so one of the things that we have been talking a lot about are how diseases are transmitted many of these things we talked about in the parasitology chapter so they could be transmitted by way of contact so direct contact so if you are bitten by rabbit animal um indirect contact by fomites we talked a little bit about that with tetanus like if you step on a rusty nail or even in droplets so like somebody coughing on you with the common cold um they can also be transmitted in vehicles so they could be water born or food born and we also talked a lot about Vector transmission and parasitology so mechanical vectors like a fly picking up parasitic eggs or biological vectors like we talked about with the mosquito and malaria and plasmodium so we know that there's a variety of ways that we can transmit diseases one thing that we definitely want to try to prevent as far as diseases go are nosocomial infections nosocomial infections these are infections acquired in a hospital or other medical facility when people are being treated this is a particular concern of course if you work in health care you probably spend the majority of your day trying to prevent these nosocomial infections no knowing what you know about disease transmission and I think even if you don't work in healthcare we've all been patients at one time or another or we've known people that have been at a medical facility and have gotten another illness so this is not as rare as it seems I know we've all heard those horror stories about somebody going into the hospital to be treated coming out with a flesh eating bacteria they are not all that extreme most of these nosocomial infections are going to be introduced by some of the Medical Treatments so maybe IVs or urinary catheters so what are some of the causitive agents so you're going to recognize a few of these culprits in this pie chart here because you've been working with them in lab so looking at basically our top three here we've got eoli we have a lot lot of eoli in the gut remember bacteria is opportunistic it gets into the urinary tract system where it normally isn't and it's going to take hold staff orius we have a lot of staff on us and then if it were to get into maybe a surgical site or an IV site it could potentially cause infections strep again we have a lot of strep on us as well pseudomonas so we've also worked with pomonis in the lab klebsiella uh we're actually going to be seeing in an upcoming lab klebsiella candida if you remember that is a fungus staff epidermitis um staff epidermitis we'll see in an upcoming lab um closely related to staff orus Sera which we've seen as well as some other pathogens so you notice that these most common causitive agents are the agents that we actually have on us and in us which means that they're opportunistic given the chance to move in they'll take it so what are the two types of nosocomial infections so they could be exogenous so caused by organisms that enter the patient from the environment so this could be from other patients this could be from staff coming in maybe not um using um the good hygiene that should visitors coming in and bringing things in insects yes we do need to be concerned about insects because they can carry a lot of things and fomite so remember those fomites those in adamant objects think about the number of fomites that a patient would have in their room the call button the rail on the bed um if they are going into the bathroom there's a number of in adamant objects that could actually spread disease endogenous means that they're caused by opportunistic um microflora so from the patient's own bacteria so again they may have ecoli in their gut and then it moves into their urinary tract and now they've got a UTI they could be on um medicines antibiotics that are making them imuno compromised and so again bacteria are opportunistic given the chance they will move in so where are you most likely to have an infection take a look at this page chart and you'll notice that UTI are going to be the biggest culprit surgical wounds respiratory tract is going to be another issue um when you're lying there you're sick in bed and you're sedentary your respiratory system isn't working as well so you want to make sure to keep moving that so that things don't settle in there things are improperly cleaned um we could have some issues with surgical wounds and again using those urinary catheters that could be a way to introduce UTI um my mother-in-law as you've heard me talk about before she had um a urinary catheter and she was very prone to UTI and ended up in the hospital many times with them um those of you that work in healthcare you may know that sometimes UTI especially with the elderly can present in a lot of different ways um you know in some behavioral conditions as well as um some other traditional symptoms so a little bit more on urinary tract infections um they tend to be mostly in females especially elderly um really having to do with the anatomy because the urethra is of course close to the anus so it's in close proximity so it's easy for bacteria to move in the other thing that has to do with the anatomy is that the urethra is shorter in females than males and so it doesn't really have far to travel um UTI can happen if people can't get out of bed and they can't empty their bladder as often or again for um for those catheters as well eoli that's going to be the culprit that's the causitive agent in most cases and probably the majority of nosocomial infections and hopefully if it's found early it can be easily treated with antibiotics as I've talked about with my mother-in-law she's actually ended up in the hospital being treated with UTI um because of the particular bacteria um for most of us that get UTI um usually a traditional antibiotic can work but it can actually lead to some other serious things so in males U prostate occur so inflammation of the prostate pylon of fridus is actually when it starts to move up into the kidneys this can be a complication and this can be really serious then you want to use some targeted antibiotics so recently my daughter um ended up with a UTI she for her job has to sit for long periods of time and of course wasn't emptying her bladder and she ended up with a UTI so she went to Urgent Care and they said you've got a UTI here's a prescription for antibiotics did she get the antibiotic prescription filled right away no she did not and so she woke up the next day and she was in such complete pain her back hurts so bad she could barely move so I said you need to get to the ER immediately so she went to the ER and it had actually moved up into her kidneys so they prescribed an antibiotic and the kidneys that's not something that you really want to mess around with so they said um if this doesn't work if you're not feeling better after a day you need to get back here immediately fortunately it worked and she was a good patient and her antibiotic but it was pretty scary so you really do need to be careful because you don't want to mess around with with your kidneys so I know that I'm kind of preaching to the choir here because many of you work in healthcare and probably spend most of your days trying to PR prevent nosocomial infections obviously um hand hygiene washing your hands maintaining sterility using gloves um also PPE so Dawning that material and then discarding it as well um preventing insect infestation and again we've talked a lot about resistance and how we want to make sure that we're prescribing antibiotics when necessary so we don't want to deplete a patient's microflora and then have a super infection move in um so we want to be very targeted with our antibiotic use