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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