NCM 112:

COMMUNICABLE
DISEASE - Lecture
  Infection – is an invasion of body tissue by
microorganism and their proliferation.
 Asymptomatic or subclinical infection – are
microorganisms that produces no clinical evidence of
Common disease.
• Some subclinical infections can cause
Terminologies significant damage, for example
cytomegalovirus (CMV) infection in a
related to pregnant woman can lead to significant
disease in the unborn child.
infection:  Disease – a detectable alteration in normal tissue
functions
 Communicable disease – are infectious agents that
is transmitted to an individual by direct or indirect
contact, through a vector or vehicle.
 Pathogenicity – is the ability to produce disease
 Pathogens – is a microorganism that causes
disease.
• A “true” pathogen causes disease or infection
in a healthy individual
 Opportunistic pathogens – are microorganism that
causes disease only in a susceptible individual.
  Center for Disease Control and Prevention
(CDC) – is the principal public health agency at
the national level concerned with disease
prevention and control.
Common  Sepsis – is the state of infection and can take

Terminologies many forms, including septic shock

 Asepsis – is the freedom from disease – causing
related to microorganism
 Contagious disease – a term given to a disease
infection: that is easily transmitted from one person to
another through direct or indirect means.
 Disinfection – the destruction of pathogenic
microorganism outside the body by directly
applying physical or chemical means
 Quarantine – is the limitation of freedom of
movement of a person or animals which have
been exposed to communicable disease for a
period of time equivalent to the longest incubation
period of that disease
 Surveillance – the act of watching.
 Two basic types of asepsis:
1. Medical asepsis – includes all practices
intended to confine a specific
Common microorganism to a specific area,
limiting the number, growth, and
Terminologies transmission of microorganism.
related to 2. Surgical asepsis, or sterile technique –
infection: refer to those practices that keep an
area or object free of all microorganism;
it includes practices that destroy all
microorganisms and spores. It is also
used for all procedures involving the
sterile areas of the body
  Pathogen is any microorganism (also called
an agent) capable of producing disease.
 Infections can be communicable
(transmitted from person to person [e.g.,
influenza]) or not communicable (e.g.,
Overview of the peritonitis).
 Microorganisms with differing levels of
Infectious Process pathogenicity (ability to cause disease)
surround everyone.
• Virulence is a term for pathogenicity.
• Virulence is related more to the
frequency with which a pathogen
causes disease (degree of
communicability) and its ability to
invade and damage a host. It can
also indicate the severity of the
disease.
 Many microorganisms live in or on the human host without causing disease.
Some microbes are beneficial.
 Each body location harbors its own characteristic bacteria, or normal flora.
Normal flora often functions to compete with and prevent infection from
unfamiliar agents attempting to invade a body site.
 In some instances, microorganisms that are often pathogenic may be present in
the tissues of the host and yet not cause symptomatic disease because of
normal flora; this process is called colonization
 In the United States, the Centers for Disease Control and Prevention (CDC)
collects information about the occurrence and nature of infections and infectious
diseases. It then recommends guidelines to health care agencies for infection
control and prevention.
 Certain diseases, such as tuberculosis, must be reported to health departments
and the CDC. The infection control practitioner (ICP) for each health care agency
is responsible for tracking infections (surveillance) and ensuring compliance with
federal and local requirements and accreditation standards.
Types of Microorganism causing infections
The categories of microorganisms cause infection in humans are:
Bacteria
▪ Are simple one – celled microbes with double cell membranes that protects them
from harm.
▪ It is the most common type of infection – causing microorganisms.
▪ Several hundred species can cause disease in human and can live and be
transported through air, water, food, soil, body tissue and fluids, an inanimate object.
▪ They are classified to
✓ Shape: cocci (spherical bacteria), bacilli (rod-shaped), spirillae (spiral-shaped)
✓ Need of oxygen: aerobic, anaerobic
✓ Response to staining: gram (+) or (-) or acid fast
✓ Motility: motile, non-motile
✓ Tendency to capsulate: encapsulated, capsulated
✓ Capacity to form spores: spore forming, non – spore forming
Answer: Bacteria damage body tissue by interfering with essential cell function or by
releasing toxins that cause cell damage.
Several types of bacterial toxins
✓ Exotoxins. Are protein release from bacterial cells into the surrounding medium.
Example: diphtheria, botulism and tetanus
✓ Enterotoxins. Are exotoxins that affects the vomiting centers of the brain and cause
gastroenteritis. Example: Staphylococcus aureus, Vibrio cholerae, Shigella dysenteriae
and other microbes that lives in the GI tract.
✓ Endotoxins. Endotoxin, toxic substance bound to the bacterial cell wall and released
when the bacterium ruptures or disintegrates. Example: E.coli. diseases associated with
such endotoxins includes septic shocks, meningitis and cholera.
Spirochete
▪ It is a bacterium with flexible, slender, undulating spiral rods that possess cell wall.
▪ 3 forms that causes disease: Treponema, Leptospira and Borilia
Viruses
▪ Are the smallest known microbes. They cannot replicate independently in the host’s cell, rather,
they invade and stimulate the host’s cells to participate in the formation of additional viruses.
▪ Some viruses destroy surrounding tissues and release toxins
▪ The immune system rapidly controls some viral invasions, producing permanent immunity to that
particular virus. Example: a person who gets sick with measles or receives measles immunization
becomes permanently immune to the measles virus.
▪ Most viruses enter the body through the respiratory, GI, or genital tract. A few, such as HIV, are
transmitted in blood and body fluid.
Rickettsia
▪ Are small, grams negative (-) bacteria – like microbes that can induce life – threatening infections.
▪ Like viruses, they require a host cell for replication.
▪ These are usually transmitted through a bite of arthropod carriers like lice, fleas, ticks as well as
through waste products.
✓ Rickettsial diseases are:
✓ Rocky mountain spotted fever
✓ Typhus fever
✓ Q fever
BACTERIA (STAPH AUREUS) SPIROCHETTE

VIRUS (COVID-19) 10

RICKETTSIA
Chlamydiae
▪ Are smaller than rickettsia but larger than a virus. These are the common cause of
infection of the urethra, bladder, fallopian tubes, and prostate gland.
▪ The most common chlamydial infection is transmitted through sexual contract.
Fungi
▪ Includes yeast and molds
▪ They live in organic matter, soil, water, animal, and plants.
▪ They can also live inside and outside the body.
▪ They may be harmful or beneficial
▪ Candida albicans is a yeast considered to be normal flora in the human vagina
▪ Fungi are beneficial in cheese, yogurt, beer, wine and certain drugs.
Parasites
▪ A parasite is an organism that lives on or in a host organism and gets its food from or at
the expense of its host.
▪ There are three main classes of parasites that can cause disease in humans: protozoa,
helminths, and ectoparasites
HLAMEDIA TRACHOMATIS BACTERIA FUNGI

PARASITES PROTOZOA
12
Protozoa are microscopic, one-celled organisms that can be free-living or parasitic in nature.
Helminths are large, multicellular organisms that are generally visible to the naked eye in their
adult stages. There are three main groups of helminths (derived from the Greek word for worms)
that are human parasites: Flatworms (platyhelminths), Thorny-headed worms (acanthocephalins),
Roundworms (nematodes)
Ectoparasites can broadly include blood-sucking arthropods such as mosquitoes
(because they are dependent on a blood meal from a human host for their survival)
Colonization
 It is the process by which strain of microorganism become resident flora.
 In this state the microorganism may grow and multiply but do not cause disease.

Infection
 It occurs when newly introduced or resident microorganism succeed in invading a part of the body
where the host’s defense mechanisms are ineffective and the pathogen cause tissue damage.
 The infection become a disease when the sign and symptoms of the infection are unique and can
 be differentiated from other conditions.
Protozoa are microscopic, one-celled organisms that can be free-living or parasitic in
nature.
Helminths are large, multicellular organisms that are generally visible to the naked eye in
their adult stages. There are three main groups of helminths (derived from the Greek word
for worms) that are human parasites: Flatworms (platyhelminths), Thorny-headed worms
(acanthocephalins), Roundworms (nematodes)
Ectoparasites can broadly include blood-sucking arthropods such as mosquitoes
(because they are dependent on a blood meal from a human host for their survival)
Colonization
 It is the process by which strain of microorganism become resident flora.
 In this state the microorganism may grow and multiply but do not cause disease.

Infection
 It occurs when newly introduced or resident microorganism succeed in invading a part of
the body where the host’s defense mechanisms are ineffective and the pathogen cause
tissue damage.
 The infection become a disease when the sign and symptoms of the infection are unique
and can be differentiated from other conditions.
Types of infections:
Local infection – are limited to the specific part of the body where the microorganism
remains.
Systemic infection – microorganism that spread and damage different parts of the body.
Acute infection – appears suddenly or last a short time
Chronic infection – may occurs slowly, over a very long period and may last months and
years.
Difference between Bacteremia and Septicemia
Bacteremia
▪ It is a condition when the culture of person’s blood reveals microorganism
▪ Bacteremia is when there are bacteria present in the patient bloodstream.
▪ Common ways in which bacteremia occurs include:
✓ through a dental procedure such as a routine teeth cleaning or through a tooth extraction
✓ from a surgery or procedure
✓ an infection spreading from another part of the body into the bloodstream
✓ via medical devices, particularly in-dwelling catheters and breathing tubes
✓ through severe injuries or burn
Different bacteria that can cause bacteremia. Examples of such bacteria include:
✓ Staphylococcus aureus, including MRSA
✓ Escherichia coli (E. coli)
✓ Pneumococcal bacteria
✓ Group A Streptococcus
✓ Salmonella species
✓ Pseudomonas aeruginosa
▪ Some cases of bacteremia are asymptomatic. In these cases, the immune system will often clear
the bacteria without any use of antibiotic.
▪ Common symptoms:
✓ fever
✓ chills
✓ shaking or shivering
▪ Bacteremia can be diagnosed using:
✓ blood culture – a sample of blood will be taken from a vein and it will then be sent to a lab
to be tested for the presence of bacteria.
✓ sputum culture – if the patient appears to have a respiratory infection or are using a
breathing tube example: patient on endotracheal tube
✓ wound culture – if patient been injured, burned, or have recently undergone surgery
✓ taking samples from in-dwelling catheters or other devices
✓ Imaging tests such as an X-ray, CT scan, or ultrasound – to identify potential sites of
infection in the body.
• The treatment for a bloodstream infection requires prompt use of
antibiotics – to prevent complications like sepsis from occurring.
When bacteria are confirmed in your blood, broad-spectrum antibiotics via
IV is given.
The length of treatment can depend on the cause and severity of the
infection. Maximum time need to be on antibiotics is 1 to 2 weeks.
Septicemia
 It is a condition when bacteremia results in systemic infection.
 Is a serious bloodstream infection. It’s also known as blood poisoning.
 It occurs when a bacterial infection elsewhere in the body, such as the
lungs or skin, enters the bloodstream.
 This is dangerous because the bacteria and their toxins can be carried
through the bloodstream to your entire body
• Septicemia can quickly become life-threatening. It must be treated in a hospital. If left untreated,
• septicemia can progress to sepsis.
Sepsis is a serious complication of septicemia.
Sepsis causes inflammation throughout the body.
This inflammation can cause blood clots and block oxygen from reaching vital organs,
• resulting in organ failure.
• The most common infections that lead to septicemia are:
Bacterial infection
Fungal infection
Viral infection
Examples: urinary tract infections, lung infections, such as pneumonia, kidney infections,
infections in the abdominal area
 High risk of developing septicemia if the patient:
have severe wounds or burns
adult older than 65
babies under 1 year of age
have a compromised immune system, which can occur from conditions, such as HIV or
leukemia, or from medical treatments such as chemotherapy or steroid injections
have a urinary or intravenous catheter on mechanical ventilation
The most common initial symptoms are:
chills
 fever
Tachypnea and tachycardia
Difficulty breathing
Clammy or sweating
Extreme pain or discomfort
Severe symptoms once septicemia progresses without proper treatment. These include the following:
confusion or inability to think clearly
nausea and vomiting
Rashes
reduced urine volume
inadequate blood flow
shock or signs of shock
Low blood pressure
Dizziness
Pale, discolored or mottled skin
Skin that feel unsusually warm or cold
Reduce alertness
Change in person’s mentation
Feeling of doom
Severe of extreme generalized body pain
Shortness of breath
Common complication of septicemia if left untreated
✓ Sepsis
• This leads to widespread inflammation throughout the body.
• It’s called severe sepsis if it leads to organ failure.
• People with chronic diseases are at a higher risk of sepsis.
✓ Septic shock
• Toxin released by the bacteria in the bloodstream can cause extremely low
blood flow, which may result in organ or tissue damage.
• Septic shock is a medical emergency.
✓ Acute respiratory distress syndrome (ARDS)
• This is a life-threatening condition that prevents enough oxygen from
reaching the lungs and blood.
• It often results in some level of permanent lung damage. It can also
damage the brain, leading to memory problems.
Treatment
treating the cause of the infection
administering antibiotics, if the infection is bacterial
providing oxygen and intravenous fluids to ensure blood flow to the
organs
providing a means of assisted breathing, if appropriate
scheduling surgery, if necessary, to remove damaged tissue
 20XX

SECTION DIVIDER SLIDE

Section Subtitle
Presentation Title 22
The chain of infection is made up of six links:
1. The pathogen
 The first link in the chain of infection is the infectious agent or pathogen which
can take the form of:
• Viruses – such as Influenza A, shingles and Hepatitis
• Bacteria – including Lyme disease and Leptospirosis
• Fungi – for example Candidiasis and Aspergillosis
• Parasitic protozoan diseases – such as Malaria, Giardia and
Toxoplasmosis
• Prions – which are the cause of rare progressive neurodegenrative
disorders such as Creutzfeldt-Jakob disease (CJD)
How well any pathogen is able to thrive depends on three factors:
• Its pathogenicity – its ability to produce disease
• Its degree of virulence – its severity or harmfulness
• Its invasiveness – its tendency to spread
The chain of infection is made up of six links:
2. The reservoir
 A reservoir is the principal habitat in which a pathogen lives, flourishes and is
able to multiply.
Common reservoirs for infectious agents include humans, animals or insects and
the environment.
a. Human reservoirs
 In humans, there are two forms of reservoir: acute clinical cases (in which
someone is infected and is displaying signs and symptoms of the disease);
and carriers (where someone has been colonized with an infectious agent
but is not unwell.
 Acute clinical cases are more likely to be diagnosed and treated which
means that the patient’s contacts and normal activities will normally be
restricted. Carriers, however, can present more of a risk to those around
them because they do not display any signs or symptoms of illness
The chain of infection is made up of six links:
C. Environmental reservoirs
 The environment contains a large number of reservoirs of infection,
including 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).
3. The portal of exit
 The portal of exit is any route which enables a pathogen to leave the
reservoir or host. In humans the key portals of exit are:
• Alimentary – via vomiting, diarrhea or biting
• Genitourinary – via sexual transmission
• Respiratory – through coughing, sneezing and talking
• Skin – via skin lesions
•Trans-placental – where transmission is from mother to fetus
The chain of infection is made up of six links:
4. The mode of transmission
 The two main ways that an infection can be transmitted from its reservoir to
a susceptible host are via direct transmission or indirect transmission.
a) Direct transmission tends to be instantaneous and occurs when there is
direct contact with the infectious agent. Examples include tetanus,
glandular fever, respiratory diseases and sexually transmitted diseases.
b) Indirect transmission can occur through animate mechanisms such as
fleas, ticks, flies or mosquitoes or via inanimate mechanisms such as
food, water, biological products or surgical instruments.
− Indirect transmission can also be airborne, in which tiny particles of
an infectious agent are carried by dust or droplets in the air and
inhaled into the lungs.
Breaking the chain of infection
• Etiologic agent (microorganisms)
– Correctly cleaning, disinfecting or sterilizing articles before use
– Educating clients and support persons about appropriate
methods to clean, disinfect, and sterilize article
• Reservoir (source)
• Changing dressings and bandages when soiled or wet
• Appropriate skin and oral hygiene
• Disposing of damp, soiled linens appropriately
• Disposing of feces and urine in appropriate receptacles
• Ensuring that all fluid containers are covered or capped
• Emptying suction and drainage bottles at end of each shift or before
full or according to agency policy
Breaking the chain of infection
• Portal of exit (from the reservoir)
– Avoiding talking, coughing, or sneezing over open wounds or
sterile fields
– Covering the mouth and nose when coughing or sneezing
• Method of transmission
• Proper hand hygiene
• Instructing clients and support persons to perform hand hygiene
before handling food, eating, after eliminating and after touching
infectious material
• Wearing gloves when handling secretions and excretions
• Wearing gowns if there is danger of soiling clothing with body
substances
Breaking the chain of infection
• Portal of entry (to the susceptible host)
– Using sterile technique for invasive procedures, when exposing
open wounds or handling dressings
– Placing used disposable needles and syringes in puncture-
resistant containers for disposal
– Providing all clients with own personal care items
• Susceptible host
• Maintaining the integrity of the client’s skin and mucous membranes
• Ensuring that the client receives a balanced diet
• Educating the public about the importance of immunizations
 The patient's immune status plays a large role in determining risk for
infection. Congenital abnormalities, as well as acquired health problems
(e.g., renal failure, steroid dependence, cancer, acquired immune
deficiency syndrome [AIDS]), can result in numerous immunologic
deficiencies.
 Depression of immunity may make the host more susceptible to infection
or impair the ability to combat organisms that have gained entry.
 Immunity is resistance to infection; it is usually associated with the
presence of antibodies or cells that act on specific microorganisms.
 Passive immunity is of short duration (days or months) and either
natural by transplacental transfer from the mother or artificial by injection
of antibodies (e.g., immunoglobulin).
 Active immunity lasts for years and is natural by infection or artificial by
stimulation of the body’s immune defenses (e.g., vaccination).
 Medical and surgical interventions may impair normal immune
response.
 Steroid therapy, chemotherapy, and anti-rejection drugs increase
the risk for infection.
 Medical devices (e.g., intravascular or urinary catheters,
endotracheal tubes, synthetic implants) may also interfere with
normal host defense mechanisms.
 Surgery, trauma, radiation therapy, and burns result in nonintact
skin. The body's skin is one of the best barriers or defenses against
infection. When this barrier is broken, infection often results.
 Microorganisms may enter the body in a variety of ways, including
the respiratory tract, GI tract, genitourinary tract, skin and mucous
membranes, and bloodstream.
Factors That May Increase Risk for Infection
in the Older Patient

33
 Environmental factors can also influence patients' immune
status and thus their susceptibility to or ability to fight
infection.
 Examples include alcohol consumption, nicotine use,
inhalation of bone marrow–suppressing toxic chemicals,
and certain vitamin deficiencies.
 Malnutrition, especially protein-calorie malnutrition, places
patients at increased risk for infection.
 Diseases such as diabetes mellitus also predispose a
patient to infection.
 Older adults have decreased immunity, as well as other
physiologic changes that make them very susceptible to
infection.
 Routes of Transmission
 Pathogens may enter the body through the
respiratory tract. Microbes in droplets are sprayed 20XX

into the air when people with infected oral or nasal

tissues talk, cough, or sneeze.
 A susceptible host then inhales droplets, and
pathogens localize in the lungs or are distributed via
the lymphatic system or bloodstream to other areas
of the body.
 Microorganisms that enter the body by the
respiratory tract and produce distant infection
include influenza virus, Mycobacterium tuberculosis,
and Streptococcus pneumoniae.

 Other pathogens enter the body through the GI

tract. Some stay there and produce disease (e.g.,
Shigella causing self-limited disease). Others invade
the GI tract to produce local and distant infection 35

(e.g., Salmonella enteritidis).

Routes of Transmission
 Some produce limited GI symptoms, causing systemic
20XX
infection (e.g., Salmonella typhi) or profound
involvement of other organs (e.g., hepatitis A virus).

 Millions of foodborne illness cases occur each year in

the United States. This type of illness results in many
hospitalizations and deaths.
 Microorganisms also enter through the genitourinary
tract. Urinary tract infection (UTI) is one of the most
common health care–associated infections (HAIs). More
than half of patients in adult intensive care units
(ICUs)have urinary catheters in place. Indwelling urinary
catheters are a primary cause of catheter-associated
urinary tract infections (CAUTIs), especially in older
adults. CAUTIs can increase hospital costs by
prolonging the patient's length of stay and complicating
the patient’s recovery. In many settings, nurse-driven
protocols have helped decrease the use of urinary 36
catheters and associated infections
 Routes of Transmission
 Although intact skin is the best barrier to prevent most
infections, some pathogens such as Treponema 20XX

pallidum can enter the body through intact skin or

mucous membranes. Most enter through breaks in
these normally effective surface barriers. Sometimes a
medical procedure creates a break in cutaneous or
mucocutaneous barriers, as in catheter-acquired
bacteremia (bacteria in the bloodstream) and surgical-
site infections (SSIs). Fragile skin of older patients and
of those receivingprolonged steroid therapy increases
infection risk.
 Microorganisms can gain direct access to the
bloodstream, especially when invasive devices or
tubes are used. Central venous catheters (CVCs) are
a primary cause of these infections.
 In the community setting, biting insects can inject
organisms into the bloodstream, causing infection
(e.g., Lyme disease, West Nile viral encephalitis). 37
 Methods of Transmission
For infection to be transmitted from an infected source to
a susceptible host, a transport mechanism is required. 20XX

Microorganisms are transmitted by several routes:

 Contact transmission (indirect and direct)
 Droplet transmission
 Airborne transmission
CONTACT TRANSMISSION
 is the usual mode of transmission of most infections.
1. Direct Or Indirect Contact
 With direct contact, the source and host have physical
contact. Microorganisms are transferred directly from
skin to skin or from mucous membrane to mucous
membrane.
 Often called person-to-person transmission, direct
contact is best illustrated by the spread of the
“common cold.” 38
 Methods of Transmission
2. Indirect Contact Transmission
 involves the transfer of microorganisms from a source to a 20XX

host by passive transfer from a contaminated object.

 Contaminated articles or hands may be sources of infection.
For example, patient-care devices like glucometers and
electronic thermometers may transmit pathogens if they are
contaminated with blood or body fluids.
 Uniforms, laboratory coats, and isolation gowns used as part
of personal protective equipment (PPE) may be contaminated
as well.
DROPLET TRANSMISSION
 Indirect transmission may involve contact with infected
secretions or droplets.
 Droplets are produced when a person talks or sneezes; the
droplets travel short distances. Susceptible hosts may acquire
infection by contact with droplets deposited on the nasal, oral,
or conjunctival membranes.
 Therefore the CDC recommends that staff stay at least 3 feet
(1 m) away from a patient with droplet infection. An example
39
of dropletspread infection is influenza.
 Methods of Transmission
 Susceptible hosts may acquire infection by contact
with droplets deposited on the nasal, oral, or 20XX

conjunctival membranes. Therefore the CDC

recommends that staff stay at least 3 feet (1 m) away
from a patient with droplet infection. An example of
dropletspread infection is influenza.
AIRBORNE TRANSMISSION
 Airborne transmission occurs when small airborne
particles containing pathogens leave the infected
source and enter a susceptible host.
 These pathogens can be suspended in the air for a
prolonged time. The particles carrying pathogens are
usually contained in droplet nuclei or dust; they are
usually propelled from the respiratory tract by
coughing or sneezing.
 A susceptible person then inhales the particles
directly into therespiratory tract. For example, 40
tuberculosis is spread via airborne transmission.
 Methods of Transmission
 Preventing the spread of microbes that are
transmitted by the airborne route requires the use of 20XX

special air handling and ventilation systems in an

airborne infection isolation room (AIIR).
 M. tuberculosis and the varicella-zoster virus
(chickenpox) are examples of airborne agents that
require one of these systems.
 In addition to the AIIR, respiratory protection using a
certified powered air purifying respirator (PAPR) is
recommended for health care personnel entering the
patient's room.
 This device has a high efficiency particulate air
(HEPA) filter and battery to promote positive-pressure
airflow and is more effective than N95 respirators.
 Other sources of infectious agents include the
environment, such as contaminated food, water, or
vectors. 41
 Methods of Transmission
 Vectors are insects that carry pathogens between two or more
hosts, such as the deer tick that causes Lyme disease. 20XX
 The portal of exit completes the chain of infection. Exit of the
microbe from the host often occurs through the portal of entry.
 An organism, such as M. tuberculosis, enters the respiratory
tract and then exits the same tract as the infected host
coughs.
 Some organisms can exit from the infected host by several
routes. For example, varicella-zoster virus can spread through
direct contact with infective fluid in vesicles and by airborne
transmission.
Physiologic Defenses for Infection
 Strong and intact host defenses can prevent microbes from
entering the body or can destroy a pathogen that has entered.
 Impaired host defenses may be unable to defend against
microbial invasion, allowing entry of organisms that can
destroy cells and cause infection.
 Common defense mechanisms include:
- Body tissues - Inflammation
- Phagocytosis - Immune Sytem 42
 Barriers Defend Against Infection
• Intact skin and mucous membranes
• Moist mucous membranes and cilia of the 20XX

nasal passages
• Alveolar macrophages
• Tears
• High acidity of the stomach
• Resident flora of the large intestine
• Peristalsis
• Low pH of the vagina
• Urine flow through the urethra

43
 Level of Disease
To determine if an infection problem exists in a
particular health care facility or geographic 20XX

area, investigators study the current incidence

of the disease in that facility por area and
compare it to past incidence rates.
 Sporadic
• Refers to a disease that occurs infrequently
and irregularly.
• Example: tetanus and gas gangrene
 Endemic
• A disease outbreak that is consistently
present but limited to a particular region.
This makes the disease spread and rates
predictable.
• Are those that are present or belong to a
particular population or community 44
 Level of Disease
• Example: Malaria in some areas of Africa,
hepatitis B in certain Asian culture 20XX

 Epidemic
• Describes as an unexpected increase in the
number of disease cases in a specific
geographical area.
• It refers to a disease or other specific
health-related behavior with rates that are
clearly above the expected occurrence in a
community or region.
• Refers to an increase, often sudden, in the
number of cases of a disease above what is
normally
• expected in that population in that area.
• Example: Yellow fever, smallpox, measles,
and polio are prime examples of epidemics 45
that occurred throughout American history.
 Level of Disease
 Pandemic
• Refers to an epidemic that has spread over 20XX

several countries or continents, usually

affecting a large number of people.
• The World Health Organization (WHO)
declares a pandemic when a disease’s
growth is exponential. This means growth
rate skyrockets, and each day cases grow
more than the day prior.
• Example: COVID
Why outbreaks occur?
There are many complex reasons why microbes that
causes infectious disease are so difficult to
overcome
1. Some bacteria develop a resistance to antibiotics
2. Some microbes such as influenza virus have so many
different strains that a single vaccine can't protect
against them all. 46
Why outbreaks occur?
There are many complex reasons why microbes that causes
infectious disease are so difficult to overcome 20XX
3. Most viruses resist antiviral drugs
4. New infectious agents occasionally arise example corona
virus
5. Some microbes localize in areas of the body that makes
treatment difficult example: CNS
6. Opportunistic organism can cause infection in
immunocompromised individuals
7. Most people are not vaccinated.
Infection Control in Health Care Settings
• Infections among patients in health care facilities are
classified as nosocomial, community acquired or
• iatrogenic
• Nosocomial infection
• Also known as a hospital-acquired infection or HAI
• It is an infection whose development is favored by a hospital
environment, such as one acquired by a patient during a
hospital stay, or one developing among hospital staff and was
not present or incubating at the time of admission.
• It usually appears before the patient is discharged, although
some typically are incubating at discharge 47
• Community-Acquired Infection
 Infection Control in Health Care Settings
• Community – acquired infection
 It is present or incubating at the time of 20XX

admission in a patient who has no history of

previous hospitalization to the same facility
 Infections that are contracted outside of a
hospital or are diagnosed within 48 hours of
admission without any previous health care
encounter.
• Iatrogenic infection
 It is caused by the actions or treatment of a
health care provider.
 Infection may also represent a secondary
condition caused by treatment of a primary
condition.
 defined as an infection after medical or
surgical management, whether or not the
patient was hospitalized.
48
 Methods of Infection Control and Prevention
• All health care workers who come in contact with
patients or care areas are involved in some aspect 20XX

of the infection control program of the agency.

According to the CDC, infections can be prevented
or controlled in several ways:
o Hand hygiene
o Disinfection/sterilization
o Standard Precautions
o Transmission-Based Precautions
o Staff and patient placement and cohorting
Hand Hygiene
 Health care workers' hands are the primary way in
which infection is transmitted from patient to patient
or staff to patient.
 Hand hygiene refers to both handwashing and
alcohol-based hand rubs (ABHRs) (“hand
sanitizers”).
49
 Methods of Infection Control and Prevention
Sterilization and Disinfection
 Sterilization means destroying all living organisms 20XX

and bacterial spores. Many invasive procedures,

such as inserting vascular access devices (VADs)
and urinary catheters, require sterile technique.
 Disinfection does not kill spores and only ensures
a reduction in the level of disease-causing
organisms.
 High-level disinfection is adequate when an item is
going inside the body where the patient has
resident bacteria or normal flora (e.g., GI and
respiratory tracts).
 As with sterilization, no high-level disinfection can
occur without first cleaning the item.
 This can be especially difficult with items that have
narrow lumens in which organic debris can become
trapped and is not easily visible. For example,
endoscopes have been especially challenging to
clean and have been linked to a number of 50
infectious outbreaks.
 Methods of Infection Control and Prevention
Standard Precautions
 Standard Precautions are based on the belief that 20XX

all body excretions, secretions, and moist

membranes and tissues, excluding perspiration, are
potentially infectious.
 As barriers to potential or actual infections,
personal protective equipment (PPE) is used. PPE
refers to gloves, isolation gowns, face protection
(masks, goggles, face shields), and powered air
purifying respirators (PAPRs) or N95 respirators

51
 Standard Precaution
 Are a set of activities designed to prevent the
transmission of organisms between patients/staff 20XX

and, in turn, prevent HCAIs

 It enquired to achieve a basic level of infection
prevention and control.
 The use of standard precautions aims to minimize,
and where possible, eliminate the risk of
transmission of infection, particularly those caused
by blood borne viruses.
 Standard precautions apply to all patients
regardless of their diagnosis or presumed infection
status.
 Standard precautions must be used in the handling
of:
✓ blood (including dried blood)
✓ all other body fluids/substances (except sweat)
✓ non-intact skin
✓ mucous membranes.
52
 Standard Precaution
 Standard precautions consist of the following
practices: 20XX

✓ hand hygiene
• Handwashing: Hands should be washed with soap
and water when visibly soiled and after using the
toilet.
• Hand rubbing: Hand rubbing with an alcohol-based
hand rub (ABHR) is the preferred method for hand
cleansing in the healthcare setting when hands are
not visibly soiled.
• The 5 moments are: before touching a client, before
performing a procedure, after a procedure or
exposure to body fluids/substances, after touching
a client and after touching the environment around
a client
 the safe use and disposal of sharps
 the use of aseptic "non-touch" technique for all
invasive procedures, including appropriate use of
skin disinfectants 53
 Standard Precaution
 reprocessing of reusable instruments and equipment
 routine environmental cleaning 20XX

 waste management
 respiratory hygiene and cough etiquette
 appropriate handling of linen.
 the use of personal protective equipment, which may
include gloves, impermeable gowns, plastic aprons,
masks, face shields and eye protection
Personal protective equipment (PPE)
 PPE protects the healthcare worker from exposure to
blood and body fluids/substances.
Gloves
 The use of gloves is not considered an alternative to
performing hand hygiene. Hand hygiene is required
before putting on gloves and immediately after
removal.
 Wear gloves (single-use non-sterile) when there is the
potential for contact with blood, body
fluids/substances, mucous membranes or non-intact 54
skin.
 Standard Precaution
 Sterile gloves are only required for certain invasive
procedures, otherwise non-sterile gloves may 20XX

 be used if a aseptic non-touch technique is used.

 Change gloves between tasks and procedures on the
same patient.
 Gloves should be removed immediately after a
procedure and hand hygiene performed so as to
 avoid contaminating the environment, other
 patients or other sites on the same patient.
 Gloves used for healthcare activities are to be single-
use only.
Gowns and aprons
 Wear an apron or gown to protect skin and prevent
soiling of clothing during procedures and
 patient care activities that are likely to generate
splashing or sprays of blood, body fluids,
 secretions or excretions, or cause soiling of clothing.
 Select a gown or apron (i.e., long or short sleeves)
that is appropriate for the activity and the 55
 Standard Precaution
 amount of fluid likely to be encountered. If an apron is
used, staff should ensure they are “bare below-the- 20XX
elbows”.
 Remove the used gown as promptly as possible and
roll it up carefully and discard appropriately.
 Perform hand hygiene immediately after removal.
Masks, eye protection, face shields
 Wear a mask and eye protection, or a face shield to
protect mucous membranes of the eyes, nose and
mouth during procedures, patient-care activities
and cleaning procedures that are likely to generate
splashes or sprays of blood, body fluids, secretions
and excretions.
 Remove the mask by holding the ties only and
dispose of the mask into a waste bin.
 Perform hand hygiene immediately after removal.
 Protective eyewear such as face-shields or goggles
should also be worn where the potential exists for
splashing, splattering or spraying of vomit and 56
feces.
 Standard Precaution
 Reusable goggles should be washed with detergent
and water between uses 20XX

Transmission-based Precautions
 Are designed for patients with documented or
suspected infection with pathogens for which
additional precautions beyond Standard
Precautions are needed to prevent transmission.
 Transmission-based precautions are required in
patients known or suspected to be infected with
highly transmissible or epidemiologically important
pathogens, in which standard precautions may be
insufficient to prevent transmission.
 Empiric or Syndrome Precaution – is a
transmission-based Precautions that are applied at
the time of initial contact, based on the clinical
presentation and the most likely pathogens
 This approach is useful especially for emerging
agents (e.g., SARS-CoV, avian influenza,
 pandemic influenza), for which information 57
concerning routes of transmission is still evolving.
 Standard Precaution
 The three categories of Transmission-based
Precautions are: Contact Precautions, Droplet 20XX

Precautions, and Airborne Precautions.

Airborne transmission precautions
 These apply to situations in which pathogens can
be transmitted by the airborne route, that is, by
small droplets of 5 µm or smaller
 Example: organisms that cause tuberculosis,
measles, and chickenpox and Aspergillus
Droplet transmission precaution
 These apply to situations in which pathogens can
be transmitted by large particle droplets, greater
than 5 µm
 Droplets can be generated by coughing, sneezing,
talking or during the performance of procedures
 Example: organisms that cause mumps, rubella,
pertussis and influenza
58
Contact transmission precautions
 These apply to situations in which pathogens can
be transmitted by direct or indirect contact 20XX
 Direct contact example: through the patient’s
secretions or bodily fluids; i.e. contact which occurs
when performing patient-care activities that require
touching the patients skin, secretions or bodily
fluids
 Indirect contact example: touching potentially
contaminated environmental surfaces or equipment
in the patients environment
 Example: methicillin-resistant Staphylococcus
aureus (MRSA), herpes simplex virus, and hepatitis
A virus
Aspects of care of patient with communicable
disease
Preventive Aspects
 Health Education

59
o Educate the family and client with respects to
availability and importance of prophylactic
immunization, manner in which infectious illness is 20XX
spread, importance of seeking medical advices for any
signs of health problem and importance of
environmental cleanliness and personal hygiene.
 Immunization – is the introduction of specific protective
antibodies in a susceptible person or animal, or the
production of cellular immunity in such persona or
animal
 Immunity – is a condition of being secure against any
particular disease
Types of immunity:
• Natural Immunity
 Passive – acquired through placental transfer
 Active – acquired through immunization and or
recovery from certain disease
• Artificial Immunity
 Passive – acquired through the administration of
antitoxin, antiserum, convalescent serum and gamma
globulin 60
 Active – acquires through the administration of
vaccine and toxoid
• Subclinical – an immunity acquired through 20XX
constant exposure to a particular disease or
organism
Types of Antigens:
• Inactivated (killed organism) – not long lasting,
multiple doses needed and booster dose is needed
• Attenuated (live organism) – single dose needed
and long-lasting immunity.
What damages Vaccine?
• Heat and sunlight damage vaccines, especially live
vaccines
• Freezing damage vaccines like those of killed
vaccine and toxoids
• Antiseptic, disinfectants and detergents may lessen
the potency of vaccines
• The safest temperature to keep all vaccines is 0 – 8
degrees Celsius
61
Environmental Sanitation
• Water policy sanitation program
• Excreta and sewage disposal policies 20XX

• Food sanitation program

• Hospital waste management program

Control System Aspect

 Isolation and quarantine
 Disinfection
 Fumigation / disinfectant fogging – application of
gaseous agents to kill or drive organism or insects

Curative and Rehabilitative Aspect

 Medical management and Nursing management
 Activity (Eliminating the source of infection,
transmission and protection of susceptible host)
and nutrition
62
Infection Control Bundles in the Critical Care
Units
Infection Control Care Bundles 20XX

 It is a simple set of evidence-based practice that

when implemented collectively, reliably and
continuously has been proven to improve patient’s
outcome (International Society for Infectious
Diseases)
▪ It is a tool with a clear parameter.
▪ These care bundles contribute to:
 Infection prevention in the critical care units
 Reduce unnecessary antibiotic prescribing
 Limit the development of antibiotic resistance in the
healthcare facilities.
General Principles of IC Care Bundles
 Assist in enhancing compliance to evidence –
based quality process measures to improve patient
care
 Create reliable and consistent care system in the 63
hospital setting
 Promotes a multi – disciplinary collaboration among
health care workers.
Aims of IC Care Bundles 20XX

 Care Bundles aim to ensure that patients receive

recommended treatment on a consistent basis.
List of IC Bundles in the Critical Care Areas
 Central Line – Associated Bloodstream Infections
(CLABSI) Bundles
 Catheter – Associated Urinary Tract Infections
(CAUTI) Bundles
✓ Ventilator Associated Pneumonia (VAP) Bundles
CLABSI Bundles
▪ What is Central Line?
 Also known as central venous catheter.
 It is a small soft tube catheter that is put in a vein
that leads to the heart.
 A central line is often used instead of a standard IV
(intravenous) line when a patient need treatment for
longer than a week or so. 64
 The line can deliver medicine or nutrition right into
the bloodstream.
Types of Central lines: 20XX

✓ Peripherally inserted central catheter (PICC)

✓ Subclavian line
✓ Internal jugular line
✓ Femoral line
Central Line – Associated Bloodstream Infections
Bundles
 It is defined as a laboratory – confirmed
bloodstream infection not related to an infection at
another site and that develops within 48 hours of
central line placement.
Components of CLABSI Bundles
 During Insertion of Central Line Access
a. Hand Hygiene
b. Maximal sterile barrier precautions is required.
c. Standardized insertion pack and the Skin should
be cleanse with alcohol – based solution e.g. 65
Chlorhexidine solution
d. Optimal catheter site selection. Avoidance of
femoral vein for venous access instead subclavian
vein 20XX
e. Staff should have finished the competency training
for central line insertion
f. Availability of insertion guidelines and use of
checklist with trained observers
 Maintenance of the bundles
a. Daily review of central line
b. Prompt removal of unnecessary lines
c. Disinfection prior to manipulation of the lines
d. Disinfect catheter hubs, port, connectors before
using the catheter
e. Change dressing and disinfect site with alcohol –
based chlorhexidine every 5 to 7 days
f. Replace administration sets within 96 hours
(immediately if used for blood products or lipids)

66
CAUTI Bundles
 CAUTI is defined as a urinary tract infection
(significantly bacteriuria plus symptoms and / or 20XX
signs attributable to the urinary tract with no other
identifiable source) in a patient with current urinary
tract catheterization or who has been catheterized
in the past 48 hours.
▪ Guidelines to prevent CAUTI
a. Hand hygiene before handling the catheter
b. Avoiding the use of urinary catheters by
considering alternative methods for urine
collection.
c. Using an aseptic technique for insertion and
proper maintenance after insertion.
d. Maintain a sterile closed drainage system
e. Position drainage bag below the level of the
bladder
f. Ensure daily catheter care hygiene measure
g. Daily assessment of the presence and need for
indwelling urinary catheters 67
 Indications for urinary catheterizations includes:
a. Urinary retention (mechanical obstruction or
neuropathic) 20XX

b. Needs to closely monitor the urine output in

unstable patients
c. To assist perineal wound care
VAP Bundles
 Ventilator Associated Pneumonia (VAP) Bundles is
defined as a new pneumonia occurring > 48 hours
after endotracheal intubation. It is common and
serious hospital – acquired infection for patients
who are on mechanical ventilator.
 International guidelines of VAP bundles:
a. Elevate the head of the bed to between 30 to 45
degrees
b. Daily “sedation vacation”
c. Daily assessment of readiness to exubate
d. Daily oral care with chlorhexidine
e. Prophylaxis for peptic ulcer disease 68
f. Prophylaxis for deep venous thrombosis
THANK YOU!
Flora M. Tel-equen