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The epithelial ele Immunostains for cytokeratin may clarify been referred to medicine qhs retrovir 300 mg visa as pleomorphic spindle ments usually predominate in the form of the diagnosis in these spindle cell cases medicine administration discount retrovir 300mg without prescription. The mesenchymal neoplasia can be found in the metaplas polygonal cells anima sound medicine generic retrovir 300mg otc, but foci of well-differenti component includes foci of heterologous tic squamous mucosa treatment 1st degree burn discount retrovir 300 mg line. Areas of squamoid differentia Cytokeratin and carcinoembryonic anti this lesion is covered in the chapter on tion may also be seen. Rarely, foci of gen are absent from the mesenchymal endocrine tumours of the gallbladder osteoclast-like multinucleated giant cells and extrahepatic bile ducts. The presence of cytokeratin in the spindle cells may help to distin Undifferentiated carcinoma guish this tumour from carcinosarcoma. Undifferentiated carcinomas are more Undifferentiated carcinoma with osteo common in the gallbladder than in the clast-like giant cells. Characteristically, tains mononuclear cells and numerous glandular structures are absent in undiffer evenly spaced osteoclast-like giant cells entiated carcinomas. The mononuclear cells show immunore Undifferentiated carcinoma, spindle and activity for cytokeratin and epithelial giant cell type. The tumour is composed of sheets of round cells with vesicular nuclei and prominent nucleoli that occasionally con tain cytoplasmic mucin. The fourth variant consists of well defined nodules or lobules of neo plastic cells superficially resembling breast carcinoma. The overlying biliary epithelium is non-neo sarcomatous component with osteoid formation. Carcinoma 209 component, which helps to distinguish association with the Peutz-Jeghers syn including somatostatin, pancreatic carcinosarcomas from spindle and giant drome or with Gardner syndrome polypeptide, and gastrin have been cell carcinomas. These ithelial neoplasia, but larger adenomas Adenocarcinomas can be divided into benign tumours are not associated with may have high-grade changes or foci of well, moderately, or poorly differentiated lithiasis. The diagnosis of well differentiat According to their pattern of growth, they most adenomas develop a pedicle and ed adenocarcinoma requires that 95% of are divided into three types: tubular, pap project into the lumen. Cytologically, extend into or arise from Rokitansky ately differentiated adenocarcinoma 40 they are classified as: pyloric gland type, Aschoff sinuses, a finding that should not to 94% of the tumour should be com intestinal type, and biliary type. Undiffer al type adenomas are more common in benign tumour is composed of tubular entiated carcinomas display less than the extrahepatic bile ducts . It consists of tubular Precursor lesions benign tumour composed of closely glands lined by pseudostratified colum Adenoma packed short tubular glands that are sim nar cells with elongated hyperchromatic Adenomas are benign neoplasms of ilar to pyloric glands. Early lesions nuclei, and high-grade dysplastic glandular epithelium (intraepithelial neo appear as well demarcated nodules changes are frequent. The glands lack plasia) that are typically polypoid, single embedded in the lamina propria and invasive properties and focally are and well-demarcated. They are composed of lobules that con adenomatous epithelium may extend into There is a wide age range; although tain closely packed pyloric-type glands, the Rokitansky-Aschoff sinuses, a finding mostly a disease of adults rare gallblad some of which may be cystically dilated. They are more common in the cuboidal with vesicular or hyperchromat endocrine cells are usually mixed with gallbladder than in the extrahepatic bile ic nuclei and small nucleoli and variable the columnar cells. Nodular frequently, peptide hormones have been bladders removed for cholelithiasis or aggregates of cytologically bland spin identified in the endocrine cells by chronic cholecystitis. A small proportion dle cells with eosinophilic cytoplasm but immunohistochemistry. Hyperplasia of of adenomas progress to carcinoma {42, without keratinization or intercellular metaplastic pyloric type glands is often 909, 967}. Adenomas are often small, asympto {984, 1361} are present in about 10% of Papillary adenoma, intestinal type. This matic, and usually discovered incidental the cases, whereas frank squamous benign tumour consists predominantly of ly during cholecystectomy, but they can metaplasia is exceedingly rare. Paneth papillary structures lined by dysplastic be multiple, fill the lumen of the gallblad cells and endocrine cells are often pres cells with an intestinal phenotype. By immunohistochemistry, serotonin adenomas, which usually arise in a back adenomas of the gallbladder occur in and a variety of peptide hormones ground of pyloric gland metaplasia, may B A Fig. In a series of five intestin the term tubulo-papillary adenoma is lary adenomas, that may involve exten al type papillary adenomas of the gall applied. Two subtypes are recognized: sive areas of the extrahepatic bile ducts bladder, one progressed to invasive car one is composed of tubular glands and and even extend into the gallbladder and cinoma . The predominant cell is papillary structures similar to those of intrahepatic bile ducts. The disease columnar with elongated hyperchromatic tubulovillous intestinal adenomas; the affects both sexes equally. The cells are pseudostratified, mitotically similar to pyloric glands and papillary Complete excision of the multicentric active, and indistinguishable from those structures often lined by foveolar epithe lesions is difficult and local recurrence is of villous adenomas arising in the large lium. Rarely, tubulo-papillary ous papillary structures as well as com same type of epithelium, but represent adenomas arise from the epithelial plex glandular formations. Because ing less than 20% of the tumour, may also invaginations of adenomyomatous hyper severe dysplasia is often present, papillo be found. Also present are goblet, Paneth, Other benign biliary lesions lesion as a form of low-grade multicentric and serotonin-containing cells. Papil the endocrine cells are immunoreactive resemble their intrahepatic counterparts lomatosis has a greater potential for for peptide hormones. This mas are seen predominantly among Intraepithelial neoplasia (dysplasia) lesion consists predominantly of papil adult females and are usually sympto If intraepithelial neoplasia is found, multi lary structures lined by cells with a biliary matic. Cholecystectomy is a consists of papillary structures lined by obstructive jaundice or cholecystitis-like curative surgical procedure for patients tall columnar cells, which except for the symptoms. More common in the extra with in situ carcinoma or with carcinoma presence of more cytoplasmic mucin hepatic bile ducts than in the gallblad extending into the lamina propria . Endocrine or Paneth neoplasms that contain mucinous or neoplasia of the gallbladder reflects that cells are not found. Only mild dysplastic serous fluid and are lined by columnar of invasive carcinoma. In situ or invasive epithelium reminiscent of bile duct which carcinoma of the gallbladder is carcinoma has not been reported in or foveolar gastric epithelium . This is Occasionally endocrine cells are pres countries in which this tumour is spo the rarest form of adenoma of the gall ent. The stroma gallbladders with lithiasis has varied from are examples of hyperplasia secondary also shows variable fibrosis. Papillo of uniformity in morphological criteria glands and papillary structures each matosis is a clinicopathological condition and sampling methods. Intraepithelial between normal-appearing columnar neoplasia is usually not recognized on cells and intraepithelial neoplasia is seen macroscopic examination because it in nearly all cases. In general, the cell often occurs in association with chronic population of dysplasia is homogeneous, cholecystitis. The mucosa may appear unlike the heterogeneous cell population granular, nodular, plaque-like, or trabec of the epithelial atypia of repair. The papillary type of intraepithe spread involvement of the mucosa by lial neoplasia usually appears as a small, intraepithelial neoplasia often occurs. For cauliflower-like excrescence that projects this reason, we have suggested that into the lumen and can be recognized on some, if not most, invasive carcinomas of close inspection. In the late two types of intraepithelial neoplasia are p53 occurs in some lesions . Reactive epithelial ical picture is that of back-to-back glands being more common. The papillary type changes (‘atypia of repair’) differs from located in the lamina propria but often is characterized by short fibrovascular intraepithelial neoplasia in consisting of a connected with the surface epithelium. Some show Intraepithelial neoplasia usually begins cuboidal cells, atrophic-appearing epithe distinctive papillary features with small on the surface epithelium and subse lium, and pencil-like cells are present. In fibrovascular stalks lined by neoplastic quently extends downward into the addition, there is a gradual transition of cells. Not infrequently, a combination of Rokitansky-Aschoff sinuses and into the cellular abnormalities, in contrast with these growth patterns is seen. Columnar, the abrupt transition seen in intraepithelial the differential diagnosis between high cuboidal, and elongated cells with vari neoplasia. The extent of nuclear atypia is grade intraepithelial neoplasia (severe able degrees of nuclear atypia, loss of less pronounced in reactive changes and dysplasia) and carcinoma in situ is diffi polarity, and occasional mitotic figures immunoreactivity for p53 protein is cult and often impossible in many cases. The dysplastic cells absent, while usually positive in intraep this is not important because the two are usually arranged in a single layer, but ithelial neoplasia. Later, papillary logically, are closely related biologically structures covered by dysplastic epitheli High-grade intraepithelial neoplasia and Histological variants of carcinoma in situ.

This has led to symptoms tonsillitis buy genuine retrovir on-line a wealth of information being available on the species which can be applied to treatment kidney infection purchase retrovir 100mg overnight delivery similar organisms symptoms indigestion order discount retrovir online. The most severe cases can result in toxic megacolon and perforation of the gut medications to avoid during pregnancy purchase retrovir, which can lead to fatalities. Levels of the bile salt taurocholate are optimum to serve as germination agents for the spores in the colon, allowing germination, outgrowth and proliferation of C. The bile salt chenodeoxycholate acts as a germination inhibitor (Sorg & Sonenshein 2009), but is only present in low levels in the colon. Studies using 027 strains have also suggested that the presence of antibiotics in the gut could promote germination of spores (Saxton et al. The elderly are more at risk from infection for a number of reasons; immunosenescence means a reduced ability to mount an effective immune response, and advanced age also leads to changes in the microflora. Immunosuppressant treatment and other under-lying conditions also contribute to increased susceptibility to C. Higher relapse rates have been reported for infections involving 027 strains (Figueroa et al. Once patients have experienced a relapse of infection, continued recurrent disease is much more likely to occur. Recurrent episodes of disease tend to occur in those who have mounted ineffective immune responses during in primary infection (Garey et al. Failure of the gut microflora to recolonise post antibiotic treatment or illness is also a common factor in relapse. The costs of relapsing infection are not only financial but are also substantial in terms of personal health. Infected individuals are isolated and strict cleaning regimens are implemented to avoid further spread of infection (Vonberg et al. However, genetic tools and molecular typing systems are now being used to track the spread of individual infections. Using these data, it was shown that around 20% of cases in hospitals have obvious sources within the hospital itself, a figure much lower than expected. The study did not 25 Chapter 1 Introduction screen all patients and visitors, so does not account for asymptomatic carriers being sources of infection within hospitals. Data from the study also suggests that a minority of symptomatic patients (<10%) could remain infectious for up to 8 weeks, far beyond the infectious period anticipated by control measures employed in hospitals. This study could be improved by screening asymptomatic patients for potential sources of infection, but it does address an important issue for C. A more recent study also addressing the issue of ward based transmission found that isolates from 45% of those cases studied were genetically diverse from existing cases in a hospital (Eyre et al. Global transmission highlights the need for widely used control measures, for example, improved antimicrobial stewardship should be global, not simply a localised effort. More recent studies are starting to address this imbalance in information however. These cases occurred in a younger age group than normally associated with nosocomial C. This implies that the burden of disease caused by this pathogen is likely to be underestimated, although more severe cases remain associated with hospital infections. Attention needs to be focused on the reservoir of infection in the community that has potential to increase in severity, just as has occurred with hospital associated cases of infection. It is difficult at some points to distinguish between community associated and health care associated infections, especially when this requires investigating the medical history of patients for exposure to risk factors for C. This information would allow more comprehensive control measures to be implemented, not just in hospitals. However, approximately 20% of initial cases will experience a relapse following this treatment (Johnson 2009), highlighting the need for more effective antibiotic agents or alternative treatments. Fidaxomycin is a recently developed antibiotic that is reported to have increased efficacy against C. It is a narrow spectrum antibiotic, having little effect against other groups in the microflora such as Gram negative aerobes, anaerobes and yeasts so causes less disruption to the microflora than broader spectrum antibiotics. This could be a factor that contributes to the lower relapse rate reported with use of fidaxomycin compared to vancomycin (Louie et al. Further development of new antibiotics is required in order to avoid issues with antibiotic resistance developing. Toxin binding A diverse range of alternative treatments have been investigated in an attempt to reduce reliance on antibiotics. One such treatment is the development of ‘Tolevamer’, a novel toxin binding polymer. This works on the basis of neutralising toxins by binding to them in 28 Chapter 1 Introduction order to prevent toxin mediated damage to the host in disease (Braunlin et al. When tested in a human gut model however, the polymer did not perform well (Baines et al. Several treatment strategies address the depletion of the microflora as a factor in disease. An example of this is the use of probiotics; studies have been carried out using various species and strains of bacteria to assess the potential for treatment of C. The current state of available information contributes to a lack of clear conclusions regarding probiotics as a potential treatment. Studies are often carried out using small sample sizes or are unclear as to the regimen used in treatment, making results difficult to replicate. As probiotic effects are likely to be species or even strain specific, clear identification of the probiotic agent is also a necessity. Improved design and communication of results is needed if probiotics are going to be considered seriously, especially when doubts exist within the scientific community (Miller 2009). Faecal therapy Building on the idea of probiotics supplementing the gut flora leads to one of the most successful alternative treatments to antibiotics. Faecal transplants use stool samples from a 29 Chapter 1 Introduction healthy ‘donor’ which are then implanted into the colon of a C. The microbiota in the donor stool recolonises the gut and enables clearance of the infection, restoring the gut environment to a normal state this treatment is reported to have excellent efficacy in resolving infection (Gough et al. This involves identifying and isolating key species within the faecal microflora and using these to create a treatment that delivers a restorative microflora to the infected gut. This eliminates the risk of transplanting further pathogens into the patient and results in a more attractive treatment option (Lawley et al. For example, a recent paper reported the identification of a germination receptor that interacts with bile salts present in the gut to initiate germination (Francis et al. This receptor could be used in drug design in order to prevent germination of ingested spores, eliminating the threat of disease, or as a potential antigen in vaccine design. Development of a preventative vaccine would reduce the use of antibiotics in treatment of this infection, addressing a key issue in finding alternative treatments. This method produces antibodies that have neutralising 30 Chapter 1 Introduction activity against the toxins produced in disease, so protects against the damage caused during infection. The correlation between antibody response against toxins and protection from disease is well established (Torres et al. This response can be achieved by immunising subjects with inactivated toxins, or toxin fragments. Several studies have used chimeric proteins which use fusions of toxin A and toxin B in vaccine formulations (Tian et al. Previous studies have addressed the use of an alternative route for immunisations, including use of cellular antigens delivered mucosally in an attempt to prevent colonisation of C. This approach used oral immunisation of spores expressing a toxin A antigen to produce protection against C. The route of dosing and use of the bacterial spore effectively as an adjuvant for the vaccine are important factors in this study. The delivery strategy of an antigen can alter the patterns of immune response produced (Lima et al. In the generation of mucosal responses, an 31 Chapter 1 Introduction entity that interacts with the innate immune system to boost responses could be important (Kaisho & Akira 2002; Rhee et al. Manipulation of multiple aspects of the immune system to evoke a more complete response is presented as an avenue worth investigation. Understanding the immune response required for protection will aid the development of more efficacious vaccines.

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In most people with acute watery diarrhea and without recent vomiting are resolved (strong medicine syringe buy generic retrovir pills, low) treatment 4s syndrome cheap retrovir 100 mg mastercard. Empiric treatment should be avoided in people with 44 Human milk feeding should be continued in infants and persistent watery diarrhea lasting 14 days or more (strong treatment regimen discount 300 mg retrovir with amex, low) medicine 027 order generic retrovir line. Resumption of an age-appropriate usual diet is recom watery diarrhea should not be offered empiric or preven mended during or immediately after the rehydration pro tive therapy, but should be advised to follow appropri cess is completed (strong, low). What is the role of a probiotic or zinc in treatment or preven tion of infectious diarrhea in children and adults Isotonic intravenous fluids such as lactated Ringer’s and normal and children with infectious or antimicrobial-associated saline solution should be administered when there is severe diarrhea (weak, moderate). Ill people with diarrhea should avoid swimming, water-related rhea in children 6 months to 5 years of age who reside in activities, and sexual contact with other people when sympto countries with a high prevalence of zinc deficiency or who matic while adhering to meticulous hand hygiene (strong, low). What strategies, including public health measures, are benef ica serovar Typhi (strong, high). Infection control measures including use of gloves and fed from stool specimens impact the control and prevention of diar gowns, hand hygiene with soap and water, or alcohol-based rheal disease in the United States All diseases listed in the table of National Notifiable Diseases product should be based upon a known or suspected path Surveillance System at the national level, including those ogen and the environment in which the organism may that cause diarrhea, should be reported to the appropriate be transmitted (strong, low). Appropriate food safety practices are recommended to Shigella, and Listeria) to ensure that control and prevention avoid cross-contamination of other foods or cooking sur practices may be implemented (strong, high). The expert panel expresses its gratitude for thoughtful reviews of an earlier version by Drs Herbert Dupont, Richard L. Clin requires full disclosure of all relationships, regardless of relevancy to the Infect Dis 2001; 32:331–51. Going from evi amount) and the relevance of the relationship (ie, the degree to which an dence to recommendations. Useh 1Department of Veterinary Pathology and Microbiology, University of Agriculture, Makurdi, 2Department of Veterinary Pathology and Microbiology, Ahmadu Bello University, Zaria, Nigeria; 3 Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America Received: November 30, 2013 Revised: January 4, 2014 Accepted: January 13, 2014 Abstract the genus Clostridium is made up of species that cause disease to both human beings and animals, with zoonotic species/strains playing critical roles in disease dynamics. Pathogenic clostridia cause lethal or life threatening infections that must be treated, while the industrial clostridia produce bio-fuels, to serve as alternative energy sources in the face of very high global prices of conventional fuels. Genetic engineering is currently developing novel strains by replacing or altering the gene configuration of pathogenic strains (gene knockout/down) to convert them to solvenogenic and non pathogenic strains for industrial uses. Therapeutic clostridia serve as vehicles for treatment of diseases, especially solid tumors. Because of the global problem of antibiotic resistance, which is a survival strategy by microbial pathogens, some of the well known chemotherapeutic protocols have failed and there is the need to evolve new treatment approaches, using novel agents that have superior mechanisms of action, compared to conventional antibiotics that are becoming inconsequential because of resistance. It is believed that natural products may be effective alternatives to resolving this puzzle, since they are cheaper, readily available and possibly effective against clostridial species. In this review article, the authors discussed some of the life threatening and solvenogenic clostridia and listed some natural products that may possibly be employed as drug targets for ameliorating the problem of resistance in the future, if their active principles are thoroughly researched. It is concluded that medical and veterinary research should be re-jigged to evolve active principles from natural products that are not so easily surmounted by the surge in drug resistant strains. Keywords: Clostridium; Industrial Uses; Medicinal Prospects; Natural Products; Ameliorative Agents; Pathogenic Species. Introduction exclusively a veterinary pathogen, only associated with blackleg in ruminants (Useh et al. Recent the genus Clostridium consists of over 100 species, reports of the disease in human beings have placed the ranking second in size next to Streptomyces (Dong et pathogen on the list of very important lethal disease al. Clostridium chauvoei, which has a strong tumor managements, the use of viral vehicles in gene phylogenetic relationship with C. All rights reserved Volume 7, Number 2 which this procedure has not been successful. Over-the-counter antibiotic access is substrates from monosaccharides to polysaccharides widespread in Nigeria and nosocomial diarrhoea (Ezeji et al. Clostridium Difficile C difficile has been reported as a pathogen of animals, affecting dogs, cats, horses and pigs (Weese et Clostridium difficile is the most common cause of al. Another study in the worldwide and substantially burdens health care Netherlands showed high C. Investigations of these and other outbreaks were present in horse and poultry samples. Outbreaks have also been associated with other patients in 2009/2010, encompassing 0. Whereas outbreaks in North piglets has yet to be conclusively elucidated (Hopman et American and European hospitals have led to increased al. This and Mwakurudwa, 2008), chicken in retail poultry meat information gap is significant since antibiotic pre © 2014 Jordan Journal of Biological Sciences. All rights reserved Volume 7, Number 2 83 in the United States of America (Songer et al. Seven types of botulinum toxins 2010) with a zero prevalence in passerine birds in are known (A through G), of which types A, B, E, and F Europe (Bandelj et al. Botulism is characterized by rapidly progressive colonize the entire environment to create havoc to cranial neuropathy and symmetric descending flaccid public health. Possible routes other than meat consumption the organism is the causative agent of muscular (direct and indirect contact) with animals, have been gangrene syndrome with clinical features that overlap speculated (Weese, 2010). It is increasingly recognized with those of other clostridial diseases and that aerial dissemination of bacterial elements can be the acute/hyperacute syndromes seen with other diseases main route of zoonotic transmission (Kuske, 2006; such as anthrax (Fasanella et al. Blackleg in ruminants has been reviewed (Useh et Traditional microbiological methods are unable to al. Soft tissues are usually affected in the pathology ill (Merchant and Barner, 1964), gangrenous myositis of the disease with an accompanying necrotizing (Williams and Andrews, 1992), clostridial myositis of infection (Gnerlich et al. In Nigeria, Jakari, Vom and histotoxic diseases in both humans and animals K76 strains have been incriminated as the aetiologic (McClane, 2007; Amimoto et al. These strains are also responsible for the environment come in contact with the host, where disease in both the natural and accidental hosts spores undergo germination followed by outgrowth, cell (Radostits et al. These neurotoxins are the biofuel producing clostridia are very important considered the most toxic substances known (Lamanna, as they are nonpathogenic and produce biogenic fuels 1959) and have been designated as category A for industrial use (Kopke et al. It can be used as a precursor in the caused by potent neurotoxins produced by the gram manufacture of a range of chemical products, including positive, anaerobic, spore-forming bacterium C. All rights reserved Volume 7, Number 2 global market of around 32 million tons per annum, clostridia (Mao et al. Apart from the usefulness valued at approximately $43 billion in sales (Xiu and of non-pathogenic clostridia in biofuel production, it is Zeng, 2008). Three (3) acetogenic members of the believed that their spores could serve as vehicles for Clostridium genus (C. Botulinum toxin in bacteria in fermentation systems that depend on sugars bioterrorism has been reviewed (Bossi et al. Aerosols of botulinum toxin could be used as a Homologues of the genes involved in the requisite biological weapon (Franz et al. The Aum while a broader expression study of Wood-Ljungdahl Shinrikyo cult in Japan attempted unsuccessfully to pathway genes has been shown to provide a release an airborne form of botulinum toxin in Tokyo on transcription-level view of one of the oldest existing three separate occasions in the early 1990s (Arnon et al. It is likely that several countries have developed form to develop new stains of clostridial organisms with and stockpiled botulinum toxin weapons (Arnon et al. This positive, strictly anaerobic bacillus that forms a is re-invigorated by the high and ever rising cost of subterminal spore. These spores can be found in soil crude and the desire for alternative energy sources to cut samples and marine sediments throughout the world. The shortage of Botulinum toxin does not penetrate intact skin (Arnon et gasoline, even in some oil producing countries, has al. Toxins act by binding to the presynaptic stimulated governments of countries like China to re nerve terminal at the neuromuscular junction and at awaken their biofuel programme (Dong et al. Human botulism is saccharoperbutylacetonicum are known for producing almost always caused by toxin types A, B, E and, in rare biofuels (Jones and Kreis, 1995). Types C and D are associated with disease in of these bacteria through gene knockout/ down systems birds and mammals. Type G is not associated with any have been developed through homologues disease in humans or animals. It has been estimated that, recombination methods based on replicable/ non weight for weight, these toxins are the most toxic replicable vectors (Harris et al.

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Revisions of these guidelines will be necessary as further experience and advances in the feld provide new information symptoms 8 months pregnant order cheapest retrovir. Although the guidelines will be updated periodically treatment zoster ophthalmicus order retrovir 100mg without a prescription, practitioners are responsible to medications for migraines purchase retrovir online pills ensure the most current knowledge and practice is applied for each case medications pregnancy discount retrovir 300mg otc. They are used in addition to Routine Practices (not in place of) and are initiated based on condition and clinical presentation (syndrome) and on specifc etiology (diagnosis). Aerosols Aerosols are solid or liquid particles suspended in the air, whose motion is governed principally by particle size, which ranges from 10µm-100µm. Administrative controls these are measures put in place to reduce the risk of infection to health care workers and patients. Examples of these procedures include: • high-frequency oscillatory ventilation • tracheostomy care • chest physiotherapy • obtaining nasopharyngeal swabs or aspirates Airborne exposure this refers to exposure to aerosols capable of being inhaled. Airborne infection isolation this was formerly referred to as a negative pressure isolation room. Airborne transmission this refers to the transmission of microorganisms via inhaled aerosols that results in an infection in a susceptible host. Alcohol-based hand rub this refers to an alcohol-containing (60 to 90 per cent) preparation (liquid, gel or foam), designed for application to the hands to kill or reduce the growth of microorganisms. Aseptic technique this technique is the purposeful prevention of transfer of microorganisms from the patient’s body surface to a normally sterile body site, or from one person to another, by keeping the microbe count to an irreducible minimum. Biomedical waste this is waste generated within a health care facility that requires special handling and disposal because it presents a potential risk of disease transmission. Material shall be considered biomedical waste if: a) They are contaminated with blood or body fuids containing visible blood. Carbapenemase this is a class of enzymes that inactivate carbapenem antibiotics by hydrolysing them. In almost all instances, these enzymes hydrolyse not only carbapenem antimicrobials, but also frst, second and third-generation cephalosporins and penicillins. The genetic information to produce carbapenemases is often located on a mobile genetic element. It is accomplished by using water and detergents in conjunction with mechanical action. Colonization Colonization is the presence of microorganisms in or on a host with growth and multiplication, but without tissue invasion or cellular injury. Cohort staffng this is the practice of assigning specifc personnel to care only for patients known to be exposed to or infected with the same organism. These personnel would not participate in the care of patients who have not been exposed to or infected with that organism. Contact exposure this refers to transmission where exposure occurs through physical contact between an infected source and a host, or through the passive transfer of the infectious agent to a host via an intermediate object (fomite). Contact Precautions Contact Precautions are used in addition to Routine Practices to reduce the risk of transmitting infectious agents through contact with an infectious person or their environment. Contact transmission this is transmission that occurs when exposure leads to an infectious dose of (direct or indirect) viable microorganisms from an infected or contaminated source, resulting in colonization or infection of a susceptible host. Direct contact this is the transfer of microorganisms via direct physical contact between an infected or colonized individual and a susceptible host (body surface to body surface). Indirect contact this is the passive transfer of microorganisms from an infected or colonized individual to a susceptible host via an intermediate object. Continuum of care this refers to care provided across all health care sectors, including settings where emergency (including pre-hospital) care is provided, hospitals, complex continuing care, rehabilitation hospitals, long-term care homes, outpatient clinics, community health centres and clinics, physician offces, dental offces, offces of other health professionals, public health and home health care. Critical items Critical items are instruments and devices that enter sterile tissues, including the vascular system. Reprocessing critical items, such as surgical equipment or intravascular devices, involves meticulous cleaning, followed by sterilization. Decontamination Decontamination is the removal of microorganisms to leave an item safe for further handling. Designated hand washing sink this is a sink used only for hand washing for healthcare workers. Referred to for health care workers as hand hygiene sink in Canadian Standards Association Canadian Healthcare Facilities Z8000-11 (current edition). Refer to Canadian Standards Association Canadian Healthcare Facilities Z8000-11 (current edition). Disinfectant Disinfectant is a product used on inanimate objects to reduce the quantity of microorganisms to an acceptable level. Disinfection Disinfection is the inactivation of disease-producing microorganisms with the exception of bacterial spores. High level disinfection this level of disinfection is required when processing semi-critical items. High level disinfection processes destroy vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non-enveloped (non-lipid) viruses, but not necessarily bacterial spores. Low level disinfection this level of disinfection is required when processing non-critical items and some environmental surfaces. Low level disinfectants kill most vegetative bacteria and some fungi as well as enveloped (lipid) viruses. Droplet Droplets are solid or liquid particles suspended in the air, whose motion is governed principally by gravity. Droplets are usually generated by an infected source by coughing, sneezing or talking. Droplet exposure Droplet exposure may occur when droplets that contain an infectious agent are propelled a short distance (within 2 metres) through the air and are deposited on the mucous membranes of the eyes, nose or mouth of a host. Droplet nucleus A droplet nucleus is the airborne particle resulting from a potentially infectious (microorganism-bearing) droplet from which most of the liquid has evaporated, allowing the particle to remain suspended in the air. However, their motion is controlled by physical parameters, including gravity and air currents. Droplet Precautions Droplet Precautions are used in addition to Poutine Practices for patients known or suspected of having an infection that can be transmitted by large infectious droplets. Droplet transmission this is transmission that occurs when the droplets that contain microorganisms are propelled a short distance (within 2 metres) through the air and are deposited on the mucous membranes of another person, leading to infection of the susceptible host. Droplets can also contaminate surfaces and contribute to contact transmission (see also contact transmission). Drug identifcation number this is the number located on the label of prescription and over-the-counter drug products that have been evaluated by the Therapeutic Products Directorate and approved for sale in Canada. Emerging respiratory infections these are acute respiratory infections of signifcant public health importance, including infections caused by either emergence of new variants of known respiratory pathogens. Exposure this refers to having contact with a microorganism or an infectious disease in a manner such that transmission may occur. Facial protection Facial protection includes masks and eye protection, face shields, or masks with a visor attachment. Facility approved disinfectant this is a disinfectant cleaner that has been approved by the facility or organization. It must achieve manufacturer’s recommended contact time on all surfaces to ensure appropriate disinfection. Febrile respiratory illness this term is used to describe a wide range of droplet and contact spread respiratory infections, which usually present with symptoms of a fever > 38°C and new or worsening cough or shortness of breath. Neonates, the elderly, and those who are immunocompromised may not have fever in association with a respiratory infection. Fit testing Fit testing is the use of a qualitative or a quantitative method to evaluate the ft of a specifc manufacturer, model and size of respirator on an individual. Fomites Fomites are inanimate objects in the environment that may become contaminated with microorganisms and serve as vehicles of transmission. Hand antisepsis this is a process for the removal or killing of transient microorganisms on the hands, using an antiseptic. It is also referred to as antimicrobial or antiseptic handwash, antiseptic hand-rubbing, disinfection or decontamination. Hand care program A hand care program for staff is a key component of hand hygiene and includes hand care assessment, health care worker education, occupational health assessment if skin integrity is an issue, provision of hand moisturizing products and provision of alcohol-based hand rub that contains an emollient. Hand hygiene this is a comprehensive term that applies to hand washing, hand antisepsis and to actions taken to maintain healthy hands and fngernails.

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