| 00:04 | Mhm. Absolutely. Anyone. Ok. All right. Um, |
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| 00:16 | see here. Ok, folks. , let's get started. Uh, |
|
| 00:28 | , it is. Me, I got severe buzz cut somewhat. My |
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| 00:34 | is lowered as my father would Um, anyway, uh, we |
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| 00:41 | tired of the shagginess, so said . Um, all right. |
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| 00:47 | uh, let's see. So we're on track. So, remember we |
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| 00:51 | have anything, uh, due uh, this week or I guess |
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| 00:56 | , this Monday. So back in , the of that, um, |
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| 01:15 | , uh, very similar to exam in terms of average 68 point |
|
| 01:20 | I forget. Um, so, , the, the, the exam |
|
| 01:24 | be open actually tomorrow. So you'll able to see it tomorrow for the |
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| 01:29 | couple of days. So, certainly take a look at it. |
|
| 01:32 | , if you have questions, come to office hours either in person |
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| 01:37 | virtually whatever you prefer, um, fine. And then, uh, |
|
| 01:44 | next exam, uh, that's that's the 18th, 19th. So |
|
| 01:50 | , uh, the, the scheduler that will open, not this |
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| 01:55 | but next Friday. Ok. but I, I'll, we'll have |
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| 02:02 | few emails before then, so I'll course, mention it again. Uh |
|
| 02:05 | than once. So, uh so section we're gonna finish uh most of |
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| 02:12 | today. So I think we just a little bit left to do on |
|
| 02:16 | . And then we'll start in with um, the sequence of 16 and |
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| 02:22 | is your uh immune system talking about immune system. We'll start that on |
|
| 02:28 | and continue that through next week and up with uh fifteens microbial pathogenesis. |
|
| 02:34 | , we look at how your body disease. And in 15, |
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| 02:36 | we look at how pathogens are able counteract your defenses and cause disease. |
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| 02:42 | that's what 15 is about. And will finish off unit three. |
|
| 02:48 | Um So, uh again, do look through, through the exam |
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| 02:55 | if you have questions, um uh me know and uh we'll certainly go |
|
| 03:00 | it. Uh Not, not a . Uh Let's see. So, |
|
| 03:05 | especially if you are. Uh I'm to, I will, I hope |
|
| 03:10 | have it done this week. Uh not this week, certainly early next |
|
| 03:15 | and have like a midterm grade posted blackboard. So it'll be everything homeworks |
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| 03:21 | units one and two. Although whatever homework grade you're seeing on mastering, |
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| 03:25 | what's getting transferred. So, um that will be transferred to Blackboard. |
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| 03:30 | So basically be uh two exams. the homeworks up through um I guess |
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| 03:39 | unit two. OK. And then blackboard quizzes. So all those, |
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| 03:44 | make a, a couple of midterm put on blackboard should be able to |
|
| 03:47 | that again. It'll probably be uh , late this week, uh |
|
| 03:52 | as late as early next week. . Well, in advance of, |
|
| 03:56 | , of the drop date, if what you're considering. So, uh |
|
| 04:00 | I'll, but I'll, I'll, keep you updated on the status of |
|
| 04:04 | . So, um, uh, let's um a couple of uh kind |
|
| 04:11 | summary slides here as we start. So again, so we're in |
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| 04:17 | we've started, then we'll continue for next, you see it in the |
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| 04:21 | on aspects really uh focused on, clinical microbiology, medical microbiology, |
|
| 04:27 | you want to refer to it. so uh this chapter 14 is really |
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| 04:32 | a I I know you're inundated with lot of terms and definitions and |
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| 04:37 | that's a lot of what 14 is for better or worse. But um |
|
| 04:42 | mean, those are the terms that probably do need to know that you'll |
|
| 04:46 | um you know, uh some more others uh from as you, as |
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| 04:50 | go on into nursing school and But um so maybe 14 is really |
|
| 04:55 | description of disease in general infectious disease and different aspects of it. |
|
| 05:01 | And so we looked at it kind in this viewpoint here in terms |
|
| 05:06 | so, pathology is the study of , of course, and then breaking |
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| 05:09 | down in terms of causes. And we looked at the colored boxes are |
|
| 05:14 | the various um subtopics if you that we looked at so far, |
|
| 05:20 | all all of these, most of . Um And so Cokes postulates how |
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| 05:24 | determine cause the, the infectious agent disease. Of course, what we've |
|
| 05:30 | in the past 100 plus years and we can, we know where we |
|
| 05:34 | to modify things or adjust based on knowledge, um pathogens also severity of |
|
| 05:40 | , extent. A lot of these basically terms to know here. Um |
|
| 05:45 | acute disease, for example. Um really uh 15, 16 and |
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| 05:51 | which are coming up uh host that's really where we zero in on |
|
| 05:56 | body's immune system. Ok? Of , the health of that has a |
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| 06:00 | to do with our ability to fight disease. Ok. And then, |
|
| 06:04 | know, there's various factors, gender , maybe geography where you live, |
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| 06:11 | general health, these all factor into you come down with infectious disease and |
|
| 06:16 | probably changes. This is more kind uh what are you experiencing? Are |
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| 06:21 | , are you, do you have fever? Do you have uh |
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| 06:24 | Do you have uh the general Uh Are you showing a rash, |
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| 06:29 | swelling? What have you? So are both can be uh certainly observable |
|
| 06:34 | not always a measurable statistic, You can measure a fever, of |
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| 06:37 | , right? But you can't really somebody's tiredness, so to speak, |
|
| 06:42 | ? Um So you can have both can be parts of any kind |
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| 06:45 | disease. Then of course, occurrence the more epidemiology. That's what this |
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| 06:51 | centered on here. And so what the we we there are diseases, |
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| 06:56 | diseases that must be by law um and we use that data to, |
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| 07:03 | see at any given time. What the state of the health of the |
|
| 07:07 | , so to speak? Right? there, is there a certain s |
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| 07:11 | in a particular type of infectious Why is it, who is it |
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| 07:16 | to? What part of the etc, these kind of things? |
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| 07:20 | we use this information to hopefully contain , see what's going on. There's |
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| 07:24 | new that we haven't seen before. uh so we need that, of |
|
| 07:28 | . And then uh then uh not communicable diseases, transmissions of communicable |
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| 07:34 | to person transmission. These are the we can uh uh get vaccinated |
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| 07:39 | right and produce this herd immunity. . So we touched on most of |
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| 07:44 | and so we're kind of gonna today kind of more about um transmission of |
|
| 07:50 | . Um uh uh the the the care environment and how that can cause |
|
| 07:57 | . Um So something that's certainly uh to you all that are gonna be |
|
| 08:03 | , certainly. And then, um then a little bit about E I |
|
| 08:07 | , we talked about that before. And I think we'll probably leave till |
|
| 08:12 | time. Some of the epidemic epidemiological stuff. OK. But anyway, |
|
| 08:18 | kind of where we're at. So let's look at this question |
|
| 08:21 | So this has some terms that we um last time, but it introduces |
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| 08:27 | , so a coup a couple that we'll talk about today. OK. |
|
| 08:31 | you're looking for the false answer OK. Um So we did talk |
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| 08:37 | herd immunity. Uh, I guess , that's, that's the only |
|
| 08:42 | The other ones are all, we talked about E I DS |
|
| 08:46 | Uh, but these other ones are kind of new. Mhm. |
|
| 09:27 | . Counting down from eight. Uh, let's see. See. |
|
| 09:42 | , that's good. Um, herd immunity. That's definitely not. |
|
| 09:48 | have to be vaccinated in order to herd immunity. All right. |
|
| 09:52 | remember, it's not just, it's just, um, getting vaccinated, |
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| 09:58 | it's also getting enough people vaccinated, ? You know, it's, |
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| 10:03 | the, the ones that are vaccinated the, are the sinks to absorb |
|
| 10:06 | infectious agent, right? And protect around us. So, uh, |
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| 10:11 | you have vaccination is a definite part that. Ok. So, |
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| 10:16 | contact transmission, indirect, uh, , that's and vehicle transmission. Those |
|
| 10:22 | modes of, of disease transmission. , both of which are true, |
|
| 10:28 | , uh, fomite. We'll talk those here in, in a few |
|
| 10:31 | . Ha I, that's the health required. Infections um what you |
|
| 10:37 | you know, you're perfectly healthy or have some other condition you're in the |
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| 10:42 | for. But while there you catch infectious disease um as, as a |
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| 10:47 | of being in the hospital. So uh that's certainly what that is. |
|
| 10:53 | we use the term, uh it to be called, uh you may |
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| 10:57 | this term uh nosocomial, nosocomial is of the older term, which specifically |
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| 11:03 | hospital, hospital acquired infection nosocomial. now they've broadened the term because health |
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| 11:10 | doesn't just occur in the hospital occurs home. It occurs in various clinics |
|
| 11:15 | around town and elsewhere. So all those are potentially um uh uh areas |
|
| 11:25 | infectious disease can be caught acquired. . So we'll talk about that here |
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| 11:30 | as well. So, um uh E I Ds, that is |
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| 11:35 | Most, most are viruses uh with origins. That's what zoonotic means. |
|
| 11:40 | . So let's uh so we're gonna through uh these um we'll get through |
|
| 11:47 | of this, but we'll probably have save that for Thursday. Ok. |
|
| 11:54 | So, um let's, I kind just introduce this through an example |
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| 11:58 | Kind of a, this is out your book. Um And so remembering |
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| 12:03 | , you know, with disease right? We have a, a |
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| 12:06 | , uh we have a, a process we have, so we have |
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| 12:10 | result of the infection in the body something happens to the body right? |
|
| 12:15 | so this is a study uh where had swimmers uh using this, using |
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| 12:20 | community pool coming down with diarrheal Ok. And so the it was |
|
| 12:28 | to get this out of the way , traced two after water analysis um |
|
| 12:36 | cryptosporidium, right? It's protozoal I talked about those previously, |
|
| 12:41 | And um this is true for any disease, there's gonna be some |
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| 12:46 | right? It'll have uh certain types features. So remember the term virulence |
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| 12:52 | , right? So you might say these are very tolerant to disinfection. |
|
| 12:56 | they actually have a AAA an envelope them that that allows them to |
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| 13:01 | Um So uh like protozoans, they have these weird life cycles. |
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| 13:08 | And uh this is no different as can see right here, going through |
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| 13:12 | cycles, uh feeding stages and reproductive , et cetera are common for a |
|
| 13:19 | . OK. Then um then of , you have, you have reservoir |
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| 13:25 | it resides, right? And cryptosporidium typically uh contaminants of water. So |
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| 13:31 | uh feces of animals and so uh uh being resistant to chlorine the |
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| 13:38 | they were able to survive in that water. OK. And so the |
|
| 13:44 | um life cycle they have so different of rance factors. So remember, |
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| 13:48 | factors is any feature or features that the organism to cause disease. |
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| 13:54 | So for this thing, it's resistance certain types of chemicals, it could |
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| 13:59 | maybe they do attach to the intestinal . So it probably has a mechanism |
|
| 14:04 | that would certainly be a rance Uh They can form a cyst, |
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| 14:08 | is kind of a dormant form that them somewhat resistant. Uh Not uh |
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| 14:13 | very typical of protozoal types that infect gut because they, because the guts |
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| 14:19 | necessarily a friendly environment because it very as you go into the stomach. |
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| 14:24 | So it has to be able to that. Um So again, same |
|
| 14:29 | of thing. This is one but as we look at different infectious |
|
| 14:33 | , they're gonna have the same features them. Ok, a reservoir, |
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| 14:38 | way to be transmitted. Ok. um causing uh in this case, |
|
| 14:45 | disease. And so the fecal oral uh is how these um intestinal pathogens |
|
| 14:51 | acquired uh through water or through Ok. As we'll explain here in |
|
| 14:57 | little bit. Ok. So, no, certainly the symptoms, |
|
| 15:02 | we are aware of, we've all at some point, not necessarily |
|
| 15:08 | but we've had some sort of gastrointestinal food poisoning at one time or |
|
| 15:12 | whether it was salmonella or the e or what have you. And very |
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| 15:18 | , of course, constant is Um It can be a severe abdominal |
|
| 15:25 | depending on the infectious agent. It even be blood appearing. So, |
|
| 15:30 | it all depends on the, on severity and, and the virulence of |
|
| 15:34 | agent? Ok. But that's typical gastrointestinal uh upsets. Ok. And |
|
| 15:40 | treatment as with most gastrointestinal infections. . There's really no treatment. |
|
| 15:50 | And why is that? Think about intestinal system if you eat something, |
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| 16:01 | you owning that forever or are you renting it? Analogy, drink |
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| 16:09 | Are you holding on to that water or are you getting rid of it |
|
| 16:13 | through? All right. So in diseases, unless it's something super |
|
| 16:20 | you just let it run its course it will literally pass. Ok. |
|
| 16:27 | um what you do is rehydration give water electrolytes, right? That's |
|
| 16:33 | you're doing. You're losing water. just do that. Um You don't |
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| 16:38 | give um antibiotics because most of these are due to viruses, stomach |
|
| 16:45 | You all heard of that, So, viral causes are really what |
|
| 16:48 | most G I tract infections. of course, if it's become |
|
| 16:53 | um you can get very bad abdominal and cramps and blood can appear in |
|
| 16:59 | stool. That's, that's another So it may require antibiotics at that |
|
| 17:04 | . Just depends on how severe. for most, it's just that it |
|
| 17:08 | its course and drink lots of Um And so this uh nn |
|
| 17:15 | oh God, I can't say Natas . OK. So those there are |
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| 17:20 | protozoal anti protozoal drugs. Uh you don't need to mem memorize |
|
| 17:24 | Um This is, this is all what I'm showing here is strictly just |
|
| 17:27 | of what is typical for any kind infectious agent cause symptoms, they produce |
|
| 17:35 | , et cetera. That's kind of this is about. Ok. And |
|
| 17:40 | prevention control or diagnostics, we will about not in this unit, but |
|
| 17:44 | next unit, we'll talk a little about detections. So we need to |
|
| 17:48 | talk a little bit about the adaptive system, right? An embodies an |
|
| 17:52 | because that serves the basis for uh , you do uh to identify different |
|
| 17:59 | agents. So of course, the deal has been for quite some |
|
| 18:03 | although you, you've been drilled into . Coax postulates uh I take a |
|
| 18:09 | , isolate the organism uh and then what you got, identify it and |
|
| 18:14 | forth. OK? That obviously takes . OK? You still do |
|
| 18:18 | OK? But you also want to , especially with something quite virulent and |
|
| 18:24 | patient is noticeably not getting well, quickly that you went through rapid ID |
|
| 18:30 | that often involves antibody antigen reactions. so there's a number of tests to |
|
| 18:36 | many different types of infectious agents and can do it within a couple of |
|
| 18:40 | and know what it is and then accordingly. But you know, you |
|
| 18:44 | , for many infectious diseases, you do them. It's got a sample |
|
| 18:48 | played it out though the, the microbiology type isolation, you still do |
|
| 18:53 | well. But this is often also um uh important step too. |
|
| 18:59 | But also there's many you can't, can't be cultivated. So you |
|
| 19:03 | it is the only, only choice have. OK. Um But rapid |
|
| 19:07 | is a very important thing. So the uh OK, not there |
|
| 19:14 | So, so, so again, is just an example. Uh uh |
|
| 19:18 | can take any infectious disease and kind go through and see that there's a |
|
| 19:23 | reservoir where the organism is found. a motor transmission, there's um uh |
|
| 19:29 | know, there's a disease state it , depending on where it's affecting. |
|
| 19:33 | there's ways to detect it and treat . Ok. So, um so |
|
| 19:39 | the question. So let's look at , this one I actually got um |
|
| 19:44 | of the book out of your book in this chapter. So it says |
|
| 19:48 | members of a group of ornithologists which bird watchers studying barn owls in the |
|
| 19:56 | have had salmonellosis. Ok. Um murderer is experiencing her third infection. |
|
| 20:03 | is the most likely source of their ? Ok. I imagine it's probably |
|
| 20:11 | obvious here. This will take us transmission of disease in a getting counting |
|
| 21:04 | for a moment. 12. That, yeah, that's slam |
|
| 21:23 | Yes. Contaminating hands while the owls handling the owls in the nest. |
|
| 21:30 | this is gonna be uh I'd say probably a fecal oral route. |
|
| 21:37 | I'm thinking so something else is gonna a gastrointestinal uh pathogen. Um I |
|
| 21:42 | the owls and the nests and the , uh, certainly you can probably |
|
| 21:46 | into contact with that. Um, , uh, the fact that the |
|
| 21:50 | water is contaminated, I don't That's really relevant here because there's nothing |
|
| 21:55 | that. They're drinking water or Uh, in fact, they have |
|
| 21:59 | carrier. I don't know, it really relevant either. I mean, |
|
| 22:04 | , you know, uh, in of, in terms of these others |
|
| 22:08 | uh disease from this person, Um Eating the same food, |
|
| 22:15 | the the implication here is that they're these birds continuously. So that would |
|
| 22:20 | to be the uh logical conclusion OK. Um The um so transmission |
|
| 22:29 | disease, right? So we, saw this graphic last time. |
|
| 22:34 | Um The reservoir is gonna be the where it lives. OK? And |
|
| 22:40 | doesn't have, it doesn't have to in the context of or there's a |
|
| 22:45 | outbreak, right? It can just at any time. This is where |
|
| 22:49 | find it typically. OK. Um so of course, then where it |
|
| 22:54 | , it has to be transmitted to . And that's what we'll talk |
|
| 22:57 | Next is different modes of transmission. Like I said before, uh this |
|
| 23:02 | over here we'll talk about in the of chapter 15. OK. So |
|
| 23:09 | look at modes of transmission. So we just mentioned reservoir, |
|
| 23:15 | So humans, humans of course, be um source from many different |
|
| 23:21 | right? Measles, mumps, diphtheria, uh certainly STD S |
|
| 23:27 | So humans are the one that, are the ones that are the reservoir |
|
| 23:31 | many. Uh, and because there be asymptomatic carriers, right? |
|
| 23:37 | uh, that don't show any signs disease and they're typically the ones that |
|
| 23:41 | the, the source for these uh, animals, um zoonosis. |
|
| 23:47 | those are animal specific, create the , an animal rabies, typical |
|
| 23:52 | Uh so lyme disease uh in a . Um So zoonosis can uh of |
|
| 24:00 | be various types of insects, um types of mammals. Um Ebola uh |
|
| 24:07 | is the bat and bat seems to a co a a not uncommon |
|
| 24:11 | Ebola, uh COVID uh SARS. these are all uh bats are thought |
|
| 24:19 | be the um reservoir for these. um nonliving uh soil and water. |
|
| 24:27 | . And so uh certainly uh soil different, different types of pathogens, |
|
| 24:34 | tetanus, of course, uh um as well. Um Then of |
|
| 24:39 | contaminated water sources, uh cholera crypto we just mentioned. OK. So |
|
| 24:49 | infection cycle. So this of course where we go from reservoir to |
|
| 24:55 | OK. And that can take many . And so uh we look at |
|
| 24:59 | in terms of contact, um a , think of the vehicle as like |
|
| 25:05 | , a medium or matrix that is the um agent. OK. And |
|
| 25:10 | vectors, vectors are very commonly not exclusively but fairly commonly insects. |
|
| 25:17 | . Um So with contact, we three types uh direct, indirect |
|
| 25:23 | So, droplet, there's droplet in , ok. Which can get somewhat |
|
| 25:30 | but uh difference between droplet and airborne distance. Ok. So those that |
|
| 25:36 | travel long distances, things like TB is one of those. Um the |
|
| 25:43 | of the length depends on is the on the nature of uh so a |
|
| 25:50 | with TB is gonna cough obviously, . And create airborne particles. And |
|
| 25:55 | think it depends on the combination of the mucus being produced and the |
|
| 26:00 | and the car being carried on air and things like that. Uh |
|
| 26:05 | some are more easily done travel that than others. OK. And so |
|
| 26:10 | droplet, that's typically things like cold flu um uh are typically droplet |
|
| 26:18 | uh typically droplet type infection short OK. The uh direct, that's |
|
| 26:24 | , probably pretty self explanatory. So uh kissing your partner or um uh |
|
| 26:31 | or, you know, STD modes transfer um hand holding these, these |
|
| 26:35 | of things uh indirect. So the might, right? So the fite |
|
| 26:40 | inanimate object, a, a a wall floor, um a used |
|
| 26:47 | or something, a um a OK. A contaminated needle. These |
|
| 26:53 | all foam mis OK. Um uh the vehicle, OK. |
|
| 27:00 | it's thing with it as a, a matrix or medium through which the |
|
| 27:04 | is transported. So it can be airborne or foodborne. There can also |
|
| 27:08 | other variants of this. Let me get this out of the way. |
|
| 27:13 | The uh blood and drugs or bloodborne . Um So, uh transfusion of |
|
| 27:23 | , one of the mechanisms uh was contaminated blood um making a bloodborne pathogen |
|
| 27:31 | well as STD. Um But any , so waterborne um typically through fecal |
|
| 27:37 | of water sources, um or a treatment system is compromised by some other |
|
| 27:43 | of catastrophe. And so you don't appropriate uh uh uh uh water treatment |
|
| 27:50 | on which can introduce contaminants. So certainly things like cholera, crypto, |
|
| 27:57 | are kind of waterborne diseases uh And so again, these are traveling |
|
| 28:03 | , OK? Very often the the part particle that's carrying the agents are |
|
| 28:09 | particles. Uh pet hair called dander carry these things. Um food borne |
|
| 28:18 | . So that can be several uh there. So it can be um |
|
| 28:23 | from uncontaminated animal, right? It's and you eating the contaminated meat, |
|
| 28:28 | not, it's not cooked properly perhaps or maybe the food is sitting out |
|
| 28:34 | room temp for quite a long time stuff begins to grow in there and |
|
| 28:38 | you ingest it. Ok. Um food as mentioned uh the handling, |
|
| 28:45 | ? The sanitary conditions of the food , right? Um Are you |
|
| 28:52 | are the uh servers wearing gloves, net. Um uh Are they cleaning |
|
| 28:57 | floor? Uh are they cleaning the . So how, how sanitary is |
|
| 29:02 | process going on? These, any that's compromised? There can be a |
|
| 29:08 | where it can introduce foodborne illness. . Washing hands, right. Workers |
|
| 29:13 | their hands when they go to the before returning to the uh rest uh |
|
| 29:17 | area. So anyway, so these all uh examples of foodborne illness. |
|
| 29:23 | so with waterborne and airborne, this be linked to this. These can |
|
| 29:31 | hand in hand. Fecal oral transmission be a result of waterborne or |
|
| 29:36 | Those can kind of be linked OK. And so um the uh |
|
| 29:43 | sorry, not airborne, doesn't make sense. Not that one. |
|
| 29:48 | OK. Food borne and waterborne can uh linked with fecal oral route, |
|
| 29:54 | ? Servers not washing their hands if haven't gone to the bathroom, for |
|
| 29:58 | , um uh waterborne fecal contaminated right? Fecal oral route. |
|
| 30:04 | Congenital transmission. Uh mother to Uh very common. Uh examples of |
|
| 30:11 | are uh the female has some sort STD that's transmitted to the baby during |
|
| 30:17 | . OK. Syphilis, for OK. That would be congenital transmission |
|
| 30:23 | than vector. Uh typically insects. The uh I'm really trying hard to |
|
| 30:34 | of one of a fact that's not insect. Um I gotta think about |
|
| 30:40 | uh mechanical and biological transmission. distinction there is think of a fly |
|
| 30:47 | is hovering around uh garbage, a can or something, right. It |
|
| 30:52 | on garbage on top of the plane then it lands on you. So |
|
| 30:57 | is on its body parts, typically and it gets on you, then |
|
| 31:03 | ingest whatever you get infected as a . Uh pretty much kind of a |
|
| 31:08 | process, but that's what's called mechanical . OK. Um And so theoretically |
|
| 31:15 | that, you catch a number of infectious diseases, right? It's kind |
|
| 31:18 | a very random kind of a process with biological transmission, OK, which |
|
| 31:25 | a specific parasitic life cycle. malaria, for example, OK. |
|
| 31:30 | humans are part of that life OK. Um So, so biological |
|
| 31:38 | in contrast isn't a random kind of thing where you can catch, you |
|
| 31:42 | , many different types of infection It's a specific one. So |
|
| 31:46 | as I said, like malaria, example, I um now OK, |
|
| 31:53 | questions for OK. So let's look this is this is the introduction into |
|
| 32:00 | HPIS. OK. So the number , this should also be a |
|
| 32:05 | The number one uh preventative to The DA I is OK. Count |
|
| 32:50 | from eight. All right. Wash your hands. Um I can |
|
| 33:04 | talked out of it if somebody is strong about, feel very strong about |
|
| 33:07 | else. Uh But yeah, what is definite uh definitely the way uh |
|
| 33:14 | might have thought your love. Um necessarily. So because the outside of |
|
| 33:20 | globes aren't necessarily disinfected OK. Um uh the the uh and you may |
|
| 33:29 | them properly, right? Maybe you uh the blood on with the, |
|
| 33:33 | the unwashed hand or something like So, uh the game was the |
|
| 33:38 | one practice um to prevent prevent. healthcare associated infection, as was |
|
| 33:45 | this used to be called hospital acquired nosocomial because health care obviously has expanded |
|
| 33:51 | we in the hospital nowadays, these all uh scenarios where infectious disease can |
|
| 33:58 | acquired. So the main thing here um you are, you know, |
|
| 34:03 | you're at a clinic or you're at hospital or a home health work |
|
| 34:09 | OK? You acquire an infectious disease the result of those interactions in the |
|
| 34:16 | you're in there for something else, just in order to get rehab on |
|
| 34:20 | knee or something. And then, know, somehow the person transmit, |
|
| 34:26 | this disease to you. And now have this, that's, that's |
|
| 34:29 | that's what this is to help the . OK. And so um |
|
| 34:36 | you know, this can be gives a value of 4 to 5%. |
|
| 34:40 | It can be a little bit higher that, depending on the facility. |
|
| 34:47 | uh but there is always ac uh level of of these infections going on |
|
| 34:51 | a hospital at any given time. ? So you're never, it's never |
|
| 34:55 | 0%. OK? There are great here and there and it's, you |
|
| 35:01 | , it's you know, when you're with humans, there's gonna be error |
|
| 35:04 | all the procedures and that's when there's , a uh breach in the |
|
| 35:11 | So, anyway, so there's kind three areas that come together. |
|
| 35:15 | microorganisms in the hospital environment. So the hos we, we take the |
|
| 35:20 | scenario was the hospital full of lots not, well, people, |
|
| 35:26 | maybe they're with different types of, , of, you know, carrying |
|
| 35:31 | that for normal healthy types, don't cause problems. But in these |
|
| 35:36 | people, you know, you have that maybe, uh, are burn |
|
| 35:39 | that some of our cancer patients and and that compromised immune systems. So |
|
| 35:44 | that sets the table for opportunistic pathogens do their thing, right? And |
|
| 35:51 | particularly what you acquire in these are opportunistic pathos. And so, |
|
| 35:57 | and so, uh, the p other, the purple one that |
|
| 36:00 | So I just a whole variety of types. Right. Me, cancer |
|
| 36:06 | on drugs that suppress the immune uh, if there's burn victims |
|
| 36:11 | they're very susceptible. Uh, because skin, skin is one of your |
|
| 36:16 | innate immune system defenses barrier, And they're certainly compromised in terms of |
|
| 36:21 | . Um, and then, you , they, uh, uh, |
|
| 36:25 | , go in for surgery. So have, um, you know, |
|
| 36:28 | exposed the body, uh, you , oops, sorry, you |
|
| 36:31 | uh, you may have a, , uh, a wound that's been |
|
| 36:34 | up and so that's the potential for , if not careful. And then |
|
| 36:38 | course, various types of, of A I DS or mechanical devices |
|
| 36:45 | are used, right? A breathing . Uh, a, a |
|
| 36:49 | a, a, um, you know, different types of |
|
| 36:53 | right. IV. Uh, a, you know, a, |
|
| 36:57 | do you call it? The, , um, like the external |
|
| 37:00 | you know, for, um, that can't urinate, they have the |
|
| 37:03 | , right? So that's your uh catheter um different types of devices put |
|
| 37:08 | the body, hip replacement, knee , these are all potential points of |
|
| 37:14 | acquiring infections. OK. And so so then of course, chain of |
|
| 37:19 | , right? So you have OK, you have uh this and |
|
| 37:28 | have this right, compromised host and organism in the hospital environment then getting |
|
| 37:35 | together, right, transmitting transmission of , right, causing infection. So |
|
| 37:42 | the um the uh routes of So of course, to go between |
|
| 37:51 | patients that are ill and maybe patients are not so ill like you, |
|
| 37:56 | ? Or me who's going in between care people, right? Nurses, |
|
| 38:04 | , doctors, what have you right going between, you know, these |
|
| 38:09 | sources. And so um not to , you know, think of the |
|
| 38:13 | the bedding that patients are on, has to be changed um the uh |
|
| 38:20 | railing the surfaces they touch and things that. And so these are all |
|
| 38:25 | points of transmission. OK. And , um types of infections you |
|
| 38:32 | OK, very often are staffs. . Staff. Uh number one, |
|
| 38:40 | think currently is this one, uh , the feile shows up tends to |
|
| 38:49 | up most often than others. Right . There's been a, it used |
|
| 38:53 | be staph. OK. What's called Mersa? It's kind of the name |
|
| 39:01 | resistant Staph for you. I think been overtaken by Clostridium, the |
|
| 39:07 | but there's others enterococcal. Uh So e coli urinary tract infection. So |
|
| 39:14 | that's the most common in terms of I. Uh So um certainly uh |
|
| 39:20 | these are things to deal with but , can be hospitals, of |
|
| 39:24 | have, have, well, if are accredited hospitals, they'll have |
|
| 39:30 | a committee, not committee but AAA or a group whose job is to |
|
| 39:37 | on track of this uh of, their rate of hospital acquired infections |
|
| 39:42 | and testing and these kind of things see. Uh Are they following? |
|
| 39:47 | everybody complying with what you're supposed to here in terms of uh not transmitting |
|
| 39:52 | ? And so I just kind of , you, you don't need to |
|
| 39:57 | this or I'm just kind of show as an example of H an ha |
|
| 40:01 | and this is the most common one days is this Clostridium defile. So |
|
| 40:05 | a, it's a gram positive. So remember those, this is one |
|
| 40:09 | the endospore form. OK. Remember group, this group is one of |
|
| 40:14 | endospore forming types. So this produces . So, again, rence |
|
| 40:18 | right? And it actually uh is the guts of, of um healthy |
|
| 40:27 | , OK? In the large Uh but it uh it's held, |
|
| 40:33 | held at bay by your normal OK? But in some individuals, |
|
| 40:39 | if you get antibiotics um then you , you, you're gonna, you're |
|
| 40:43 | affect your gut microbiome. And so , it can change the balance of |
|
| 40:48 | in there. And that's when clostridium cell can take hold. Ok. |
|
| 40:53 | can begin to uh dominate, And that's when issues can occur. |
|
| 40:57 | so what happens is they produce Uh this can cause inflammation. So |
|
| 41:04 | is healthy intestinal tissue. See the here, here's the tract going through |
|
| 41:10 | then uh the cells begin to die a result. You can certainly see |
|
| 41:14 | difference between these, these two panels on the right B and C compared |
|
| 41:19 | A which is healthy. And so this can uh of course cause a |
|
| 41:25 | gastrointestinal tract inflammation, diarrhea, uh among the elderly. This is really |
|
| 41:31 | a is a, is an issue uh can uh can lead to, |
|
| 41:37 | be fatal. OK. And so a, it's a kind of AAA |
|
| 41:43 | oral route transmission. Um patients uh acquire this oftentimes the betting has not |
|
| 41:50 | properly or it's not changed very And that's what leads to the uh |
|
| 41:55 | they're on antibiotics for something else. so uh that puts them in this |
|
| 42:01 | that this can, this can um . And so um uh and those |
|
| 42:07 | have it, uh so memory forms those spores. So it can be |
|
| 42:11 | from one health care worker can be go between, between patients and transmit |
|
| 42:16 | to others. So, um so , it is an issue. Um |
|
| 42:22 | so what you do is to stop antibiotics, whatever the person's on, |
|
| 42:30 | ? So that their system kind of recover and then uh use what's called |
|
| 42:35 | vancomycin, which is specifically ramp positives probiotics, right? So, |
|
| 42:41 | get their microbiome back to normal as as you can because that's what's keeping |
|
| 42:47 | thing at bay, right? Uh forgot to look up fed uh Fedom |
|
| 42:54 | . But the fecal transplant is Ok. So what would a fecal |
|
| 42:59 | do for the person? They had ? Yeah. It's basically like taking |
|
| 43:05 | . It's just a, it's, a, it's a natural way to |
|
| 43:09 | probiotics, I guess. Um But you would um uh I forget how |
|
| 43:14 | administer it. Uh But anyway, , but that's what the, that's |
|
| 43:17 | source of, kind of like the uh we didn't talk about that in |
|
| 43:21 | . Uh The wastewater treatment plant. But um if you have a wastewater |
|
| 43:27 | plant which treats your water, bacteria basically in the water that are |
|
| 43:31 | treating the breaking down the bad stuff the water. And if it was |
|
| 43:35 | treatment plant goes down and not working , you can go to a nearby |
|
| 43:40 | and take some of their bacteria and it in yours and they'll get it |
|
| 43:43 | again. So this is kind of this is if you can do a |
|
| 43:46 | transplant and get your microbiome back much quickly. OK? Because that's the |
|
| 43:51 | of the mechanism that keeps these things bay. Ok. So, um |
|
| 43:57 | so in terms of different uh procedures, parts of the body, |
|
| 44:05 | . So these, these cannot be to again, different medical devices. |
|
| 44:11 | , urinary tract infections, mishandling of catheters. All right. So these |
|
| 44:16 | all prepackage, sterile, um implements you have to treat, use open |
|
| 44:24 | and use them and put your hands it or whatnot. Then that introduces |
|
| 44:28 | contamination, ok. Surgical site infections certainly not the cleaning wounds properly. |
|
| 44:35 | can lead to that lower res respiratory infections. Again, breathing tubes, |
|
| 44:40 | like that get contaminated um G I infections um often due to just see |
|
| 44:48 | file through immunocompromised patients. So, uh so again, the different devices |
|
| 44:56 | , uh here's a uh bag for patient. We that would be the |
|
| 45:02 | tract, uh catheter um assisted uh gloves, et cetera. Um |
|
| 45:09 | the uh some kind of IV device . I think here's a breathing |
|
| 45:14 | I think here. So, oh it is. So any of these |
|
| 45:17 | get contaminated and introduce these infectious OK. So what's done? |
|
| 45:23 | what's done? Of course is what call universal precautions, which kind of |
|
| 45:28 | a, encompasses two areas. Which is called basic minimal precautions. |
|
| 45:34 | . What are called trans transmission specific ? OK. So collectively this is |
|
| 45:39 | to break that chain of transmission. ? And, and to do things |
|
| 45:46 | a way that um minimize those sources infection. OK. So the standard |
|
| 45:52 | , that's where hand washing comes right? Aseptic techniques, you |
|
| 45:56 | you have these that raise devices that used, catheters, et cetera, |
|
| 46:01 | know, open them, use them aseptically, right? Um uh handing |
|
| 46:07 | 10 material. So bedding, Bedding from patients, right? Put |
|
| 46:10 | in the proper receptacles, throw leave them sitting around on the |
|
| 46:15 | Um You know, dispose of them you're supposed to wash them frequently, |
|
| 46:19 | kind of things, right? Um of isolation rooms and wards and um |
|
| 46:27 | you have a burn victim, you know, it's gonna be very |
|
| 46:31 | to infection, then isolate them, them in a specific area, you |
|
| 46:34 | need to have areas that are ventilation the to the to the room is |
|
| 46:39 | in a certain way. OK. uh again, to minimize transmission, |
|
| 46:44 | P pe right, your gloves, , et cetera. Uh And of |
|
| 46:50 | , very important also is education right have monthly, if not uh biweekly |
|
| 47:00 | monthly meetings to go over this and beyond people about maintaining these procedures, |
|
| 47:09 | , the transmission based precautions. Again, to minimize transmission. So |
|
| 47:16 | um contact precautions, these, I to write some of these down, |
|
| 47:23 | are things that you might come in direct contact with and cause transmission, |
|
| 47:28 | ? So whether it's um uh whether urine or feces or, or |
|
| 47:34 | with uh skin infections, uh or the equipment or, or, or |
|
| 47:38 | that the patients would touch is to sure that you clean these areas that |
|
| 47:44 | are uh being cautious, uh droplet . So, uh this is typically |
|
| 47:50 | those that have like obviously respiratory but things like pneumonia, flu um |
|
| 47:58 | are, that are transmitted through droplet . So you may need to certainly |
|
| 48:03 | a mask, but also maybe you to put them in a, in |
|
| 48:07 | kind of a tent uh over the the surrounding their bed, right, |
|
| 48:11 | minimize uh spread of these materials. , airborne precautions certainly can involve that |
|
| 48:17 | maybe a specialized ventilation system, um in a isolating them in a, |
|
| 48:24 | a, in their own ward. tuberculosis would fit in that category. |
|
| 48:28 | it's not uncommon for TB patients to in their own isolated area as well |
|
| 48:33 | this reason. Ok. Again, in the effort to, you |
|
| 48:37 | really break that chain of transmission um, do things to so that |
|
| 48:44 | people coming into the hospital don't get with something else. Right. Or |
|
| 48:49 | , you know, people that are sick but don't acquire these infectious |
|
| 48:54 | on top of what they already Right. So, you certainly wanna |
|
| 48:57 | that. And, um, also, of course not anywhere on |
|
| 49:02 | though, but implied, I guess the, uh, you know, |
|
| 49:05 | have SAN, you have the sanitizer everywhere in the hospital almost. Um |
|
| 49:12 | so with E I Ds, we talked a little bit about this |
|
| 49:16 | um first day or at least in one. So, um again, |
|
| 49:25 | are, these may have been, have been diseases that had been known |
|
| 49:31 | for quite some time but, but occurred like here and there or maybe |
|
| 49:38 | and then kind of went away and wasn't made of it. OK? |
|
| 49:42 | could just be some something that completely blew up all of a sudden. |
|
| 49:47 | . And like as mentioned, they more often than not tend to be |
|
| 49:53 | in nature. OK. Um It here are three quarters of E I |
|
| 49:59 | uh are of that type and uh uh uh zoonotic. And so, |
|
| 50:05 | know, as you mentioned, the COVID, which has its uh ancestry |
|
| 50:11 | the SARS virus and in the MERS , which is the Middle Eastern |
|
| 50:17 | Um uh So all three of those , are, are bat origins. |
|
| 50:23 | , as is Ebola. Um, it's a, uh, definitely something |
|
| 50:29 | keep watch on. Ok. And the, how do we identify these |
|
| 50:36 | ? Well, like I mentioned, it's something that was not really common |
|
| 50:39 | all of a sudden now it Ok. Um, maybe there were |
|
| 50:43 | few cases previously and now all of sudden you see a burst of |
|
| 50:47 | Um, the, uh, maybe was a disease that had, you |
|
| 50:53 | , maybe a slight fever and headache now that agent causes, um, |
|
| 50:59 | know, severe, so, really fever, uh, abdominal pains or |
|
| 51:04 | , right? In other words, severe. And that's also a |
|
| 51:07 | So, um, the, or maybe this completely new set of |
|
| 51:13 | . Ok. And so it's um, it is something to be |
|
| 51:20 | on, in particular, those that out there kind of looking for the |
|
| 51:23 | one. They're really looking at animal and seeing. Um, are we |
|
| 51:29 | changes in, you know, are we seeing now, animals coming |
|
| 51:33 | with something we haven't seen before? . That's a cue that, you |
|
| 51:36 | , with the zoonotic disease, which seem to be like more often than |
|
| 51:40 | , that's what you wanna look at animal populations out there. And |
|
| 51:44 | um, the, and seeing, we seeing different behaviors, are we |
|
| 51:47 | maybe some outbreaks among different animals that be a cause for alarm that maybe |
|
| 51:53 | need to be aware of and look this more closely. Ok. Of |
|
| 51:57 | , become because the, if it's , you have to have the human |
|
| 52:02 | there somewhere, right? Because that's gonna enable the agent, whether viral |
|
| 52:07 | whatever to evolve and infect the Right? Ultimately, it has to |
|
| 52:11 | contact. And so that's why as get human populations increasing, right, |
|
| 52:18 | more and more this is gonna become issue because we're gonna be just the |
|
| 52:22 | that we're humans, we're just gonna in contact more readily with these |
|
| 52:26 | Ok. Um Certainly climate change because has affected um migration patterns of certain |
|
| 52:36 | like insect vectors. Now maybe can what it used to be contained in |
|
| 52:41 | certain environment because of the temperature. getting warmer, they can expand their |
|
| 52:46 | and so that can affect more Um, other types of animals, |
|
| 52:51 | same way their migratory pattern can be due to climate change and that can |
|
| 52:55 | uh humans that now become affected. And so certainly misuse of antibiotics, |
|
| 53:03 | , pesticides, um just using blanket to treat the disease or without |
|
| 53:09 | really um isolating the organism or finding what it is and being more specific |
|
| 53:14 | it. Uh But now they have use antibiotics for everything, not just |
|
| 53:18 | disease in humans, but uh give to animals, um, animals that |
|
| 53:23 | farm to, to make them less because they're in crowded conditions, more |
|
| 53:27 | to disease. So, let's give antibiotics to, to prevent that. |
|
| 53:32 | of course, that gets, we the, we eat them, |
|
| 53:35 | the antibiotics get into us. If track, um, wastewater, there's |
|
| 53:40 | bunch of stuff in there. many different types of antibiotics, people |
|
| 53:44 | them down the toilet as well. , uh, these are all |
|
| 53:47 | right, because what does the bacteria to become resistant? Exposure? Right |
|
| 53:52 | these antibiotics. And they get that through the misuse and the using them |
|
| 53:57 | everything nowadays. And um all you to do is have a population of |
|
| 54:03 | , of the bacterium that has the combination of genes that make them |
|
| 54:08 | and that's they'll proliferate right in the of these antibiotics. So that's, |
|
| 54:13 | a problem. Ok. And so genetic recombination evolution. Um all, |
|
| 54:21 | mean things evolve but when you have that can grow as fast as we |
|
| 54:26 | how they grow, right? And get amputation in there, well, |
|
| 54:30 | quickly, they can blow up in numbers, right? Simply with |
|
| 54:34 | , viruses mutate rather quickly. And um the the number, their numbers |
|
| 54:40 | uh grow rapidly. And so it's , it certainly ha it happens, |
|
| 54:45 | evolve uh at a faster rate because that because they're fast growth rate. |
|
| 54:50 | , um so it's all something that have to keep on top. |
|
| 54:56 | Um Because there are, we have , we have multidrug resistant variants of |
|
| 55:02 | bacterial types um, viruses can mutate , and, uh, uh, |
|
| 55:08 | know, get around our host defenses things like that. So, |
|
| 55:11 | it's, it's an, it's an obviously. So, um, unfortunately |
|
| 55:16 | , I wish I could say um, COVID is the last time |
|
| 55:20 | see a pandemic. But would you on that? I know. |
|
| 55:27 | um, I hope not. uh, well, wait, |
|
| 55:33 | I didn't think I said that I hope there isn't another pandemic. |
|
| 55:36 | . That's what I meant to So uh with epidemiology, I'm just |
|
| 55:40 | touch on just the, the start this. I'm not gonna go into |
|
| 55:42 | the we'll save for Thursday, the mechanisms but uh epidemiology, of |
|
| 55:49 | All right, we look at data and so data of, you |
|
| 55:54 | the incidence and prevalence of diseases and this can help us in different |
|
| 56:00 | Uh We can break it down in of uh if there's an out all |
|
| 56:05 | a sudden surge in cases, it's . Where is it happening? Um |
|
| 56:11 | it happening to? Is there a in terms of, is it this |
|
| 56:16 | uh ethnic group? Is it this , is it mostly in, in |
|
| 56:20 | certain gender and not, not not the other? Is it, |
|
| 56:24 | there a geographical component? Is that in this kind of climate and not |
|
| 56:28 | climate? Uh What time of year these are these cases prevalent? So |
|
| 56:33 | of that can be used to kind figure out what's going on. |
|
| 56:37 | And maybe even to control the So, um controlling uh so controlling |
|
| 56:43 | , right? So, very common Houston for sure is um so down |
|
| 56:50 | , of course, West Nile virus , is endemic in this area, |
|
| 56:54 | cared by a mosquito. And so what's, what's one thing we do |
|
| 57:01 | terms of controlling the reservoirs is to have standing water laying around to dump |
|
| 57:05 | standing water to because that's a reservoir the mosquito, they grow, larva |
|
| 57:10 | in the standing water and then I transmit disease. So that's one |
|
| 57:15 | So food inspection, uh that's how do that right to minimize foodborne |
|
| 57:22 | The uh sewage disposal is certainly using practices to minimize um transmission of |
|
| 57:29 | Um And then of course, looking um graph, look at data, |
|
| 57:35 | ? Uh looking at instance of uh you can look at effectiveness, |
|
| 57:40 | , effectiveness of control mechanisms like OK. Vac vaccination versus decline in |
|
| 57:48 | in disease. Uh This is Lyme . It is caused by a |
|
| 57:53 | Uh Well, a tick transmits the due to a bacterium, but it's |
|
| 57:57 | by a tick. And so this just looking at numbers of cases of |
|
| 58:01 | disease over 16 years and um seeing and valleys and then looking at, |
|
| 58:10 | , what, what is this uh about? There's about 10. Is |
|
| 58:20 | about? OK. What are these about why is it going up? |
|
| 58:25 | . So we can look at, , at least here, right, |
|
| 58:31 | to that big peak is the summer . So, um, that may |
|
| 58:37 | to, uh, I don't know specifics but maybe, uh, summer |
|
| 58:42 | , uh, your rainfall amounts. , this is the tick is, |
|
| 58:48 | , carried on like deers and all of, of animals. So there |
|
| 58:51 | be a correlation between summer months and of food for those sources, |
|
| 58:57 | or, or rainfall amounts, things that can affect, uh, tick |
|
| 59:02 | . And so, uh, maybe some correlation there. So, |
|
| 59:06 | you know, this is kind of you use this data for. Maybe |
|
| 59:09 | can see some kind of a pattern then, uh, based on |
|
| 59:13 | uh, make assumptions and, and, uh, see what's going |
|
| 59:18 | , ok, to control it if becomes serious. Ok. So, |
|
| 59:24 | , uh, so there's different ways use this epidemiological data, um, |
|
| 59:28 | kind of, um, figure out causing disease and, um, how |
|
| 59:32 | we stop it then, uh, so forth? And so we'll look |
|
| 59:35 | those, there's like three different types that that we'll look at next |
|
| 59:37 | Ok. Uh, any questions? all I'm gonna do today, |
|
| 59:43 | So let's, let's, uh, you all on Thursday and look out |
|
| 59:47 | the exam will be up tomorrow. , take a look at |
|
