Basic Microbiology

Infection and it’s Spread

Infection
• A process Pathogenic
organisms gain access to a
susceptible human body.
Spread of infection-
3 elements:
• A source – of Infecting
microorganisms
• A means - of Transmission
for the microorganism
• A susceptible host
Source and Type Of Infections

• Endogenous Infections:
Caused by Microorganisms that are already
present on or in the human body which acts as
Reservoir of infection (Source)
• Exogenous Infections:
Caused by microorganisms from the external
environment (Source)
Type of Transmission

• Horizontal Transmission:
Occurs from person to person
• Vertical Transmission:
Transmission from mother to fetus
across the placenta
Horizontal Transmission thru Contact

• Direct Contact
Direct exposure to skin
and body secretions.
such as their skin or an
infected wound, to
another part of their own
body or to another
individual.
Contact Transmission
• Indirect Contact
Occurs when organisms
from an infected host or
other reservoir are
transmitted to a
susceptible host via an
inanimate object or fomite.
such as endoscopes,
clothing, bedding,
dressings and sinks.
Contact Transmission
 Droplet Transmission
(Airborne
Transmission)
Transmission of
infectious agents in
droplets from
respiratory secretions
by coughing, sneezing
or talking
eg: cold and influenza
viruses, Tuberculosis.
Preventing Infection in
Endoscopy
Control the source of microorganisms
Prevent their transmission
Minimise the risks associated with
increased host susceptibility.
These are achieved thru:
Cleaning, Disinfection, Sterilization
Standard and Additional Precautions
Immunization
Standard and Additional Precautions

In 1996, the National Health and Medical

Research Council (NHMRC)/Australian
National Council on AIDS (ANCA) Infection
Control Working Party adopted the terms,
'standard precautions' and, 'additional
precautions', to define appropriate work
practices, based on modes of transmission
of infectious agents.
This principle is applied universally to all
patients, regardless of their infectious
status or perceived risk.
Standard Precautions
Work practices required for the basic level of infection
control- recommended for the treatment and care of all
patients.
They include:
• hygienic practices, particularly washing and drying hands
before and after patient contact
• use of protective barriers when necessary, such as
gloves, gowns, plastic aprons, masks, eye shields or
goggles
• appropriate handling and disposal of sharps and other
contaminated or clinical waste
• appropriate reprocessing of reusable equipment and
instruments use of aseptic technique
• use of environmental controls
Additional Precautions
• These precautions are implemented
when standard precautions may be
insufficient to prevent transmission of
infection patients known, or suspected to
be, infected or colonised with disease
agents that cause infections in health
care settings that cannot be contained by
standard precautions alone and can
cause infection by the following means
 Microorganisms

• Gram Negative
Stain- prefer all
conditions
especially wet

• Gram Positive
Stain- prefer dry
environments
Normal Flora

• Gastrointestinal Tract  Environmental Organsims-

Flora Water borne
 Micrococcus,
 Respiratory Flora  Flavobacterium,
 Serratia,
 Chromobacterium,
 Acinetobacter and Achromobacter,
 Pseudomonas and atypical
 mycobacteria (i.e. not M.
tuberculosis)
 E. coli and
 Klebsiella
Common Microorganisms in
Endoscopy
Bacteria Viruses
• Clostridium difficile
 Enteroviruses
• Helicobacter
 Hepatitis B virus
• Legionella
 Hepatitis C virus
• Multi-resistant
organisms  Human immunodeficiency
virus (HIV)
• Mycobacterium
• Pseudomonas
• Salmonella
• Serratia
 Clostridium Difficile- Gram Positive
Disease
• causes antimicrobial associated diarrhoea
and colitis
Mode of Transmission
• Transmission is via the faecal-oral route
and can occur from patient to patient
Significance in endoscopy
• C. difficile spores are less resistant to a
variety of chemical disinfectants.
• Exposure for 10 minutes to 2%
glutaraldehyde has been shown to
inactivate C. difficile spores
 Helicobacter
• A spiral shaped bacteria with the human gastric
mucosa being its major habitat.
Disease
• major cause of gastritis
• major factor in duodenal/ gastric ulcers
• factor in some cases of gastric cancer
Mode of transmission
• Most probably acquired by oral-oral transmission
Significance in endoscopy
• Helicobacter pylori transmission by contaminated
biopsy forceps has been demonstrated.
 Legionella
Disease
• Main cause of legionellosis or Legionnaire's disease
• other species may also cause disease particularly in
immunocompromised patients
Mode of transmission
• By the inhalation of aeosols containing Legionella
• By aspiration of water or respiratory
• By direct instillation during respiratory tract manipulation
Significance in endoscopy
• Pseudoepidemics have occured where L. pneumophilia has
been found in broncheoalveolar lavage specimens due to
contaminated water used to rinse disinfected
bronchoscopes
 Multi Resistant Organisms

• MRSA (Methicillin Resistant

Staphylococcus Aureus)
• VRE (Vancomycin Resistant
Enterococci)
• MDRTB (MultiDrug-Resistant
Tuberculosis)
Potential risk for contamination of
the environment by an infected
patient.
• Additional precautions (contact
transmission) are recommended
 Microbacterium Pseudomonas
• Gram negative, live in water, moist and dry
environments
Disease
• Pneumonia, urinary tract infections, burn and
wound infections, eye infections, bacteraemia
Mode of transmission
• contact with environmental reservoirs or from
person to person
Significance in endoscopy
• Transmission from from the hospital environment
• largely been confined to E.R.C.P
 Salmonella
• Gram negative bacillus that can be found in the gut of
humans and almost all animals throughout the world
Disease
• Gastroenteritis
• typhoid caused by Salmonella typhi (not usually transmitted
by endoscopy)
Mode of transmission
• Thru faecal-oral route most commonly via food such as eggs,
meats and dairy products.
Significance in endoscopy
• Historically, most common causes of infections in endoscopy.
• associated with inadequate cleaning of accessories,
 Serratia
• Gram negative, thrives in moist environments.
Contaminates solutions and hospital equipment,
human reservoirs are the urinary and respiratory
tracts, gastrointestinal tract of children
Disease
• pulmonary, urinary, and surgical site infections.
Mode of transmission
• from person to person via the hands of HCW's or
from environmental reservoirs to patients.
Significance in endoscopy
• Several outbreaks of S. marcescens infection have
been tracked to bronchoscopic transmission.
 Enteroviruses
• Polio viruses, Coxsackie viruses, Echo
viruses as well as Entero viruses
Disease
• Acute febrile illness to meningitis,
encephalitis and myopericarditis
Mode of transmission
• Faecal-oral
Significance in endoscopy
• Polioviruses are more resistant to many
chemical disinfectants.
• cleaning and disinfection of endoscopes
was totally effective
 Hepatitis B Virus
• A DNA virus from the Hepadnavirus family
Disease
• acute hepatitis
Mode of transmission
• By exposure to infected tissues, blood or other
body fluids.
• by exposure of mucous membranes, such as
eyes, nose and mouth to infected material.
Significance in endoscopy
• HBV is a highly infectious virus and
• moderately sensitive to the majority of
chemicals.
Hepatitis C Virus
• an RNA virus closely related to the Flavivirus group
Disease
• cirrhosis, liver failure or hepatocellular carcinoma
Mode of transmission
• via contaminated blood, human body fluids
including saliva, ascites and urine, Significance in
endoscopy
• Transmission of HCV associated with endoscopic
procedures, in many cases this seems related to
inadequate cleaning.
 Human Immunodeficiency Virus
(HIV)
• A blood borne retrovirus that was first recognised in
1981
Disease
• Acquired immune deficiency syndrome
Mode of transmission
• Sexually, direct contact with blood or other body
fluids, percutaneous injury.
• Standard precautions are sufficient to prevent HIV
transmission.
Significance in endoscopy
• HIV is sensitive to many chemical disinfectants
including aldehydes.
• Scrupulous manual cleaning removes all traces of
blood and proteinaceous material.
 Prions
A proteinaceous infectious agent, which accumulates in neural cells
Disease
• Transmissible spongiform encephalopathies (TSEs), fatal
degenerative brain disease include:
Classical Creutzfeldt-Jakob disease (cCJD)
Variant CJD (vCJD)
Gerstmann-Straussler-Scheinker Syndrome (GSS)
Fatal Insomnia (FI), Kuru
Mode of Transmission
• after use of contaminated medical equipment
• after use of extracted pituitary hormones or gonadotrophin
• after implantation of contaminated grafts of dura mater or cornea
Significance in Endoscopy
• Accessory items used in patients with known, or a higher risk of, CJD
shall be single use only items.
END