New and Emerging Pathogens

Red blood cells inside a blood vessel – high magnification

Despite the advances in engineering, work practices, personal protective equipment and on-going pathogen research, the health risks posed by the handling of blood and Other Potentially Infectious Materials (OPIM), remain very high. Although exposure to blood by tattoo artists and body piercers is relatively low, they are not exempt from universal precautions to protect themselves. A single drop of blood could contain enough disease-causing organisms to cause significant illness. Most body art employees are required to take a bloodborne pathogen class as a condition of employment. The requirements of the OSHA Bloodborne Pathogens Standard continue to be essential in maintaining safe work environments for all employees engaged in handling blood and OPIM.

Employer implementation of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard has been continually guided by OSHA’s interpretation of the Standard, OSHA’s citations for violations of the Standard and court rulings specific to the Standard. The Standard has motivated manufacturers to introduce new engineering controls (e.g, needleless systems) and develop and produce a wide variety of products that offer greater choice for worksite safety and personal protection.

Even with large federal agencies involved in breakthroughs in work place safety, new and emerging bloodborne pathogens continue to be a major global concern in the past 20 years. OSHA, the World Health Organization (WHO) the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) are constantly updating their bloodborne pathogen research and information. Pathogens are getting smarter than ever in their constant fight against the drugs used to kill them. Some scientists believe the pathogens are winning. When it comes to matching wits against the tiny organisms that cause a variety of disease from strep throat to whooping cough to tuberculosis and cholera, it’s easy to assume humans have the upper hand and clear advantage. Large brains, clever scientists, state of the art laboratories and powerful computers should easily outpace one-celled organisms. But a disturbing and unsettling number of bacteria are growing resistant to the health industry’s mainstay drugs. Misuse of anti-biotics is part of the problem, experts say.

The discovery of penicillin triggered the anti-biotic era. Before its introduction in 1928, there were no effective treatments for infections such as pneumonia, gonorrhea, rheumatic fever, strep throat and tuberculosis. Turn of the century hospitals were packed with patients with blood poisoning contracted from simple scratches and cuts and doctors were helpless and could do nothing for them but wait and hope. Anti-biotics are compounds produced by bacteria and fungi which are capable of killing or inhibiting microbial species. This phenomenon has long been known and may explain why the ancient Egyptians had the practice of applying a soft, moist mass of moldy bread to infected wounds.

In 1928, penicillin, the first true anti-biotic was discovered by Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital in London. Fleming began sorting through petri dishes containing colonies of staphylococcus, bacteria that cause boils, sore throats and abscesses. He noticed something unusual on one dish. It was dotted with colonies except one area where a blob of mold was growing. The zone immediately around the mold later identified as a rare strain of penicillin notatum, was clear. The mold had secreted something that inhibited bacterial growth. Fleming found that his mold “juice” was capable of killing a wide variety of harmful bacteria such as streptococcus, meningococcus and the diphtheria bacillus. Fleming wrote, “When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first anti-biotic, or bacteria killer. But I guess that was exactly what I did.”

Fleming had neither the laboratory resources at St. Mary’s nor the chemistry background to take the next giant steps of isolating the active ingredient of the penicillium mold juice. Processing and purifying the mold juice proved to be very difficult. Fleming and his microbiologists tried everything in their power to purify the mold juice but failed consistently. In 1938, the task of purification was taken on by Dr. Howard Florey, a professor of pathology who was the director of the Sir William Dunn School of Pathology at Oxford University. He was a master at extracting research grants from tight-fisted bureaucrats and an absolute wizard at administering a large laboratory filled with talented scientists. In 1942, large pharmaceutical companies began to show interest in assisting Dr. Florey in his endeavors.

To illustrate the complexity and difficulty of purifying the mold juice, one scientist at one of the largest pharmaceutical companies at the time said, “The mold is temperamental as an opera singer, the yields are low, the isolation is difficult, the extraction is murder, the purification invites disaster and the quality control is unsatisfactory.” Even during the difficult, initial stages of the purification process of mass producing penicillin, the drug was ready to be used in 1944.

Next month we will continue to discuss the mass production of penicillin, it’s life saving properties and the eventual over-use of the drug causing massive bacterial resistance.

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