Basic Principles, Disinfection and Sterilization, Introduction to Microbiology and Parasitology

Last updated: November 12, 2024
  • What are the notifiable or critical values in microbiology?
    • Refers to certain test results that fall outside of the normal range and may indicate a serious or potentially life- threatening condition. Examples include:
      • Positive results for certain pathogens eg. MRSA, Clostridium difficile
      • High bacterial counts in blood cultures (indicates sepsis)
      • Low WBC counts (sign of severe infection or immunosuppresion)
  • Describe the levels of Bioterrorism agents and diseases.
    • Category A:
      • Can be easily disseminated or transmitted from person to person
      • results in high mortality rate
      • Have the potential for major public health impact, and therefore might cause panic and social disruption.
      • Examples include*: Bacillus anthracis, Clostridium botulinum, Yersinia pesits, Variola major, Francisella tularensis, Ebola, Marbug, Lassa, Machup*
    • Category B:
      • Moderately easy to disseminate
      • Result in moderate morbidity rates and low mortality rates
      • Require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance
      • Examples include: Brucella spp, Clostridium perfringens, Salmonella spp. Eschericia coli, Burholderial mallei, Burkholderia pseudomallei, Chlamydia psittaci, Coxiella burnetii, Ricinus communis, Staph aureus, Rickettsia prowazeki, Vibrio chlerae, cryptosporidium parvum
    • Category C:
      • Emerging pathogens that could be engineered for mass dissemination in the future
      • Ease of production and dissemination
      • Have potential for high morbidity and mortality rates and major health impact
  • Mention 3 reliable methods of sterilization
    1. Autoclave: steam sterilization which involves exposing equipment to direct steam at a certain temperature and pressure for a specified period of time.
    2. Dry air sterilization: exposing equipment to dry heat, which gets absorbed by the external layer and is transferred to the internal layers by conduction.
    3. Ethylene oxide gas sterilization: includes preconditioning and humidification, gas introduction, exposure, evacuation and air washes.
    4. Hydrogen peroxide gas plasma sterilization: Hydrogen peroxide diffusion and gas plasma generation→ formation of free radicals→ damage enzymes, nucleic acid and disrupt cellular metabolisms of pathogenetic organisms
    5. Pasteurization: pathogen destruction through brief heating, especially of milk and other protein- containing products.
  • Mention 5 groups of disinfectants
    1. Alcohol- based disinfectants eg. isopropyl alcohol and ethyl alcohol
    2. Bisbiguanides eg. chlorhexidine
    3. Phenol eg. orthophenylphenol and ortho-benzyl-para-chlorophenol
    4. Halogen-releasing agents
      • Iodine and iodophors eg. povidone-iodine and poloxamer-iodine
      • Chlorine-releasing agents eg. Sodium hypochlorite and Chlorine dioxide
    5. Hydrogen peroxide
    6. Aldehydes eg. glutaraldehyde
    7. Quaternary ammonium compounds eg. Benzalkonium chloride
  • List the various microscopy modalities available to the microbiologist in the study of microorganisms
    1. Light microscopy
    2. Dark-field microscopy
    3. Fluorescence microscopy
    4. Micrometry (measurement)
  • How is sterilization controlled?
    1. Using temperature, pressure, and time indicators: These indicators help to ensure that the sterilization process has been carried out under the correct conditions for the required amount of time.
    2. Using biological indicators: These are biological substances that are designed to be sensitive to the sterilization process. They can be used to confirm that the sterilization process has been effective.
    3. Using chemical indicators: These are chemicals that change color or some other physical property when exposed to the sterilization process, indicating that the process has been successful.
    4. Using physical indicators: These are devices that are placed in the sterilization chamber to ensure that the correct conditions are being maintained.
    5. Using process challenge devices: These are devices that are designed to simulate the resistance of microorganisms to the sterilization process, and are used to confirm that the sterilization process is effective.
    6. Using process control charts: These are graphical representations of the sterilization process that are used to monitor and control the process
  • Briefly describe Spaulding’s classification of devices’ risk of infection.
    • Critical: contact sterile intermediate (High risk)
    • Semicritical: contact mucous membrane or non-intact skin (High to intermediate risk)
    • Non-critical: contact skin (low risk)
  • Briefly describe the levels of disinfection.
    • High level disinfection (HLD): Chemical sterilants, Heat (pastuerization)
    • Intermediate-level disinfection (ILD): Chlorine based products, phenolics – EPA measured with tuberculoid activity
    • Low-level disinfection (LLD): Chemicals – EPA measured with tuberculoid activity
  • What are the temperatures and durations employed in sterilization?
    • Autoclave: 121*C for 15 minutes
    • Flash sterilization: 131*C for 3 – 10 minutes (emergencies)
    • Dry heat: 150C for 150 minutes or 160C for 120 minutes or 170*C for 60 minutes
  • Describe the order of resistance of microorganisms to sterilization and disinfection.
    1. Spores are the most resistant to sterilization and disinfection methods. They can survive high temperatures, pressure, radiation, and chemicals.
    2. Bacteria and viruses are less resistant than spores, but can still survive some sterilization and disinfection methods.
    3. Fungi and algae are less resistant than bacteria and viruses.
    4. Protozoa and helminths are the least resistant to sterilization and disinfection methods
  • What are the sections of a Central Sterile Supply Department (CSSD)?
    • Receiving area
    • Dirty area for cleaning
    • Inspection, Assembly, and packaging area
    • Decontamination and Sterilization (FIFO)
    • Clean area for storage of sterilized packs
    • Dispatch
Reference Intervals
Biochemistry
ACTHP: <80 ng/L
ALTP: 5–35 U/L
AlbuminP: 35–50 g/L
AldosteroneP: 100–500 pmol/L
Alk. phosphataseP: 30–130 U/L
α-AmylaseP: 0–180 IU/dL
α-FetoproteinS: <10 kU/L
Angiotensin IIP: 5–35 pmol/L
ADHP: 0.9–4.6 pmol/L
ASTP: 5–35 U/L
BicarbonateP: 24–30 mmol/L
BilirubinP: 3–17 μmol/L
BNPP: <50 ng/L
CRPP: <10 mg/L
CalcitoninP: <0.1 mcg/L
Calcium (ionized)P: 1.0–1.25 mmol/L
Calcium (total)P: 2.12–2.60 mmol/L
ChlorideP: 95–105 mmol/L
CholesterolP: <5.0 mmol/L
VLDLP: 0.128–0.645 mmol/L
LDLP: <2.0 mmol/L
HDLP: 0.9–1.93 mmol/L
Cortisol AMP: 450–700 nmol/L
Cortisol MidnightP: 80–280 nmol/L
CK ♂P: 25–195 U/L
CK ♀P: 25–170 U/L
CreatinineP: 70–100 μmol/L
FerritinP: 12–200 mcg/L
FolateS: 2.1 mcg/L
FSHP: 2–8 U/L ♂; >25 menopause
GGT ♂P: 11–51 U/L
GGT ♀P: 7–33 U/L
Glucose (fasting)P: 3.5–5.5 mmol/L
Growth hormoneP: <20 mu/L
HbA1C (DCCT)B: 4–6%
HbA1C (IFCC)B: 20–42 mmol/mol
Iron ♂S: 14–31 μmol/L
Iron ♀S: 11–30 μmol/L
Lactate (venous)P: 0.6–2.4 mmol/L
Lactate (arterial)P: 0.6–1.8 mmol/L
LDHP: 70–250 U/L
LHP: 3–16 U/L
MagnesiumP: 0.75–1.05 mmol/L
OsmolalityP: 278–305 mosmol/kg
PTHP: 0.8–8.5 pmol/L
PotassiumP: 3.5–5.3 mmol/L
Prolactin ♂P: <450 U/L
Prolactin ♀P: <600 U/L
PSAP: 0–4 mcg/mL
Protein (total)P: 60–80 g/L
Red cell folateB: 0.36–1.44 μmol/L
Renin (erect)P: 2.8–4.5 pmol/mL/h
Renin (recumbent)P: 1.1–2.7 pmol/mL/h
SodiumP: 135–145 mmol/L
TBGP: 7–17 mg/L
TSHP: 0.5–4.2 mU/L
T4P: 70–140 nmol/L
Free T4P: 9–22 pmol/L
TIBCS: 54–75 μmol/L
TriglyceridesP: 0.50–2.3 mmol/L
T3P: 1.2–3.0 nmol/L
Troponin TP: <0.1 mcg/L
Urate ♂P: 210–480 μmol/L
Urate ♀P: 150–390 μmol/L
UreaP: 2.5–6.7 mmol/L
Vitamin B12S: 0.13–0.68 nmol/L
Vitamin DS: 50 nmol/L
Arterial Blood Gases
pH7.35–7.45
PaCO₂4.7–6.0 kPa
PaO₂>10.6 kPa
Base excess±2 mmol/L
Urine
Cortisol (free)<280 nmol/24h
Hydroxyindole acetic acid16–73 μmol/24h
Hydroxymethylmandelic acid16–48 μmol/24h
Metanephrines0.03–0.69 μmol/mmol cr.
Osmolality350–1000 mosmol/kg
17-Oxogenic steroids ♂28–30 μmol/24h
17-Oxogenic steroids ♀21–66 μmol/24h
17-Oxosteroids ♂17–76 μmol/24h
17-Oxosteroids ♀14–59 μmol/24h
Phosphate (inorganic)15–50 mmol/24h
Potassium14–120 mmol/24h
Protein<150 mg/24h
Protein/creatinine ratio<3 mg/mmol
Sodium100–250 mmol/24h
Haematology
WCC4.0–11.0 ×10⁹/L
RBC ♂4.5–6.5 ×10¹²/L
RBC ♀3.9–5.6 ×10¹²/L
Hb ♂130–180 g/L
Hb ♀115–160 g/L
PCV ♂0.4–0.54 L/L
PCV ♀0.37–0.47 L/L
MCV76–96 fL
MCH27–32 pg
MCHC300–360 g/L
RDW11.6–14.6%
Neutrophils2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes1.0–4.5 ×10⁹/L (20–45%)
Eosinophils0.04–0.44 ×10⁹/L (1–6%)
Basophils0–0.10 ×10⁹/L (0–1%)
Monocytes0.2–0.8 ×10⁹/L (2–10%)
Platelets150–400 ×10⁹/L
Reticulocytes0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time10–14 s
APTT35–45 s
Paediatric
Pulse Rate (bpm)
Neonate140–160
Infant <1yr120–140
1–5 years110–130
5–12 years80–120
>12 years70–100
Respiratory Rate (tachypnoea)
0–2 months≥60/min
2–12 months≥50/min
1–5 years≥40/min
>5 years≥30/min
Blood Pressure (mmHg)
Term65/45
1 year75/50
4 years85/60
8 years95/65
10 years100/70
Weight Formulas
3–12 months(a + 9)/2 kg
1–6 years2a + 8 kg
>6 years(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn13–20
1 month11–18
2 months10–15
1–2 years10–13
>2 years11–14
MUAC (6 months–5 years)
Obese>17.5 cm
Normal13.5–17.4 cm
At risk12.5–13.4 cm
Moderate malnutrition11.5–12.4 cm
Severe malnutrition<11.5 cm
Developmental Milestones
Social smile1.5 months
Head control4 months
Sits unsupported7 months
Crawls10 months
Stands unsupported10–12 months
Walks12–13 months
Talks18 months
CSF WBC (/mm³)
Term newborn0–25
>2 weeks0–5
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