminths.
 Protozoa
 Protozoa are more complex one-celled microorganisms
 They are often parasitic and are able to move from place to place
 by pseudopod formation,
 by the action of flagella, or
 by cilia.
 Pseudopod movement
 is an amoeboid action in which a part of the cell is pressed forward and
the rest of the cell rapidly follows.
 Flagella
 are whiplike projections on the protozoa, which move the cell by their swift
movements.
 Cilia
 are smaller and more delicate hairlike projections on the exterior of the
cell wall, which move swiftly and in a synchronous manner to propel the
microorganism.
 Many protozoa are able to form themselves into cysts,
 which are protected by a cyst wall in adverse conditions to
prolong their existence.
 Many of the diseases in humans caused by protozoa affect
the
 gastrointestinal tract,
 genitourinary tract, and
 circulatory system.
 Some of the common protozoa diseases are
 amoebiasis,
 giardiasis,
 trichomoniasis,
 malaria, and
 toxoplasmosis.
Helminths
 Helminths can be simply described as parasitic worms classified as
either
 Platyhelminthes (flatworms) or
 Aschelminthes (roundworms).
 Many of these worms can live in the human intestinal tract for long
periods of time if they are not treated.
 Some of the more pathogenic types of helminths migrate to the body
organs, where they cause serious illness.
 Although some can be seen with the naked eye, an examination of
their eggs is necessary to make a positive identification before
initiating treatment.
 Common diseases caused by helminths are
 enterobiasis (pinworm),
 trichinosis, and
 infection with Diphyllobothrium latum (tapeworm).
Viruses
 Viruses
 Viruses are minute microorganisms that cannot be visualized under an ordinary
microscope.
 They are the smallest microorganisms known to produce disease in humans.
 The genetic material of a virus is either DNA or RNA, but never both.
 A virion is a complete infectious particle with a central nucleoid.
 The genetic material is protected by a capsid or protein coat that is composed
of minute protein units called capsomeres.
 The complete nucleocapsid with a nucleic acid core constitutes a complete
virus.
 Some viruses are surrounded by an envelope that is composed of a lipoprotein.
 Viruses must invade a host cell in order to survive and reproduce.
 Whatever its structure, the virus is transported by way of its capsid to a host cell that has
receptor sites on its surface that are suitable to a particular virus that it invades.
 A virus does not invade a cell at will.
 It must attach itself at a membrane receptor site for which it has a specificity; that is,
specific for that particular type of host cell and no others.
 Once in the cell, production of new viral particles does not take
place with certainty.
 Other factors in the cell environment must be favorable for the
multiplication to take place.
 There are various theories concerning what makes the
environment favorable. These include, but are not limited to,
 poor nutritional status of the host,
 poor health related to heart disease or diabetes,
 increased life stress for the host, or
 excessive use of drugs and alcohol.
 To reproduce,
 the virus uses the genetic machinery of the host cell.
 When reproduction is complete, new viruses leave the original host cell.
 As some types of viruses leave the host cell, they destroy the cell by the
rapid release of new viruses. This is called lysis.
 The second type of viral replication produces viruses that lie dormant, but
very much alive and destructive, within the host cell.
 Some viruses have the capacity to invade nerve
ganglia and leave their genetic material in the
ganglia in a latent phase after an acute infective
period.
 The virus remains there
 until
the body is under some type of stress such as an
emotional life event or illness or
 until it is exposed to sunlight for a period of time.
 This will often induce the virus to take over nearby
cells and produce more viruses, as in the case of
 herpes simplex (fever blisters) or
 herpes zoster (shingles).
 Such viral infections may occur repeatedly.
 A virus may be classified on the basis of its
 genetic composition;
 the shape or size of the capsid;
 the number of capsomeres or
 the absence of an envelope;
 the host it infects;
 the type of disease it produces; or
 its target cell and immune properties.
 Viruses are capable of infecting plants, animals, and humans.
 Some common viral diseases that affect humans are
 influenza,
 the common cold;
 mumps;
 measles;
 HIV (AIDS); and
 hepatitis A, B, C, D, and E.
Prions
 A prion is a protein that does not contain DNA or RNA.
 Like microorganisms, there are a number of prions present in brain cells that prevent
neurologic diseases; however, they may mutate and become an infectious disease.
 A mutant prion may be present by genetic predisposition or may be the result of
infection.
 Acquiring an infectious prion is the result of transmission from an infected animal or
person.
 Creutzfeldt-Jakob
 The disease most often resulting from a mutant infectious prion disease.
 Mad cow disease
 This disease is transmitted to humans by eating infected meat or meat products and
 Prion diseases are known as transmissible spongiform encephalopathies (TSE).
“When TSE is suspected clinically, elaborate precautions must be taken in the
autopsy room and histology laboratory because the agents of these infections
survive formalin fixation and are even demonstrable after tissue is embedded in
paraffin blocks” (Koneman, 2006, p. 1367).
 There is currently research ongoing to determine if prions are contributory to
Alzheimer’s disease.
ELEMENTS NEEDED TO TRANSMIT
INFECTION
1. An infectious agent
 which may be a bacterium, a fungus, a virus, a prion, or a
parasite.
 Infectious agents vary in their ability to cause disease.
 These characteristics
 Pathogenicity
 refers to the causative organism’s ability to cause disease.
 Virulence
 refers to the causative organism’s ability to grow and multiply with speed.
 Invasiveness
 is the term used to describe the organism’s ability to enter tissues.
 Specificity
 characterizes the organism’s attraction to a particular host.
2. A reservoir
 or an environment in which the pathogenic
microbes can live and multiply.
 The reservoir can be any combination of organic
materials that support the life of a particular
pathogen.
a human being,
 an animal,
a plant,
 water, food, earth,

 Infection is prevented by removing the causative

microbe from the reservoir.
3. A portal from which to exit from the
reservoir
 In the case of a human reservoir,
 The portals of exit might be the
 nose,

 mouth,

 urinary tract,
 intestines, or
an open wound from which blood or purulent
exudate can escape.

 There can be more than one portal of exit.

4. A means of transmission
 Infection is transmitted by direct or indirect contact,
 by droplet,
 by vehicle,
 by vector, or
 by airborne route.
 Carrier
 A person who transmits disease-causing organisms but has no apparent signs or symptoms
of that disease
 Particular organisms require specific routes of transmission for infection to occur.
 Direct Contact
 when a person or an animal with a disease or his blood or body fluids are touched.
 This contact can be
 by touching with the hands,
 by kissing,
 by percutaneous injection, or
 by sexual intercourse.
 Indirect contact
 is defined as the transfer of pathogenic microbes by touching objects (called fomites) that have been
contaminated by an infected person.
 These objects include
 dressings,
 instruments,
 clothing,
 dishes, or anything containing live infectious microorganisms.

 Droplet contact
 involves contact with infectious secretions that come from the conjunctiva, nose, or mouth of a host or
disease carrier as the person
 coughs, sneezes, or talks.
 Droplets can travel from approximately 3 to 5 feet and should not be equated with the airborne route of
transmission.
 Vehicles
 may also transport infection.
 Vehicle route of transmission includes food, water, drugs, or blood contaminated with infectious
microorganisms.
 The airborne route of transmission
 indicates that residue from evaporated droplets of diseased microorganisms are suspended in air for
long periods of time.
 This residue is infectious if inhaled by a susceptible host.
 Vectors
 are insect or animal carriers of disease.
 They deposit the diseased microbes by stinging or biting the human host.
5. A portal of entry into a new host

 Entry of pathogenic microorganisms into a new

host can be
 by ingestion,
 by inhalation,
 by injection,
 across mucous membranes, or,
 in the case of a pregnant woman, across the placenta.
Thank You and God Bless You