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1. Explain why is each of these is often resistant to disinfectants.
1. Mycobacterium
Mycobacterium is often resistant to disinfectants because of their waxy outer layer which classifies them as an acid fast bacterium. Mycobacterium are the rod shaped aerobic bacteria.
2. Pseudomonas may be resistant to disinfectants dependent on which surfaces may be disinfected with which product.
3. Bacillus are often resistant to disinfectants as these gram-positive rods have the ability to form an endospore. Endospores can survive environmental changes and usually kill the bacteria. When extreme cases of high temperature, high UV irradiation, desiccation, chemical damage and enzymatic destruction they cannot.
There are many disinfecting products available for use, including Cavicide, Cidexplus, Clorox, Exspor, Lysol, Renalin and Wavacide.

2. Entamoeba histoltyica and Giardia lamblia were isolated from the stool sample of a 45 year old man, and Shigella sonnei were isolated from the stool sample of a 18 year old woman. Both patients experienced diarrhea and severe abdominal cramping, and prior to the onset of digestive symptoms both had been treated by the same chiropractor. The same chiropractor had administered colonic irrigations (enemas) to these patients. The device used for this treatment was gravity –dependent apparatus using 12 liters of tap water. There were no check valves to prevent back flow, so all parts of the apparatus could be contaminated with feces during each colonic treatment. The chiropractor provided colonic treatments to four or five patients a day. Between patients, the adaptor piece this is inserted into the rectum was placed in a “hot water sterilizer.” What two errors were made by the chiropractor?
Entamoeba histoltyica is an anaerobic parasite and is transmitted through water, soil and food. The bacteria can be killed by heat or freezing conditions.
Giardia lamblia is a flagellated parasite that colonizes and reproduces in the small intestine. Transmission is waterborne and fecal-oral. Chlorine concentration of 8mg/liter kills all Giardia cysts and low water temperatures.
Shigella is a bacterium, and it is one of the most contagious types of diarrhea that is caused by diarrhea. It is a foodborne illness that is found in water that is polluted with human feces and is transmitted through the fecal-oral route. Water should be brought to a rolling boil for 3 minutes to kill Shigella.
This chiropractor did not wash his hands in between patients, nor properly sanitize the equipment that is used for the colonic irrigations.
3. Between March 9 and April 12, five chronic peritoneal dialysis patients at one hospital became infected with Pseudomonas aeruginosa. Four patients developed peritonitis, and one of the patients developed a skin infection at the catheter insertion site. All the patients with peritonitis had low grade fever, cloudy peritoneal fluid, and abdominal pain. All patients had permanent indwelling peritoneal catheters, which the same nurse wiped with gauze that had been with an iodophor solution each time the catheter was connected to or disconnected from the machine tubing. Aliquots of iodophor were transferred from stock bottles to small in use bottles. Cultures from the dialysis concentrate and the internal areas of the dialysis machine were negative: iodophor from a small in use plastic container yielded a pure culture of P. aerugiosa. What improper technique led to this infection?
The improper technique that led to this infection was the nurse transferring the iodophor from the stock bottles to small in use bottles. P. aeruginosa is a common bacterium that is found in water, soil, skin flora, and most man made atmospheres. It is a gram negative, aerobic bacterium. This bacterium thrives on moist surfaces, and is also found on and in medical equipment, such as catheters.
4. Eleven patients at your office received injections of methylprednisolone and lidocaine to relief the pain of arthritis at the same orthopedic surgery office. All of them developed septic arthritis caused by Serratia marcescens. Unopened bottles of methylprednisolone from the same lot numbers tested sterile, the methylprednisolone was preserved with a quat. Cotton balls were used to wipe down multiple use vials, before the medication was drawn up into a disposable syringe. The site of the injection of the injection was also wiped with a cotton ball. The cotton ball was soaked in benzalkonium chloride, and then fresh cotton balls were added as the jar was emptied. Opened methylprednisolone and the jar of cotton balls contained S marcescens. How was the infection transmitted? What part of the routine procedure caused the contamination?
When giving a patient a dose of methylprednisolone, a fresh alcohol prep pad should be used, not a cotton ball that has been sitting in benzalkonium harvesting bacteria, and having “fresh cotton balls” added as the jar empties. Is this person who adds the cotton balls wearing gloves? Using a multi-use vial is not effective either in preventing infection.

http://ncbi.nlm.gov/pubmed/11128146 http://en.wikipedia.org/wiki/Shigellosis http://en.wikipedia.org/wiki/Giardia_liamlia http://www.researchgate.net/publication http://en.wikipedia.org/wiki/Entamoeba_histolytica http://en.wikipedia.org/wiki/Pseudomona_aeruginosa http://www.cdc.gov/hicpac/Disinfection_Sterilization

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