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Antibiotic-Resistant Organisms
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7.03 Patients with Infectious Disease The center adheres to infection control policies to ensure the safety of patients, physicians, and staff members. Patients who are currently being treated for an infectious disease or condition that is transmitted via the contact route may not be treated at the center. Patients with disease spread via droplet (e.g. influenza) or airborne (e.g. tuberculosis, measles) routes will reschedule their procedures in consultation with their physicians. The infection control nurse, in consultation with the infection control consultant, will determine whether the patient requires isolation or other additional precautions. If a patient with current Clostridium difficile-associated diarrhea is treated at the center, all rooms where the patient was housed, even briefly, should be cleaned by housekeeping under supervision of the staff at the center. Physicians must document relevant information in their pre-admission documentation. Standard Precautions will be followed in the care of all patients. Cigarroa Interventional Institute establishes policies to ensure compliance with infection control policies for the care of patients with drug-resistant organisms. The physician will screen patients through the medical history review prior to scheduling a patient at the center. During the pre-operative (pre-op) phone call or interview, a pre-op screening of the patient will be conducted. Strict isolation policies are required to treat patients with active MRSA, VRSA, or tuberculosis. Since this facility has no provisions for strict isolation, those patients with active infections will be referred elsewhere for treatment. Patients who are undergoing or completed a course of antibiotic therapy, are colonized and/or are not actively infected may be treated at the center. Patients with active infections requiring transmission-based precautions are not appropriate candidates for this facility and will be referred to another facility or rescheduled. Procedures cannot be scheduled for patients currently undergoing an infection with transmission based precautions. The patient must finish the course, and they will be rescheduled. Definitions and Standards: The following definitions and standards are provided for informational purposes only: Airborne Transmission and Precautions: This mode of transmission occurs by the spreading of either airborne droplet nuclei (small particle residue of 5 microns or smaller), of evaporated droplets which contain microorganisms that remain suspended in the air for long periods of time) or dust particles containing microorganisms. Patients must be isolated in private rooms with special air handling and ventilation, and the door must remain closed. Patient transport should be restricted to essential transport only. Respiratory precautions must be taken when in the presence of patients with active tuberculosis, including respiratory masks. Droplet Transmission and Precautions: Droplets are transmitted from the host source by coughing, sneezing, talking, or during procedures such as suctioning or bronchoscopy. Patients must be isolated, and a distance of 3 feet maintained between the infected patient and others. Caregivers within 3 feet of the patient should wear a mask. Patient transport should be minimized. Contact Transmission and Precautions: Direct contact transmission involves direct body surface to body surface contact with physical transfer of microorganisms between a susceptible host and an infected person. Indirect contact transmission involves contact with an intermediate object (usually inanimate) and a susceptible host. Patients should be isolated as much as possible. Gloves and hand washing are essential for all contact with the patient and contact with objects, which come in contact with the patient. Gloves should be changed after each contact. Reportable Condition If the patient is determined to have a reportable condition at any time during pre-admission, the Director of Operations/Nurse Manager will be notified. The procedural physician will be contacted and the case will be canceled. The Department of Health will also be notified the same day following state regulations regarding Reportable Communicable Diseases. To report a disease or condition, contact: The City of Laredo Epidemiology 24/7 Reporting Line: (956) 763-2915, if unable to report locally, call The Texas Departmrent of Health Services epidemiology program: 24/7Number for Immediately Reportable – 1-800-705-8868Lide 1: Introduction to Bioreactor A bioreactor is a vessel used for growing microorganisms, plant or animal cells Provides controlled conditions for biological reactions Maintains optimum pH, temperature, oxygen, and nutrients Widely used in fermentation, enzyme, vaccine, and antibiotic production Ensures sterile and aseptic environment Scale ranges from laboratory to industrial production Slide 2: Basic Design Requirements of a Bioreactor Must be constructed with non-toxic, corrosion-resistant materials Should allow effective mixing and mass transfer Provision for sterilization (in situ sterilization) Must maintain uniform temperature and pH Easy sampling without contamination Should support scalability and automation Slide 3: Materials Used in Bioreactor Construction Stainless steel (SS-316) for industrial bioreactors Glass for laboratory-scale bioreactors Plastic (polycarbonate) for disposable bioreactors Materials must withstand heat and pressure Should be smooth to prevent microbial attachment Resistant to chemicals and cleaning agents Slide 4: Main Parts of a Bioreactor Vessel: holds the culture medium and microorganisms Agitator (impeller): provides mixing Sparger: supplies sterile air Baffles: prevent vortex formation Sensors: monitor pH, temperature, dissolved oxygen Ports: used for inoculation, sampling, and feeding Slide 5: Agitation System Ensures uniform mixing of nutrients and cells Improves oxygen transfer rate Common impellers: Rushton turbine, marine propeller Speed controlled by motor Prevents settling of cells Affects shear stress on cells Slide 6: Aeration System Supplies oxygen for aerobic fermentation Air introduced through sparger Types of spargers: ring, nozzle, sintered Maintains dissolved oxygen concentration Air is filtered for sterility Essential for high cell density cultures Slide 7: Temperature and pH Control Temperature controlled by heating/cooling jackets pH maintained using acid or alkali addition Sensors continuously monitor parameters Automated control systems used Ensures optimal microbial growth Prevents enzyme denaturation Slide 8: Foam Control System Foam formed due to protein and agitation Excess foam reduces oxygen transfer Mechanical foam breakers used Chemical antifoam agents added Foam sensor detects foam formation Maintains efficient fermentation Slide 9: Types of Bioreactors – Based on Mode of Operation Batch bioreactor Fed-batch bioreactor Continuous bioreactor Choice depends on product type Widely used in industrial fermentation Controls productivity and yield Slide 10: Batch Bioreactor All nutrients added at the beginning No addition or removal during process Simple and easy to operate Low risk of contamination Used for antibiotics and enzymes Limited control over nutrient depletion Slide 11: Fed-Batch Bioreactor Nutrients added during fermentation Prevents substrate inhibition High product yield Widely used in industrial fermentation Allows better control of growth rate Used in insulin and enzyme production Slide 12: Continuous Bioreactor Fresh medium continuously added Culture removed at same rate Maintains steady-state conditions High productivity Risk of contamination is high Used in wastewater treatment and SCP production Slide 13: Types of Bioreactors – Based on Design Stirred tank bioreactor Airlift bioreactor Bubble column bioreactor Packed bed bioreactor Fluidized bed bioreactor Photobioreactor Slide 14: Stirred Tank Bioreactor (STR) Most commonly used bioreactor Mechanical agitation using impellers Suitable for aerobic fermentation Excellent mixing and oxygen transfer Used for bacteria and fungi Easy scale-up Slide 15: Airlift Bioreactor Mixing achieved by air circulation No mechanical agitator Low shear stress Energy efficient Suitable for shear-sensitive cells Used in wastewater treatment Slide 16: Bubble Column Bioreactor Air bubbles provide mixing Simple design and low cost No moving parts Limited mixing efficiency Used for microbial fermentation Suitable for large-scale operations Slide 17: Packed Bed Bioreactor Contains immobilized cells or enzymes Substrate flows through packed matrix High cell density Used in continuous processes Limited oxygen transfer Used in enzyme and wastewater treatment Slide 18: Fluidized Bed Bioreactor Immobilized particles kept in suspension Better mass transfer than packed bed Reduced clogging Suitable for continuous operation Used in biotransformations Higher operational complexity Slide 19: Photobioreactor Designed for photosynthetic organisms Provides light source Used for algae and cyanobacteria Controls light, CO₂, and temperature Used in biofuel and pigment production Can be tubular or flat-plate design Slide 20: Applications of Bioreactors Production of antibiotics and vaccines Enzyme and organic acid production Single cell protein production Wastewater treatment Biofertilizer and biopesticide production Biopharmaceutical manufacturingBacterial Cell One of the very first organisms to evolve on earth was probably a unicellular organism, like modern bacteria. Ever since then, life has evolved into a multitude of life forms over many millennia. However, we can still trace our ancestry back to this single-celled organism. Bacteria Definition “Bacteria are unicellular organisms belonging to the prokaryotic group where the organisms lack a few organelles and a true nucleus”. Internal Structures • Cytoplasm: A gel-like substance that fills the cell, containing water, enzymes, nutrients, and waste, where metabolic activities occur. • Nucleoid: A region within the cytoplasm that houses the bacterial chromosome, a single, continuous circle of DNA. • Ribosomes: Responsible for synthesizing proteins within the cell. • Plasmids: Small, circular, extra-chromosomal DNA molecules that can provide advantageous traits, such as antibiotic resistance. • Mesosomes: (Optional, less prominent in some views) Folds in the plasma membrane that are believed to be involved in cell division and respiration. Outer Structures & Layers • Cell Wall: A rigid outer layer composed of peptidoglycan that provides structural support, maintains cell shape, and protects against osmotic lysis. Capsule: (Optional) A sticky outer layer of polysaccharide that can help the bacteria adhere to surfaces, protect against phagocytosis by the immune system, and serve as a food reserve. • Plasma Membrane: A selectively permeable barrier that regulates the passage of nutrients and waste products into and out of the cell. Appendages • Flagella: Long, whip-like structures that provide motility, allowing the bacterium to move through its environment. • Pili (and Fimbriae): Hair-like protein appendages. Pili are longer and involved in bacterial conjugation (transfer of genetic material), while the shorter, more numerous fimbriae primarily function in attachment to host cells or surfaces.Antibiotic Resistance DevelopmentAntibiotic ResistanceAntibiotic Resistance & Natural SelectionAntibiotic Resistance MechanismsGram positive, gram negative bacterias and resistance to antibiotics