Chain of Infection

CHAIN OF INFECTION
Learning Objectives:
At the end of the topic, the students can:
• Discuss the links in the chain of infection;
• Identify how pathogens are transmitted; and
• Discuss breaking links to the chain of infection.
Chain of Infection Overview
Pathogen
• Pathogens are microorganisms that cause
disease.
• Bacteria
• Viruses
• Fungi
• Parasites
• How well a pathogen infects its host has to do

with its:
• Pathogenicity
• Degree of Virulence
• Transmissibility
Reservoir
A reservoir serves as a place in the environment where a pathogen

lives, replicates and thrives.
Areas where a pathogen may live include:
•Humans
•Animals or insects
•Environment
Human Reservoirs
In humans, there are two forms of
reservoirs: Symptomatic infection and asymptomatic
carriers.
Symptomatic infections are more likely to be

recognized. This means that the patient's contacts
and normal activities will normally be restricted.
Carriers do not display any signs or symptoms of

illness. They are asymptomatic but can still spread
disease
Animal & Insect Reservoirs
Any infectious disease that is naturally

transmitted from animal to human is
considered a zoonotic disease.
Examples of disease spreading from animals or

insects to humans include:
•Lyme disease (ticks)
•Rabies (animals)
•Salmonella (raw meats, eggs, and dairy)
Environmental Reservoirs
Environmental reservoirs harbor many

infectious diseases.
Some examples include:

•Soil (which acts as a reservoir for
Clostridium tetani, the causative agent of
tetanus); and
•Water (which is a reservoir for Legionella
pneumophila, the causative agent of
Legionnaire's disease.)
Portal of Exit
• The Portal of Exit refers to any route that the pathogen can
leave the reservoir. This depends entirely on the characteristics
of the reservoir.
• In humans, the main portals of exit include:
• Alimentary: vomiting, diarrhea, saliva

• Genitourinary: sexual contact
• Respiratory: secretions from coughing, sneezing, or talking
• Skin: open wounds
Mode of Transmission: Direct Contact
Direct contact is usually considered person-to-person contact. Examples
of direct contact include:
•Skin-to-Skin contact (like touching)
•Kissing
•Sexual contact
•Contact with oral secretions
•Contact with body lesions
Pathogens that are spread by direct contact include:

•Gonorrhea
•Mononucleosis
•Bacterial Conjunctivitis
•COVID-19
Mode of Transmission: Droplet
• Droplet transmission requires a pathogen to be transferred through
the air from its reservoir in a droplet of body secretions.
• These droplets are relatively large and usually will fall from
suspension after 3-6 feet of travel.
• The droplets will rapidly fall on nearby surfaces and may remain
viable.
• The survivability of the pathogen depends on its type. Some

pathogens will live for a few minutes to hours, while others may
survive for a few days, outside of a host.
• Droplet transmission occurs when a droplet from
coughing, sneezing or talking carry the pathogen to
the hosts body. The transmission is completed by:
• Inhaling droplets
• Droplets entering the mucous membranes of the face
• A host touching droplets that have settled on surfaces and
then touching their face (mouth, eyes, nose).
• Examples of illnesses caused by droplet transmission

are:
• Strep Throat
• Influenza
• The common cold
• COVID-19
Mode of Transmission: Blood-Borne
Some pathogens are transmitted directly

through blood. These pathogens require that
infected blood from the reservoir be directly
exposed to the blood of the susceptible host.
Examples of blood-borne pathogens include:
•Human Immunodeficiency Virus (HIV)

•Hepatitis-B Virus
•Hepatitis-C Virus
Mode of Transmission: Airborne
Airborne transmission occurs when pathogens <5 microns in size

remain suspended in the air long after the infected person has left the
area. A host then enters the space where the pathogen is suspended
and has the potential to become infected.
An example of an airborne illness is measles. Measles can remain

suspended in the air for up to 18 hours after the infected individual
coughs, sneezes, or talks.
Tuberculosis can remain suspended for up to 6 hours.

Mode of Transmission: Vector
Vector transmission utilizes insects to transport the pathogen. Insects
such as fleas, ticks, and mosquitos are unharmed by the pathogens
they potentially carry but can transmit the bacteria or virus when they
bite a host.
Examples:
•Mosquito: West Nile Virus
•Fleas: Bubonic Plague (Yersinia pestis)
•Ticks: Lyme Disease ( Borrelia burgdorferi )
Portal of Entry
Opposite the Portal of Exit is the Portal of Entry. This is any route that a
pathogen uses to enter the body (host).
Examples include:
•Inhalation
•Absorption
•Ingestion
•Inoculation
•Introduction
Susceptible Host
This is the organism that will feel the effects of the infectious
disease that has traveled through the chain of infection.
How susceptible a host may be, depends on many factors:
• Age: The very young or very old are usually more

susceptible.
• Health status: Malnourished, dehydrated, or otherwise
unhealthy persons are more at risk
• Medication usage: Immune suppressing drugs allow
pathogens to take hold more freely
• General resistance factors: Intact mucous membranes and
skin, and robust cough and sneeze reflexes help defend
against invading pathogens.
Breaking the Chain
To break the chain of infection, and stop infectious disease spread,
interventions can be directed at:
•Controlling or eliminating agent at source of transmission

•Protecting portals of entry
•Increasing host's defenses
Breaking the Chain: Controlling the
Source of Transmission
The first step at breaking the chain is to identify the offending

pathogen. This will allow for treatment protocols specific to the
disease-causing microorganism.
Examples include:
•A patient with a bacterial infection, like strep throat, can be
treated with antibiotics to clear the infection.
•A patient who is an asymptomatic carrier may also be treated
to clear the infection and prevent spread to others.
•Cooking food to safe temperatures ensures that all bacteria
and/or spores have been killed before consumption.
Breaking the Chain: Protect Portals of
Entry
Other interventions protect portals of entry. There are many ways
that targeting the portal of entry can help to prevent the spread
of communicable disease.
Examples include:
• Wearing proper PPE when you are knowingly exposed to a
pathogen
• Masks, gloves, face shields, etc.
• Practicing hand hygiene consistently.
• Handwashing and using alcohol-based hand rubs
• Isolating those who are infectious and minimizing contact
• Filtering or changing the flow of air
• Negative pressure rooms
Breaking the Chain: Increasing the Host's
Defense
• Vaccination programs help the body to create antibodies to
targeted pathogens before exposure.
• Prophylactic drug use for high-risk patients can help to mitigate the
spread of disease by preventing a pathogen from gaining ground
over the immune system.
• Herd immunity suggests that if a high
enough percentage of individuals in a
population are resistant to a pathogen, then
those few who are susceptible will be
protected by the resistant majority.
• The theory is that the pathogen will not have

a sufficient number of reservoirs available to
survive until it finds a susceptible host.

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CHAIN OF INFECTION

• How well a pathogen infects its host has to do

A reservoir serves as a place in the environment where a pathogen

Areas where a pathogen may live include:

Symptomatic infections are more likely to be

Carriers do not display any signs or symptoms of

Any infectious disease that is naturally

Examples of disease spreading from animals or

Environmental reservoirs harbor many

Some examples include:

• In humans, the main portals of exit include:

• Alimentary: vomiting, diarrhea, saliva

Pathogens that are spread by direct contact include:

• The survivability of the pathogen depends on its type. Some

• Examples of illnesses caused by droplet transmission

Some pathogens are transmitted directly

Examples of blood-borne pathogens include:

•Human Immunodeficiency Virus (HIV)

Airborne transmission occurs when pathogens <5 microns in size

An example of an airborne illness is measles. Measles can remain

Tuberculosis can remain suspended for up to 6 hours.

How susceptible a host may be, depends on many factors:

• Age: The very young or very old are usually more

•Controlling or eliminating agent at source of transmission

The first step at breaking the chain is to identify the offending

• The theory is that the pathogen will not have

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