1. Mutation is a permanent change in the sequence of the nucleotide bases in the DNA.

Mutations can occur spontaneously (one in every 10^9 cell divisions) or induced via
mutagens such as chemical mutagens (carcinogens) or radiation (ionising such as X-rays
which break hydrogen bonds or non-ionising such as UV which produces thymine dimers
that distort DNA molecules). There are two types of mutations:
Point mutations = base substation where one base is changed
Frameshift mutation = insertion or deletion of a base. The reading frame is changed and
every single amino acid after the mutation is different.
Silent: different codon but same AA, so no change in protein function
Missense: change in one AA in the sequence leading to alteration in protein function
Nonsense: codes for stop codon creating a truncated protein
2. Synergism is when the action of one drug is enhanced in the presence of another. For
example, penicillin damages the cell wall and allows better penetration of the large
aminoglycoside molecule.
3. Endogenous infections are caused by flora that are already present on/within the person’s
own body. E.g. cystitis in the bladder caused by normal bacteria in the colon, thrush C.
albicans.
Exogenous infections are derived from an outside source or external environment e.g. from
other patients or staff or the hospital environment
4. Medically important bacteria are grouped by their spore-forming ability, Gram staining
characteristics, shape and oxygen requirements.
5. Zoonosis are infectious diseases of animals that can be transmitted to humans can be
transmitted from animals by direct contact, through body secretions, by the ingestion of
cysts or carried via insect vectors (e.g. arboviral diseases such as dengue fever, Murray River
encephalitis, Ross River fever).
6. Lag phase = cells adapt to the fresh medium before they start to divide
Log phase = cells are dividing at maximum rate via binary fission, numbers increase
exponentially
Stationary phase = rate of cell division is equal to rate of cell death
Decline phase = cell division stops and cell numbers decrease
7. Healthcare-associated infections (HAIs) are infections acquired by patients in a hospital or
other health facility; also known as nosocomial infections. They usually include superbugs.
HAIs increase patient suffering, prolong hospital stay, and increase the mortality rate.
Bacteria are the most common cause of HAIs, followed by fungi and viruses.
8. Antibiotic stewardship is a concept being promoted in Australian hospitals to minimize
antimicrobial resistant organisms by implementing responsible use of antimicrobials:
Establishing prescribing systems that include restriction of broad spectrum and newer
antimicrobials to patients where their use is clinically justified
Reviewing antimicrobial prescriptions with intervention and feedback
Monitoring and surveillance of resistance patterns of hospital organisms
Educating about good prescribing practices and antimicrobial resistance
Changing from parenteral to oral administration as soon as practicable
Liaising with infection control teams to implement infection control procedures
9. Cocci = spherical. Diplo, Strepto, Staphylo
Bacilli = rod shaped. Diplo, Strepto
Spiral = vibrio, spirilla (flagellated), spirochete (corkscrew with axial filaments)
10. Gram +ve = thick layer of ppg, -ve teichoic acids which play a role in cation movement
 Gram -ve = more complex as it has 3 layers: inner membrane, thinner peptidoglycan layer,
and outer membrane with LPS (O-polysaccharide), LPP and phospholipids. Lipid A endotoxin
11. Repeated
12. Selective toxicity refers to antimicrobials which kill or inhibit microbes that cause disease
without causing harm to host cells. Selectively toxic chemicals rely upon differences in
structures or reactions in the microbes.
13. Epidemiology is the study of the cause, pattern of spread and methods of control of
diseases. This involves the systematic collection of information about disease in order to
determine the reasons for an outbreak of infection, as well as the development of methods
to prevent disease and the analysis of factors contributing to disease. Reduce the spread of
disease by minimising risk factors and developing public health guidelines and infection
control policies. Immunisation programs, antibiotic therapy, infection control programs,
public health programs, predict future outbreaks
14. Endemic diseases require a permanent reservoir and are always present in a community.
Epidemic diseases occur when there is a sudden rapid rise in the incidence of disease in a
particular locality.
Pandemics are a series of epidemics that occur when the disease spreads worldwide.
15. Communicable diseases are spread directly from one host to another and are considered
contagious (or easy to spread) via respiratory aerosols, body substances, shed infected skin
cells, open lesions or wounds, or contact with contaminated surfaces or contaminated
objects (known as fomites)
Non-communicable diseases are not usually spread to a healthy person during the normal
course of infection and tend to be opportunistic, require a vector or mechanical transfer of
the pathogen into the host, or be caused by a toxin
16. HAI create additional suffering for patients and their families. Also, for the patient there may
be long-term effects on their quality of life, loss of personal income and sometimes death.
HAIs also prolong the length of hospital stay, resulting in an additional financial burden on
the health system. Other impacts of HAIs include the costs of antimicrobial therapy, of
replacing infected workers, and of reduced productivity. HAIs also add substantially to the
problem of resistance to antimicrobial drugs (see Chapter 12). Another important
consequence is that, once a patient is infected, they become an additional reservoir of
infection in the hospital or community.
17. Urinary tract, surgical sites, lower respiratory tract, skin, blood.
18. Toxic shock syndrome, scalded skin syndrome, sepsis, impetigo, bacteraemia. Patients and
healthcare workers are frequently colonised by MRSA without evidence of infection. Readily
transferred from person to person and from person to fomites. Debilitated = susceptible,
drug resistant.
19. Contact transmission refers to transmission of infectious microorganisms to a susceptible
host by touch or via contact with blood or other body substances. Staphylococcus, S.
pyogenes, rotavirus
Direct = directly from one person to another
Indirect = transferred via an intermediate object or person
Droplet transmission occurs when a person with a respiratory infection coughs, sneezes or
talks (sometimes) and thereby expels large infectious droplets that directly infect the
mucosal surfaces (throat, nose, eyes) of another person. Influenza
Airborne transmission occurs via small particles (aerosols) expelled during coughing,
sneezing or talking, or when large droplets (above) partially evaporate to form smaller,
lighter particles. Small particles remain suspended in air and can be dispersed over long
 distances by air currents, and, if infectious, can transmit the microbes into the airways of a
susceptible host. Measles
20. Iatrogenic infections are infections caused by medical procedures or treatments. Procedures
that involve penetration of skin or MM provide microbes with access to susceptible tissue.
Insertion of intravenous cannula, urinary catheter (S. epidermis, S. aureus, enterococci)
bypass skin barrier. Endoscopes can damage mucosal lining and are hard to sterilise.
Prosthetic implants allow microbes to be introduced during surgery. Hypodermic needling
injections can cause infection due to contamination at injection site.

Long Answer

1. Transformation is the process in which naked DNA passes from one bacterial cell to another
resulting in a change in the properties of the recipient cell.

• Conjugation is the transfer of genetic material from one bacterium to another by means of sex
pili.

• Transduction is the transfer of DNA from one bacterial cell to another by a bacteriophage. There
are two types of transduction:
– specialised transduction; the bacterial DNA carried to the new cell will usually be the
DNA that was adjacent to the prophage DNA when it was in the lysogenic state,
therefore is a specific sequence.
– whereas in generalised transduction random fragments of DNA are transferred.
– Transduction can be used to provide information about the location of specific genes on
the bacterial chromosome, and can also be used to select particular genes to be
transferred.

2. Personal protective equipment (PPE) consists of the barriers used to protect the mucous membranes,
airways, skin and clothing of the healthcare worker and/or patient from contamination with infectious
microorganisms. aprons, gowns, gloves, surgical masks, protective eyewear or face shields Pg 308

4.

5. Microorganisms are continuously shed from the body during normal activities and when a person is
suffering from an infectious disease, the pathogens responsible are also shed in large numbers through
portals of exit; these may then infect other susceptible people

The main portals of exit include the upper respiratory tract, gastrointestinal system, skin, urogenital tract
and blood;

Microorganisms such as viruses are expelled as fine aerosols by talking, coughing and sneezing and can
be directly inhaled or indirectly transmitted by the contamination of a fomite – diphtheria, influenza,
measles, SARS, rubella, TB

Faeces contains normal flora and pathogens that may contaminate food, surfaces and water – polio,
cholera, typhoid

Microorganisms are shed on dead skin as particles from dried crusts on wounds or from skin lesions

Microbes responsible for sexually transmitted diseases are present in semen and vaginal secretions –
Chlamydia, Gonorrohoeae, AIDS
Urine contains bacteria from urinary tract infections as well as other pathogens such as cytomegalovirus
and Leptospira

Blood-borne pathogens such as HIV and hepatitis are present in blood and body fluids

6. There are a number of factors that may predispose patients to hospital infections and include microbial
factors, patient susceptibility (including underlying disease, existing infection, prescription drugs and
treatments, medical procedures, and broken protective barriers such as skin), movement of patients
around wards and the type of healthcare facility

Many hospital patients have a lowered resistance to infection due to age (young or old), immobility,
underlying disease, or surgical or traumatic wounds

some medical treatments can also lower a patient’s resistance to infection, such as cancer therapy or
immunosuppressive drugs

Medical procedures that involve the penetration of the skin or mucous membranes (e.g. urinary
catheterisation, indwelling intravascular devices) provide access for microorganisms to susceptible
tissues

infections caused by medical procedures or treatments are called iatrogenic infections

implanted prostheses are readily colonised by microorganisms, increasing risk

Physical contact between patients and staff in hospitals is frequent and varied, allowing easy
transmission of microorganisms from person to person