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McCann Technical School 70 Hodges Cross Road North Adams, MA 01247 MA104 MEDICAL SOCIAL SCIENCE 4 Credits Fall Semester Part I MICROBIOLOGY INSTRUCTOR: Terry LeClair, MA METHODOLOGY: Lecture and demonstration COURSE DESCRIPTION This course provides overview of the concepts and principles of Microbiology including; history and significant people, the use of the microscope, the study of microscopic life forms, the relationship of microbes to disease conditions and immunology. The course also provides the necessary principles of medical asepsis, disinfection, and sterilization. Universal and Standard precautions, OSHA guidelines, and CLIA regulations in relation to ambulatory health care are also emphasized. TEXTS: MICROBIOLOGY FOR HEALTH CAREERS, 5th edition, Grover-Lakomia, and Fong, Delmar. 1999. CLINICAL PROCEDURES FOR MEDICAL ASSISTANTS 7TH edition, Bonewit-West, Saunders Elsevier, 2008. TABER’S CYCLOPEDIC MEDICAL DICTIONARY, 21th edition, F. A. Davis, 2009. COURSE OBJECTIVES: 1. To list the important scientists and their discoveries in relation to microbiology. 2. Demonstrate knowledge of microbiology in relation to his/her role as a medical assistant in ambulatory care. 3. Identify the purpose and principles for maintaining environmental control in the medical office. 4. Identify the parts of the microscope and its operation. 5. Differentiate between the basic microorganism and their disease causing ability. 6. Describe the chain of infection and methods of breaking the chain. 7. List the immunizations for the common communicable diseases. 8. Integrate principles of medical asepsis including sanitation, antisepsis, disinfection, and sterilization. 9. Demonstrate knowledge of the preparation and sterilization of equipment and supplies. 10. Demonstrate knowledge of the principles and procedures in relation to Universal and Standard Precautions, OSHA guidelines, and CLIA regulations. 11. The student will demonstrate (psychomotor) proficiency in the clinical skills of an entrylevel medical assistant. 12. The student will demonstrate (cognitive) knowledge of the didactic learning of an entrylevel medical assistant. 13. The student will demonstrate (affective) personal behaviors consistent with the expectations of the profession and employer of an entry-level medical assistant. COURSE CONTENT: Unit 1-The historical perspective of microbiology-Grover-Lakomia & Fong pgs 1-20, Thompson Learning pgs 32-38. Unit 2-The microscope-Grover-Lakomia & Fong—pgs 21-38 Bonewit-West pgs 726-730. Unit 3-Bacteria and their cell structure—Grover-Lakomia & Fong pgs 6777, 100-124 Unit 4-The protists: algae and fungi-Grover-Lakomia & Fong—pgs 125132,149-167 Unit 5-The protists: parasites—Grover-Lakomia & Fong—pgs 133-139, 168-191 Unit 6-The protists: bacteria—Grover-Lakomia & Fong—pgs 139, 192-212 Unit 7-The protists: richettsia, chlamydia, mycoplasm, and viruses— Grover- Lakomia & Fong pgs 140, 213-242 Unit 8-Universal and Standard Precautions, OSHA guidelines and CLIA Regulations—Bonewit-West-Chp 2, Grover-Lakomia & Fong pgs 375400,413-425 Unit 9-The chain of infection-Grover-Lakomia & Fongs pgs 269-278. Bonewit-West Chp 2. Unit 10-Immunity: natural and acquired including common immunizations—Grover-Lakomia & Fong—pgs 279-292, 302, 311. Unit 11-Infection control: Medical asepsis and methods to control microscopic agents including sanitation, antisepsis, disinfection, and sterilization.Grover-Lakomia & Fongs-pgss 317-335. Bonewit-West Chp 2 CLINICAL COMPETENCIES: Using the microscope Prepare a slide for microscopic examination Sanitization of instruments Chemical disinfection of instruments Wrap instruments for autoclaving Perform sterilization procedures OUTCOMES MEASUREMENT: Grading: Exams including final Quizzes/homework/checklist Class participation/attendance 60% 30% 10% Homework due as announced. Late assignments will lose 5 points per day. Students will have 1 week to make up exams and quizzes. Final grade accounts for 35% of Medical Social Science Grade Passing grade for each component is 76. ATTENDANCE: Attendance at all classes is mandatory. Unit 1-The historical perspective of microbiology GOAL: To present the history of microbiology including the contributions of scientists in the field of Microbiology and the conquest of disease OUTCOMES: The students will demonstrate knowledge of the history of microbiology including the Contributions of scientists in the field of microbiology and the conquest of disease LEARNING OBJECTIVES: 1. Define a list of related terms 2. Describe the contributions of scientists in the conquest of disease CONTENT: I. II. The science of microbiology A. Definitions Milestones in the developement of the science of microbiology A. Anton von Leeuwenhoek 1. Inventor of the microscope 2. The father of microbiology B. The theory of spontaneous generation 1. Abiogenesis C. Francesco Redi and Lazzaro Spanllanzani 1. Experiments to disprove spontaneous generation D. Edward Jenner 1. Cowpox vaccine for smallpox E. Louis Pasteur 1. Disprove theory of spontaneous generation with experiments 2. Developed pasteurization 3. Germ theory of fermentation 4. Germ theory of disease 5. Vaccines against anthrax, chicken pox, cholera, and rabies 6. Father of Bacteriology F. Oliver Wendell Holmes and Ignaz Phillip Semmelweis 1. Holmes--suggested puerperal fever might be caused by doctors and nurses not washing hands between patients 2. Semmelweize—concluded puerperal fever was infectious and promoted handwashing and clean rooms G. John Tyndall 1. Developed method of killing heat resistant bacteria known as Tyndallization I. Lord Joseph Lister 1. Introduced and used carbolic acid as a disinfectant in handwashing, cleaning surgical tools, and misting the air in his operating room—antiseptic surgery 2. Led to concept of aseptic surgery J. Robert Koch 1. One kind of organism responsible for specific diseases 2. Isolated pathogens for anthrax, tuberculosis, diphtheria, typhoid fever, and gonorrhea 3. Developed Koch’s Postulates K. Paul Eurlich 1. Discovered salvarsan as a treatment for syphilis L. Gladys and George Dick 1. Developed the Dick test to determine susceptibility to scarlet fever M. Rebecca Craighill Lancefield 1. Developed the Lancefield grouping serological tests to differentiate the different streptococcal organisms N. Bella Schick 1. Developed Schick test for susceptibility to diphtheria Sir Alexander Fleming 1. Discovered penicillin Martinus Willem-Beiherinck 1. First to crystallize a virus- the tobacco mosaic virus Reed, Gorgas, and Sternberg 1. Developed the Yellow Fever Commision to find cause of yellow fever Salk and Sabin 1. Developed polio vaccines in the 50’s Krugman and Blumburg 1. Work led to discovery of Hepatitis A and B Hillman—Merck, Sharp and Dohme Labs 1. Marketed first Hepatitis B vaccine HTLV virus was isolated, now known as HIV Research continues to find cure for HIV O. P. Q. R. S. T. U. V. RESOURCES: Lecture/discussion Handouts OUTCOMES MEASUREMENT Homework assignments Exam Final-exam UNIT 2- The microscope GOALS: To present the parts of the microscope and describe their function To demonstrate the use of the microscope OUTCOMES: To demonstrate knowledge of the parts of the microscope including their function To use the microscope in the laboratory setting LEARNING OBJECTIVES: 1. List and describe the different types of microscopes and their functions 2. Identify the parts of the microscope and describe their functions 3. Demonstrate the use of the microscope by focusing on a prepared slide CONTENT: 1. The microscope A. Types of microscopes 1. Electron microscope a. description b. use 2. Bright field microscope a. description b. use 3. Darkfield microscope a. description b. use 4. Flourescent microscope a. description b. use 5. Phase contrast microscope a. description b. use B. The compound microscope 1. Two lens system of magnification a. ocular lens b. objective 2. Compound light microscope a. ocular lens in eyepiece and several objective lenses b. monocular microscope 1. one ocular lens in one eyepiece c. binocular microscope 1. two ocular lenses in separate eyepiece housing d. ocular lens in eyepiece 1. magnification of 10x (10 times) e. objective lens mounted on turret (rotating wheel) 1. also called revolving eyepiece 2. 3 lenses A. low power objective B. high power objective C. oil immersion f. Description of three lenses 1. low power lens A. shortest length B. used to locate microbes to be studied C. 10x magnification D. total magnification with ocular lens—10x times 10x = 100x 2. high power lens A. 40-45 x B. used to study larger microbes in greater detail C. total magnification 40-45x times 10=400x- 450x 3. oil immersion lens A. 95-100x B. used to enhance color and clarity of stained material C. total magnification—950x-1000x D. highest magnification E. requires greatest care and attention—comes close to specimen—fraction of a mm from coverslip F. needs more light G. drop of immersion oil is used to prevent loss of light in air space between coverslip and objective lens H. lens carefully rotated into the oil I. focus away from coverslip to prevent breakage of Coverslip, slide, or objective lens 3. 4. 5. 6. 7. 8. Mechanical parts of microscope a. body tube b. revolving nosepiece c. stage d. stage clips e. mechanical stage f. stage knobs g. arm h. base i. course adjustment knob j. fine adjustment knob Resolution of microscope a. definition b. contrast with magnification Illumination system of microscope a. built in lamp b. Abbe condenser lens c. iris diaphragm d. light switch Processing of specimens a. fixation b. staining Care and cautions in handling microscope Demonstration of operation of monocular and binocular microscopes RESOURSES: Lecture/discussion Demonstration Handouts OUTCOMES MEASUREMENTS: Homework assignments Skills assessment checklist Exam Final Exam VTE REFERENCE 2.J.12 Use a compound microscope 2.J.01 Prepare a bacteriological smear 2.J.03 Identify characteristics of a wet slide and hanging drop slide preparation UNIT 3-Bacteria and their cell structure GOALS: To present the differences between the eukaryotic cell and the prokaryotic cell of the bacteria OUTCOMES: The student will demonstrate knowledge of the differences between the eukaryotic cell and the prokaryotic cell of the bacteria LEARNING OBJECTIVES: 1. Define a list of related terms 2. List the types of organisms with a eukaryotic cell structure 3. Differentiate between the structure of the eukaryotic cell and the prokaryotic cell 4. State the difference between encapsulated and non-encapsulated bacteria 5. Differentiate between the cell walls of gram-negative and gram-positive bacteria 6. Describe the value of sporogenesis 7. Describe the three kingdom classification of living organisms 8. List some examples of genus and species names CONTENT: I. Eukaryotic cell—true nucleus A. Plants, animals, protazoa, fungi, most algae B. More complex structure to cell C. Cell membrane 1. Bilayer of phospholipids 2. Selectively permeable membrane II. Prokaryotic cell—before nucleus A. Bacteria and cyanobacteria (blue-green algae) B. Less complex structure—less organelles C. Cell membrane 1. Complex structure a. cell membrane, cell wall, capsule make up cell envelope b. capsule—encapsulated bacteria 1. slime layer 2. function of capsule A. protective covering B. reservoir for food storage or waste disposal C. found around pathogens—enhances infective ability 3. non-encapsulated A. no capsule B. easily engulfed by WBC’s c. characteristics of gram negative cell wall 1. structure 2. broken down more easily by mechanical forces 3. secretes toxins d. characteristics of gram positive cell wall 1. structure 2. thicker than gram negative 2. Cytoplasmic membrane a. location b. selectively permeable c. contains respiratory enzymes d. excretion of exoenzymes 3. Nucleoid a. contains DNA in localized area but not bound by nuclear envelope b. no distinct nucleus c. highly coiled DNA 4. Plasmid a. another area of genetic DNA—not in chromosomes b. transmits information regarding resistance to one or several antibiotics 5. Pili ( fimbriae) a. pathogens especially gram negative tend to have b. allow bacteria to stick to another or to other cells—intestine,RBCs 6. Endospores ( spores) a. forms a protective coat b. aerobic-bacillus c. anaerobic-clostridium d. sporogenesis occurs 1. subjected to poor living conditions 2. lack of food, moisture, oxygen, temperature e. resistant to chemicals, drying, freezing, heating, radiation f. survive for many years—150,000 years g. dormant—no metabolic activity h. will germinate on a moist suface and become a vegetative bacterial cell i. some bacteria also produce deadly toxins from spores III. Principles of classification A. Taxonomy 1. Definition 2. Three kingdoms of classification a. Plants b. Animals c. Protists 3. Binomial nomenclature a. Genus b. Species c. Examples of genus and species names RESOURCES: Lecture/ discussion Handouts OUTCOMES MEASUREMENT: Homework assignments Exam Final Exam UNIT 4-The Protists: algae and fungi GOAL: To present the beneficial and harmful effects of algae and fungi OUTCOMES: The student will demonstrate knowledge of the beneficial and harmful effects of algae and fungi LEARNING OBJECTIVES: 1. Define a list of related terms 2. Name the organisms that make up the five protist group 3. List some uses of algae 4. Differentiate between yeasts and molds 5. Identify the beneficial and harmful activities of yeasts 6. Differentiate between harmful molds that cause superficial infections and those that cause systemic infections 7. List some of the beneficial uses of the mold penicillin CONTENT: I. Algae A. Description 1. Simple plant-like structures 2. Contain chlorophyll 3. One or more cells 4. Non-pathogenic B. Uses 1. Soil fertility 2. Prevent erosion 3. Food 4. Commercial uses a. diatoms produce silica 1. insulation 2. filter 3. cosmetic base 4. polishing agent b. medicinal products—kelp c. agar culture media d. jel jams e. stabilizer—salad dressings f. puddings 5. Some types eaten by shellfish are toxic to animals including humans—bloom II. Fungi A. Description 1. Simple plant-like 2. No chlorophyll 3. Saprophytes a. definition 4. Mycology a. definition 5. Includes yeast and molds 6. Some can live both yeasts and molds—dimorphism B. Yeasts 1. Description a. one celled b. saprophytes if living on sugars c. parasites if living on living organisms d. reproduce by budding e. killed by boiling 2. Beneficial uses a. make wine from grapes b. make cider from apples c. beer from malt and hops d. raising bread dough—Saccharomyces cerevisiae e. Baker’s yeast source of Vitamin B and proteins f. produce alcohol and carbon dioxide 3. Harmful effects a. spoil fruits, syrups, jellies by fermentation 4. Usually non-pathogenic a. exception—immuno-suppressed patients C. Molds 1. Description a. multicellular b. fuzzy mass due to hypha—fillamentous threads, mycelium—term for hypha together c. form knobs—sporangia—when ripe release spores d. need air, food,water, and darkness to grow 2. Harmful molds that cause superficial infections a. dermatophytes—live on skin and mucus membrane 1. athletes foot 2. ringworm—scalp, body, beard, nails 3. Candida albicans—thrush, vaginal candidiasis 3. Molds that spoil crops a. Ergot mold—wheat and rye b. aflatoxin—aspergillus mold—cotton seed, peanuts c. harmful to humans 4. Molds that cause systemic infections—dimorphs a. Histoplasma and Coccidiodes—bird droppings, chickens, pidgeons— inhaled with dust, open cuts and sores b. Blastomyces c. Cryptococcus—produces type of meningitis d. a and b produce serious lung infections and major problems in other organs leading to death e. Candida, Aspergillus, Cryptococcus especially in immunosuppressed 1. usual antifungals do not work—chemotherapy drugs to treat D. Beneficial molds 1. Penicillin notatum a. discovered by Alexander Fleming b. antibiotic penicillin c. used to flavor cheese—Roquefort, Gorganzola, Stilton, Camembert d. can cause respiratory, GU, and skin infections in immunosuppressed RESOURCES: Lecture/ discussion Handouts OUTCOMES: Homework assignments Exam Final Exam UNIT 5- The protists: parasites GOAL: To present the types of parasites and the disease conditions they cause OUTCOME: The student will demonstrate knowledge of parasites and the disease conditions they cause LEARNING OBJECTIVES: 1. Define a list of related terms 2. Differentiate among the types of parasites 3. Define the characteristics of parasites and the nature of their activity 4. List and describe disease conditions caused by parasites CONTENT: I. II. Types of parasites A. Protozoa B. Helminths-worms C. Arhtropods 1. Insects 2. Arachnids Related terminology A. Parasites 1. Organisms that live on or within another living organism and benefit from if at the expense of the other living thing 2. Damages host B. Host C. D. E. F. 1. Living plants and animals on which parasites lives and obtains nourishment Infection 1. When parasites cause disease Infestation 1. Presence on host of animal parasites such as ticks, lice, flatworms Symbiosis 1. Organisms living together to benefit both Neutralism 1. Organisms coexist with neither harmful or beneficial effects—bacteria in human intestine G. Antibiosis 1. III. Organisms cannot coexist—penicillin mold on agar plate with certain staphylococci—will kill staph Protozoa A. one celled animals B. Paramecium, Volvax, Euglena 1. No human infections C. Ciliates 1. Balantidium coli a. only parasitic ciliated protozoan in human b. rarely causes severe dysentary c. if symptoms-abdominal pain d. diagnosed by presence of cysts or living organisms in feces D. Flagellates-move with one or more flagella 1. Giardia lamblia and Giardia intestinalis a. cause dysentary 2. Giardia lamblia a. most common intestinal parasite in US b. travelers diarrhea c. ingesting contaminated water 1. springs, residential water supplies, water slides 2. improperly treated swimming pools d. spread through nursing homes, day care centers e. “beaver fever”- outbreak in Pittsfield about 15+ years ago f. beaver may be reservoir host g. also found in dogs, cats, muskrats h. diagnosed by cysts or active form of protazoa in feces or duodenal contents 3. The trypanosomas- rhodesiense, gambiense a. cause African sleeping sickness-fatal disease b. Tsetse fly transmits to humans 4. Trypanosoma cruzi a. Changas’ disease b. heart muscle, CNS, liver, spleen, lymph nodes c. usually fatal 5. Trichomonas vaginalis a. sexually transmitted disease b. may be found in vaginal secretions, urethra, epididymis, prostate c. active form of organism found on PAP smear, in urine during urinalysis d. symptoms 1. vaginal inflammation 2. yellowish foul discharge 3. burning urination 4. woman more likely to have symptoms E. Amoeba (sarcodina) 1. move with amoeboid movement-pseudopodia 2. Entamoebas a. several varieties b. cause dysentary c. cysts in feces d. can cause hepatitis F. Plasmodiums IV. 1. cause malaria 2. transmitted by bite of anopheles mosquito G. Toxoplasma 1. causes toxoplasmosis 2. host most often cats 3. found in cat feces 4. dangerous to pregnant women 5. can cross to the fetus causing death, blindness, or mental retardation 6. usually diagnosed by rising antibody titers H. Pneumocystis carinii 1. causes pneumonia in immunosuppressed patients such as AIDS patients 2. can be fatal Helminths A. Types 1. Nematodes—roundworms 2. Cestodes—flatworms (tapeworms) 3. Tremodes—flukes B. Nematodes 1. Pinworm (Enterobius vermicularis) 2. Whipworm (Trichuris trichirua) a. found mostly in children 3. Ascaris lumbricoiedes a. severe bowel obstruction 4. Wuchereria bancrofti a. causes elephantiasis 1. enlargement of the legs b. carried by mosquitoes c. lodges in bloodstream 5. Hookworm (Necator americanis) a. infects people and animals b. attaches to intestinal wall-drains blood from it c. can cause severe anemia 6. Trichina a. causes trichinosis b. ingested in poorly cooked pork c. enclosed in a protective covering called a cyst which is imbedded in the muscles of the host animal C. Cestodes 1. Taenia family a. tapeworms found in beef, pork b. fish tapeworm c. may grow to several feet d. slough off parts of their bodies into the stool e. cause intestinal disorders and can cause severe weight loss if untreated f. cook meat and fish well to kill the eggs V. D. Trematodes 1. Flat, leaf-shaped flukes 2. Found in intestine, liver, lung, and blood vessels Anthropods A. Types 1. Insects a. flies, mosquitoes, true bugs, lice, fleas 2. Arachnids a. spiders, ticks, mites B. Insects 1. Pediculus- head lice 2. Phthirus a. causes crab louse (pubic louse) infection b. sexually transmitted 3. Fleas a. dogs and cats b. infest houses c. can cause the tapeworms of dogs and cats in humans of fleas are ingested-usually small children 4. Mosquitoes a. Anopheles 1. transmits malaria b. Aedes 1. transmits yellow fever 5. Tsetse fly a. transmits African sleeping sickness C. Arachnids 1. Sarcoptes (itch mite) a. causes scabies 2. Ixodes a. tick that transmits Lyme disease to humans 1. a bacterial disease 2. hosts for tick are deer and rodents 3. causes a serious pseudo-rheumatoid arthritis 4. can be treated with antibiotics if recognized early 5. in process of developing a vaccine against 6. prevention A. wear light colored clothing covering arms and legs B. insect repellent C. use precautions (latex gloves when handling deer carcasses or dressing deer) 3. Wood tick a. RESOURCES: Lecture/ discussion Handouts OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam transmits organisms (Rickettsias) of Rocky Mountain Spotted Fever and Tularemia (rabbit fever) UNIT 6- The protists: bacteria GOAL: To present bacteria including pathogenic and nonpathogenic and their effects on humans OUTCOME: The student will demonstrate knowledge of bacteria including pathogenic and nonpathogenic and their effects on Humans LEARNING OBJECTIVES: 1. To define a list of related terms 2. Differentiate between pathogenic and nonpathogenic bacteria 3. Differentiate between gram-positive and gram-negative cocci and bacilli 4. List and describe disease conditions caused by pathogenic bacteria CONTENT: 1. Definitions A. Pathogenic bacteria 1. Harmful disease causing bacteria 2. Invade plant or animal tissue often secreting enzymes or toxins into the host tissue B. Non-pathogenic bacteria 1. Beneficial bacteria that decompose refuse and improve soil fertility C. Normal flora 1. Specific microorganisms that live in a specific area of a host without causing disease 2. Non-pathogenic saprophytes 3. Found in respiratory tract, mouth, skin, and bowel D. Opportunistic pathogens 1. An organism that normally does not cause disease in a healthy person but becomes pathogenic under certain conditions especially when the host is immunocompromised or immunosuppressed E. Nitrifying bacteria 1. convert ammonia into nitrites and nitrates that plants use for food. Animals eat plants, die and return nitrogen to the soil after acted on by bacteria F. Putrifactive bacteria 1. Breaks down dead organisms returning carbon and nitrogen to soil G. Denitrifying bacteria 1. Extract oxygen from nitrates releasing free nitrogen into the atmosphere H. Nitrogen-fixing bacteria 1. Build nitrates by extracting nitrogen from the air and returning nitrates to the soil 2. Found on peas, clover, alfalfa, and peanuts II. 3. Used on crop rotation to enrich soil with nitrogen Types of pathogenic bacteria A. Gram-positive cocci-round sphere-like 1. Staphylococcus aureus a. causes boils, carbuncles, impetigo, postoperative wound infections, toxic shock syndrome, nosocomial (pertaining to or originating in a hospital) (hospital acquired), hospital infections 2. Streptococcus viridans a. causes subacute bacterial endocarditis (SBE) 3. Streptococcus pyogenes (Group A Streptococcus) a. causes strep throat, rheumatic fever, scarlet fever 4. Streptococcus pneumoniae a. causes bacterial pneumonia and bacterial meningitis B. Gram-positive bacilli-rectangular rod-shaped 1. Bacillus and clostridium species tend to form spores 2. Bacilli are strict (obligate) anaerobes a. are normal soil contaminators found in air and on bench tops 3. Clostridia are strict (obligate) anaerobes 4. Disease causing Bacilli a. Bacillus cereus 1. causes food poising i.e. warmed over fried rice 2. also severe pneumonia in immunocompromised patients b. Bacillus anthracis 1. causes anthrax in cattle 2. deadly to humans 3. of concern in biological “germ” warfare c. Bacillus subtilis 1. pneumonia is IC patients 5. Disease causing Clostridia a. Clostridium perfringens 1. causes gas gangrene b. Clostridium tetani 1. causes tetanus (lockjaw) c. Clostridium botulinum 1. causes botulism or food poisoning d. Clostridium difficele 1. causes severe colitis e. Toxins of tetani and botulinum are a million times more potent than rattlesnake venom 5. Other gram positive bacilli a. Corynebacterium diphtheria 1. causes diphtheria C. Gram-negative cocci—usually diplococci 1. Neiseria a. Neiseria gonorrhoeae 1. causes gonorrhea 2. causes blindness in newborn b. Neiseria meningitidis 1. causes bacterial meningitis c. Branhamella (formally Neisaria) catarrhalis 1. normal flora of upper respiratory tract 2. causes severe pneumonia in IC patients D. Gram-negative bacilli (rods) 1. Enterobacteriaceac family a. enteric or coliform bacteria b. inhabit the lower bowel c. are normal flora there d. Escherichia coli (E. Coli) e. f. g. h. i. RESOURCES: Lecture/ discussion Handouts OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam 1. causes urinary tract infections 2. causes intestinal disorders in children 3. causes appendicitis, peritonitis, wound infections Proteus species 1. causes appendicitis, peritonitis, and wound infections Pseudomonas aeruginosa 1. causes appendicitis, peritonitis, and wound infections (nosocomial) 2. pneumonia especially in elderly and IC patients 3. ear infections 4. severe infections in burn patients Salmonella and shigella groups 1. causes dysentery 2. causes food poisoning Salmonella typhi 1. causes typhoid fever and resulting septicemia Campylobactor group 1. transmitted by contaminated food, milk, water 2. may cause gastritis and peptic ulcers 3. seen in AIDS patients UNIT 7- The protists: rickettsias, chlamydias, mycoplasmas, and viruses GOAL: To present the rickettsias, chlamydias, mycoplasmas, and viruses and the disease conditions they cause OUTCOME: The student will demonstrate knowledge of the rickettsias, chlamydias, mycoplasmas, and the disease conditions they cause LEARNING OBJECTIVES: 1. Define a list of related terms 2. Differentiate among the characteristics of rickettsias, chlamydias, mycoplasms, and viruses 3. List and describe disease causing rickettsias, chlamydias, mycoplasmas and viruses 4. Explain the role of interferon CONTENT: 1. II. Introduction A. Rickettsia, chlamydia, and mycoplasmas are prokaryotic organisms that differ from bacteria B. Much smaller C. Unusual cell wall structure D. Rickettsia cannot live outside cells of living organisms E. Chlamydia and mycoplasma organisms include members that cause pneumonias and STDs F. Difficult to grow and require special growth nutrients G. Rickettsia identified by serological testing because they are difficult and hazardous to work with Rickettsias A. Once thought to be between bacteria and viruses B. Cell structure is a true bacteria C. Occur in rod and spherical forms D. Non-motile, gram-negative E. Obligate intercellular parasites (can’t live outside cells of living organisms) F. Infect many types of animals that serve as reservoir hosts G. Transmitted by bites of fleas, ticks, lice, and mites H. Humans are the reservoir for epidemic typhus fever I. Named for Dr. Howard T. Ricketts, American, who first identified agent of Rocky Mountain Spotted Fever J. Examples of rickettsia causing disease in humans 1. Rickettsia prowazekii a. causes typhus b. transmitted by a louse c. responsible for typhus epidemics in World War I & II 2. Rickettsia typhi a. typhus b. transmitted by the ratflea c. found worldwide 3. Scrub typhus a. mite borne typhus 4. Diagnosed by elevated antibody titers-Weil-Felix reaction III. IV. Chlamydias A. Intracellular, microscopic, gram-negative obligate bacteria with a spherical shape B. Energy parasites-depend on a host cell for energy C. Need host cell to reproduce D. Once grouped with the viruses because of B & C above E. Cause very severe infections in humans F. Examples of Chlamydias that cause disease in humans 1. Chlamydia psittaci a. causes severe pneumonias b. Psitticosis or ornithosis—associated with birds c. Also systemic infections in IC patients 1. treated with tetracycline 2. Chlamydia trachomatis a. causes trachoma, a severe eye infection leading to blindness b. STD- chlamydia urethritis & cervicitis 1. often associated with gonorrhea, but is resistive to penicillin 2. can cause pelvic inflammatory disease (PID) 3. be transmitted to eyes of newborn during delivery and to the infant as well 4. diagnosed by antibody test 5. most common STD in industrialized countries c. cause of lymphogranuloma venerum (LGV) 1. tropical areas 2. causes systemic disease 3. poor recovery rate Mycoplasmas A. Small prokaryotic microbes surrounded by a single triple-layered membrane B. Do not have typical bacterial cell wall C. Simplest life form capable of independent growth and metabolism D. When grown on agar medium-display a characteristic “fried-egg” appearance E. Pleomorphic- without cell walls they can assume many shapes F. Pathogenic to many animals and some plants G. Normal flora of genital and respiratory tracts H. Cause cervicitis, prostatitis, and urethritis I. Found in deep tissue abscesses in humans J. Can cause a type of arthritis in lab animals V. K. Example of mycoplasmas that cause disease in humans 1. Mycoplasma pneumoniae a. respiratory diseases from URIs to pneumonia b. atypical or “ walking pneumonia” c. resistant to antibiotics that inhibit cell-wall synthesis-have no cell wall d. treated with tetracycline (erythromycin used for pregnant women) e. cold autoagglutinins develop-apparent only at refrigerated temperatures f. RRP and VDRL tests for syphilis are positive during disease g. Diagnosed with serological testing Viruses A. First discovered virus was Tobacco mosaic virus—1892-Beijerinck B. First means of culturing virus using tissue culture—1932 C. Smallest infectious agents D. Can be seen only with the electron microscope E. Intercellular agents F. Cannot carry on independent metabolism or reproduction G. Must replicate in a host cell H. Are not cellular—consist of RNA or DNA with a protein coat I. Protein coat protects the nucleic acid inside and determines what kind of cell the virus can live in J. Bacteriophage 1. Virus that attacks a bacterial cell K. Six stages of virus (phage) attacking a bacterial cell 1. Adsorption ( Attachment) 2. Penetration 3. Uncoating 4. Replication and nucleic acid replication 5. Maturation 6. Release L. May cause no change or damage to the host L. Interferon 1. A chemical that prevents replication of viruses in cells of the same kind 2. Produced by infected or parasitized cells 3. Can be used to prevent cancer cells from reproducing 4. Once costly, now can be made in lab M. Some viruses such as influenza can change genetic material producing a new virus that person is not immune to N. Virus groups that contain members causing disease in humans 1. Poxvirus a. smallpox, cowpox 2. Herpesvirus a. coldsores, shingles, chickenpox, Herpes, EpsteinBarr, cytomegalovirus 3. Adenovirus—catarrhs—URI’s, LRI’s, conjunctivitis 4. Papovavirus a. wart virus b. papilloma virus (HPV),genital warts 5. Myxoviru a. influenza viruses 6. Paromyxovirus a. measles, mumps 7. Rhabdovirus a. rabies 8. Arbovirus a. arthropod borne b. yellow fever, equine encephalitis 9. Picornavirus a. enteroviruses including polio b. rhinoviruses cause of common cold 10. Retrovirus a. HIV-1 11. Hepadnavirus a. Hepatitis B O. Virus facts 1. More resistant to disinfectants than are most bacteria 2. Same susceptibility to heat except the hepatitis virus which are very resistant 3. Most are not affected by sulfonamide drugs or antibiotics P. HTLV-3 (human T-cell lymphotropic virus, type III) 1. now called (HIV-1) Human immunodeficiency virus type 1 causes AIDS (acquired immunodeficiency syndrome) Q. Viral agents of hepatitis include Hepatitis A, Hepatitis B, Hepatitis C and hepatitis delta RESOURCES: Lecture/discussion Handouts OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam UNIT 8- Universal and Standard Precautions, OSHA guidelines, and CLIA regulations GOALS: To present Universal and Standard Precautions as measures to protect all health care providers, patients, and visitors from infectious disease To present OSHA guidelines as methods to require employers to ensure employee safety in regard to potentially harmful substances To present CLIA regulations as methods of regulating testing of specimens taken from the body To present information as to how these regulations apply to the student in a medical assistant program OUTCOMES: The student will demonstrate knowledge of Universal and Standard Precautions, OSHA guidelines, and CLIA regulations as methods of protecting patients and healthcare workers The student will demonstrate knowledge of how these regulations apply to the student in a medical assistant program LEARNING OBJECTIVES: 1. Define a list of related terms 2. Explain why universal precautions were introduced in 1985 3. Describe the purpose of standard precautions and examples of ways health care providers should practice standard precautions 4. Explain the term transmission based precautions 5. List 8 types of body fluid and give and example of each 6. Describe 5 situations in which exposure to a patient’s blood can occur and discuss why standard precautions are important 7. Describe the disposal of infectious waste 8. Identify the governmental agency that regulates procedures performed on patients and describe the agency’s main concerns 9. List the types of human specimens that CLIA regulates 10. List several tests that are in the waived category 11. Discuss the importance of CLIA to the medical assistant 12. Identify two OSHA standards that seek to safeguard employees 13. Describe MSDS manuals and their purpose 14. Discuss components of the bloodborne standard and analyze what the law covers 15. Describe how the preceding regulations apply to the medical assistant in the school laboratory and in the externship areas CONTENT: I. II. Medical Asepsis-Infection control A. Procedures and practices that health care professionals use to prevent the spread of infection State and Federal agencies have policies, procedures, and guidelines for health providers and employers to follow in order to reduce the risk of transmission of infectious diseases A. Centers for Disease Control and Prevention—Atlanta Georgia 1. Division of US Public Health Department 2. Agency investigates various diseases to control them 3. Makes recommendations on how to prevent the spread of disease 4. Issued 7 isolation categories for patients with infectious disease—1970 5. Recommended Universal Precautions—1985—revised in 1991 6. Release Standard Precautions—1996 a. most current and comprehensive approach to infection control b. measures to protect all health care providers, patients, and visitors from infectious disease 7. Transmission Based Precautions—1996 a. for those with a highly transmittable disease—i.e. in hospital b. designed to reduce airbourne, droplet, and contact transmission of pathogens c. Used in addition to Standard Precautions B. Occupational Safety and Health Administration (OSHA) 1. Department of Labor 2. Issued Occupational Safety and Health Administration Guidelines a. requires employers to ensure employee safety in regard to occupational exposure to potentially harmful substances C. Health Care Financing Administration (HCFA) 1. United States Department of Health and Human Services (HHS) 2. Issued Clinical Laboratory Amendments of 1988 (CLIA 88) a. III. Universal Precautions A. B. C. IV. Safeguards the public by regulating all testing of specimens taken from the body Issued in 1985 by CDC to curb the transmission of AIDS, Hepatitis B, and other infectious diseases Called Universal Blood and Body Fluid Precautions Consider every patient potentially infectious and use the techniques routinely and consistently D. Review of summary of Universal Precautions Standard Precautions A. A set of infection control guidelines B. Combine many techniques of Universal Precautions with techniques of body substance isolation (BSI) C. Personal Protective Equipment (PPE) should be worn for contact with all body fluids whether or not blood is visible D. Include all of major recommendations of Universal Precautions and BSI while incorporation new information E. New terms to avoid confusion with existing infection control and isolation systems F. Intended to protect all patients, health care providers, and visitors G. Designed to reduce risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals H. Apply to: V. VI. 1. Blood 2. All body fluids, secretions, and excretions regardless of whether or not they contain visible blood 3. Non-intact skin 4. Mucus membranes I. Overview of Standard Precautions—refer to handout 1. Wash hands 2. Wear gloves 3. Wear mask or eye protection or face shield 4. Wear gown 5. Patient care equipment 6. Environmental control 7. Linen 8. Occupational health and bloodbourne pathogens 9. Never recap used needles using both hands 10. Use resuscitation devices 11. Patient placement Occupational Safety and Health Administration (OSHA) Regulations A. Occupational Exposure to Hazardous Chemicals in the Laboratory 1. Intended to heighten employee awareness of risks linked with chemical dangers 2. Includes employer training and identification of hazardous chemicals that exist in the workplace 3. Use of protective equipment is utilized to protect employees 4. Components of a Chemical Hygiene Plan a. inventory of chemicals b. material safety data sheet (MSDS) manual must be complied c. chemicals must be labled using National Fire Protective Associations color and number method 1. Refer to handout 2. Examine MSDS sheets B. The Bloodbourne Pathogen Standard 1. Effective 1992 2. To reduce occupational-related cases of HIV and Hepatitis B infections among health care workers 3. To seek to limit exposure of employees to pathogens 4. Scope of the law a. Exposure determination b. Methods of control of exposure, especially Standard Precautions c. HBV vaccine d. Post-exposure follow-up e. Disposal of biohazardous waste f. Labeling g. Housekeeping and laundry functions h. Training for employee safety and documentation Clinical Laboratory Improvement Amendments of 1988 (CLIA 88) A. B. C. D. VII. Designed to set safety policies and procedures to protect patients Revised in 1988—amendments took effect 1992 States may seek exemptions Intent is to protect the public by regulating laboratory tests performed on specimens taken from the human body E. Regulations based on 1. The complexity of the tests performed 2. Specify the type of test performed 3. Personnel involved in testing 4. Quality control F. Categories of testing 1. Waived tests 2. Physician-performed microscopy tests, all of which are waived tests 3. Moderate-complexity tests 4. High-complexity tests G. Review of waived tests How rules and regulations apply to the student A. Review of PPE used by students in laboratory B. Review of precautions for students to avoid injury C. Review of procedure in regards to exposure (needle stick or sharps contact) in externship rotations D. Review of methods to avoid exposure to chemicals E. Review of impact of CLIA regulations on the MA student RESOURCES: Lecture/discussion Handouts Guest speaker—Berkshire Medical Center—Review of BMC’s Standard Precautions Audiovisuals OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam UNIT 9- The chain of infection GOAL: To present the components of the chain of infection OUTCOMES: The student will demonstrate knowledge of the chain of infection LEARNING OBJECTIVES: 1. Define a list of related terms 2. Define and state the critical importance of infection control in the ambulatory care setting 3. Outline the six links in the chain of infection and describe each link CONTENT: I. The chain of infection A. Definition 1. The necessary steps for infectious disease to spread B. II. III. C. Steps in the chain 1. Infectious agent ( Etiologic agent ) (cause) 2. Reservoir or source 3. Portal of exit (means of escape of infectious agent) 4. Means of transmission—from reservoir to new host 5. Portal of entry (means of entry) 6. Susceptible host Infectious agent A. Viruses B. Bacteria C. Rickettsia D. Fungi E. Parasites Reservoir A. Humans 1. Carriers—Carry the disease with or without symptoms— Typhoid Mary B. IV. V. Infection control based on the fact that the transmission of infectious diseases will be prevented when any of the levels in the chain are broken or interrupted Animals or insects ( vectors) C. Inanimate carriers—equipment, supplies, water, food Portal of exit A. Respiratory tract B. Intestinal tract—feces C. Urinary tract—urine or discharge D. Skin and mucous membrane—open lesions or discharges—on surface of body E. Reproductive tract—discharges F. Blood G. Across the placenta Means of transmission A. Direct transmission (contact) 1. Inhalation—coughing sneezing 2. Physical contact—sexual contact, kissing, contact with open lesion 3. Blood transmission B. VI. VII. VIII. Indirect contact 1. Touching contaminated articles 2. Vectors—insects 3. Fomites—non-living inanimate objects a. water, milk, foods, soil, air, excreta, clothing, bedding, towels, instruments, syringes, needles, toiletries, contaminated objects Portal of entry—means of entry A. Respiratory tract—organisms are inhaled B. GI tract—organisms are ingested C. Skin, mucous membrane—cuts, abrasions, open wounds D. Urinary tract—external body orifices (openings) E. Reproductive tract—external body orifices F. Blood G. Across the placenta Susceptible host A. Number and specific type of pathogen B. Duration of exposure to pathogen C. General physical condition—diet, rest D. Psychological health status E. Occupational or lifestyle environment—poor living conditions F. Presence of underlying diseases or conditions—genetic traits (immunosuppression, diabetes, sickle cell anemia) G. Youth or advanced age (immature immune system in the young—declining in old age) Stages of the infectious process A. The invasion and multiplication of the pathogen in the body B. Incubation period—few days, months, years C. Prodromal period—first mild signs and symptoms—malaise, fever, highly contagious period D. Acute period—signs and symptoms most severe E. Recovery or convalescent period—signs and symptoms subside, body heals, state of health RESOURCES: Lectures/discussion Video Handouts OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam UNIT 10- Immunity: natural and acquired including common immunizations GOALS: To present the bodies defenses against disease and the concept of immunity To present the immunizations for the common communicable diseases OUTCOMES: The student will demonstrate knowledge of the bodies defenses against disease and the concept of immunity The student will demonstrate knowledge of the immunizations for the common communicable diseases LEARNING OBJECTIVES: 1. Define a list of related terms 2. List and describe the bodies natural defense mechanisms used to control or prevent disease and infection 3. State the function of the immune system 4. List and briefly describe the four critical phases of each immune response 5. Discuss and compare the various types of immunity 6. List five classic signs and symptoms of inflammation and briefly describe the inflammatory process 7. List the immunizations for the common communicable disease CONTENT: I. II. The bodies defenses against infection A. Physical and chemical barriers to infection 1. Skin a. intact skin—physical b. acid pH of skin—chemical-inhibits bacteria c. sweat—lactic acid and lysozyme an enzyme 2. Mucous membrane a. lysozyme found in tears, saliva kills bacteria b. mucous traps organisms c. cilia in nose sweep 3. Respiratory tract a. coughing, sneezing reflexes b. hairs and mucous trap particles c. cilia sweep in upper and lower respiratory tract d. shape of passageway from mouth to lungs 4. GI tract a. HCL and digestive juices—in stomach kill bacteria b. Bile-small intestine may also c. Peristalsis and defication remove bacteria 5. Blood and lymphoid tissue a. Produces cells and antibodies 1. WBC’s, phagocytes b. Lymphoid tissue-produces antibodies 6. Genitourinary tract—frequent urination 7. Vaginal mucosal secretions—acidity of vagina The antigen-antibody reaction III. A. Antigens 1. Definition B. Antibodies 1. Definition 2. Different antibodies produce in response to different antigens 3. Only effective against specific antigen 4. Methods of destroying antigens C. Definition of antigen-antibody reaction D. Immunity may last months or years Immune system A. Complex system that defends against microorganisms or cancer cells B. Function-to produce immunity—resistance to disease C. Components of the immune system D. Four critical phases of immune response 1. Recognition of the enemy 2. Amplification of defenses 3. Attack 4. Slowdown E. Immunity 1. Types of immunity a. Active immunity 1. antigens are introduced into the body b. Passive immunity 1. antibodies are introduced into the body c. Natural immunity 1. 2. 3. an inborn resistance to a disease as a result of antibodies that are normally present in the blood d. Acquired or induced immunity 1. results from antibodies that are not normally present in the blood e. Active and passive immunity can be either natural or aquired Natural immunity a. Inherited (active) immunity 1. acquired by being the member of a race or species b. Congenital (passive) immunity 1. immunity possessed at birth 2. passed from mother who is immune through the placenta to the fetus 3. duration (5-6 months) 4. colostrum and mother’s milk also supply some immunity 5. does not protect against whooping cough Acquired immunity a. Natural active immunity 1. carrier 2. having a disease 3. having a subclinical case of the disease b. c. IV. V. Artificial active immunity 1. vaccine—killed or attenuated (weakened) organism Artificial passive immunity 1. Gamma globulin—viral hepatitis, measles 2. Antitoxin-diphtheria, tetanus 3. Immune serum 4. Used for prevention and treatment of disease Immunizations A. Provide immunity with active or passive vaccines B. Reasons children are not fully immunized C. Review of vaccine administration guidelines 1. DPT a. diphtheria, pertussis (whooping cough), tetanus 2. MMR a. measles, mumps, rubella (German measles) 3. OPV (oral polio vaccine) a. poliomyelitis 4. Hib (H. influenza B) a. meningitis caused by the organism 5. HBV a. Hepatitis B virus Inflammatory process A. Review of inflammatory process B. Signs and symptoms 1. Local a. redness b. heat c. swelling d. pain e. limitation of function in the area 2. Systemic a. leukocytosis b. fever c. increased pulse rate d. increased respiratory rate RESOURCES: Lecture/discussion Handouts OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam UNIT 11- Infection control: Medical Asepsis and methods to control microscopic agents including sanitation, antisepsis, disinfection, and sterilization GOAL: To present the methods of controlling microscopic organisms including sanitation, antisepsis, disinfection, and sterilization OUTCOME: The student will demonstrate knowledge of methods of controlling microscopic organisms including sanitation, antisepsis, disinfection, and sterilization LEARNING OBJECTIVES: 1. Differentiate between medical and surgical asepsis 2. Differentiate among sanitation, antisepsis, disinfection, and sterilization 3. Explain the importance of sterilization of instruments and supplies prior to using them for medical procedures 4. List and briefly describe methods used for disinfection of equipment and methods for sterilization of equipment 5. Describe how items are to be wrapped, positioned, and removed from a sterilizer for sterilization to be effective 6. List three critical factors in steam sterilization 7. Describe types of sterilization indicators and reasons for using 8. Discuss storage of sterilized items CONTENT: I. II. III. IV. Review of medical aseptic practices used in daily living Review of medical aseptic practices used in the ambulatory care setting including handwashing technique Surgical asepsis (sterile technique) A. Destruction of all microorganisms, pathogenic or nonpathogenic B. Goal is to prevent infection or introduction of microorganisms into the body C. Examples of surgical asepsis Methods to control microscopic agents A. Sanitation 1. Cleaning and scrubbing items with soap or detergent and water 2. Use disposable gloves 3. Ultrasonic cleaners B. Antisepsis 1. Use of a substance to inhibit the growth or action of a microorganism without killing them 2. Antiseptics are generally safe for use on body tissue 3. 70% alcohol and other antiseptics C. Disinfection 1. Methods that destroy most pathogens 2. Does not kill spores 3. Does not kill some viruses such as Hepatitis B 4. Methods of disinfection a. chemicals V. 1. items that can be disinfected 2. examples of substances used b. boiling water 1. items that can be boiled 2. process c. flowing steam D. Sterilization 1. Methods that completely destroy all microscopic life 2. Methods of sterilization a. gas sterilization 1. items that can be gas sterilized 2. process 3. advantages and disadvantages b. dry heat 1. items that can be sterilized 2. methods and process 3. advantages and disadvantages c. chemical sterilization 1. items that can be chemically disinfected 2. agents 3. process 4. advantages and disadvantages d. steam sterilization under pressure (autoclave) 1. items that can be steam sterilized 2. process 3. advantages and disadvantages The autoclave A. How to load packages B. General rules to ensure proper sterilization 1. Sanitize and dry items to be autoclaved 2. Place articles to allow adequate exposure of all surfaces 3. Place containers on sides with lids loosely in place 4. Wrapping material must be autoclave approved 5. Start timing when gauges reach 15 pounds pressure and 250 degrees 6. When cycle complete, open door slightly to allow steam to escape 7. Do not handle packages while damp C. Autoclave maintenance and cleaning D. Quality control and assurance 1. Sterilization strips 2. Culture tests E. Autoclave wrapping material 1. Muslin 2. Paper sterilization wrapping squares 3. Sterilization pouches or bags F. G. H. I. VI Autoclave tape Labeling packages for the autoclave Wrapping techniques Methods of storage CBE procedures demonstration and practice CBE procedures performance and evaluation CLINICAL COMPETENCIES FUNDAMENTAL PROCEDURES Sanitization of instruments Chemical disinfections of instruments Wrap items for autoclaving Sterilizing articles in the autoclave VTE FRAMEWORKS REFERENCE 1.D.01 Demonstrate proper chemical disinfection of instruments 1.D.02 Wrap instruments for sterilization in the autoclave 1.D.03 Perform steam sterilization of instruments (autoclave) 1.D.04 Clean and maintain autoclave RESOURCES: Lecture/discussion Demonstration Handouts Audiovisuals OUTCOMES MEASUREMENT: Homework assignments Exam Final-exam