MODULE 12: INTRODUCTION TO - They are self-limiting (can die alone)

COMMUNICABLE DISEASES AND STANDARD 4. Rickettsiae - small, gram negative bacteria-like

PRECAUTIONS microbes that can induce life-threatening infections.
They require a host cell for replication. They are
Communicable disease – an illness due to an usually transmitted through a bite of arthropod
infectious agent or its toxic products, which is carriers like lice, ticks, fleas. The rickettsial
transmitted directly or indirectly to a person through diseases are:
an agent, vector (insects or animals) or inanimate a. rocky mountain fever
object (FOMITES - contaminated articles) b. typhus fever “tipus”
- Easily transmitted c. Q fever
Infectious Disease – an illness wherein there is a
presence of living microorganism in the body which 5. Chlamydiae – these are the common cause of
may not be transmitted through ordinary infection of the urethra, bladder, fallopian tubes, and
contact prostate gland. The most common chlamydial
- Transmitted to one person to another infection is transmitted through sexual contact.
(prolonged contact) - Can cause STD
- Eg; leprosy
Contagious Disease – an illness that is easily 6. Fungi – they thrive inside or outside the body
transmitted from one person to another through and may be harmful or beneficial.
direct or indirect means
- Eg; covid-19 7. Protozoa – simplest single–celled organisms of
the animal kingdom.
CHAIN OF INFECTION -
A. CAUSATIVE AGENT – any microbe capable of 8. Parasites - live on or inside other organisms
producing a disease (called hosts) at the expense of those organisms.
1. Bacteria – simple, one- celled membrane They don’t usually kill their host but take only the
microbes with double cell-membranes that nutrients they need.
protect them from harm. They reproduce - Eg; ticks, lice
rapidly and are considered as the most
common cause of fatal infectious diseases. The variability of Pathogenicity depends on the
following:
They are classified according to: a. Mode of action – how the organism
a. shape (cocci, bacilli, spirillae) produces a pathologic process
b. need for oxygen (aerobic, anaerobic) b. Infectivity – invasiveness; ability to invade
c. response to staining (Gram (+) or (-), or and multiply
acid-fast) c. Virulence – degree of microbe’s
d. motility (motile, non-motile) pathogenicity
e. tendency to capsulate (encapsulated, d. Antigenicity – ability to induce an immune
capsulated) response to the host
f. capacity to form spores ( spore-forming, non e. Toxigenicity – amount and destructive
spore-forming) potential of release toxin, ability to cause
toxic effect
2. Spirochete – a bacterium with flexible, slender, > Toxin – any poisonous protein that is produced
undulating spiral rods that possess cell wall. There by bacterial action
are three forms of spirochete that cause a disease: > Exotoxin – exists outside of the bacteria and
1. Treponema circulates independently of the cell body
2. Leptospira > Endotoxin – confined within the body of the
3. Borilia bacteria and released only when bacteria are
broken down.
3. Virus – smallest known microbes. They cannot
replicate independently of the host’s cells; rather B. RESERVOIR of infection refers to the
they invade and stimulate the host’s cells to environment and objects on which an organism
participate in the formation of additional viruses. survives and multiplies. The following are reservoir
- Predispose in air and droplet of infection:
1. Human reservoir snails, transfers the microbes to another living
a. Frank cases or the very ill organism.
b. Sub-clinical or ambulatory E. PORTAL OF ENTRY- a venue through which the
c. Carriers organism gains entrance into the susceptible host.
Incubatory carrier - a person who is incubating the - Eg: mouth, nose, urinary tract, blood
illness F. SUSCEPTIBLE HOST- a person presumably not
Convalescent carrier – a person who is at the possessing resistance against a particular
recovery stage of illness but continues to shed the causative agent (eg, people)
pathogenic microorganism - It depends on factors that increase or decrease
An intermittent carrier – a person who host vulnerability such as
occasionally sheds the pathogenic microorganism ● Age, sex, and genes
A chronic or sustained carrier – a person who ● Geographic and environmental factors
always has the infectious organism in his or her ● General condition (physical, emotional and
system. mental states)
- CONSISTENT ● Underlying diseases (Diabetes Mellitus,
Lymphoma, Leukemia, Neoplasm or
2. Animals - killer instinct Uremia)
3. Non-living things - fomites ● Treatment with certain antimicrobial,
corticosteroids, radiation,
C. THE PORTAL OF EXIT - the path or way in immunosuppressive drugs - because they
which microorganism leaves the reservoir can cause decreased immune system
1. Respiratory system
2. Genitourinary tract system **SHARE ME
3. Gastrointestinal system ● Susceptible
● Host
4. Skin and mucous membrane ● Agent
5. Placenta ● Reservoir
● Exit
D. MODE OF TRANSMISSION- the means by ● Mode of Transmission
which the infectious agent passes through from the ● Entry
portal of exit of the reservoir to the susceptible host.
There are four modes by which infectious agents STAGES OF INFECTION
can be transmitted 1. Incubation Period – time from invasion of the
- Weakest link in mode of transmission disease to the appearance of first symptoms
- HAND WASHING - best preventive way in 2. Prodromal stage – interval from onset of
transmission of microorganisms nonspecific signs and symptoms (FLU-LIKE
1. Contact transmission SYMPTOMS: malaise, low grade fever, fatigue) to
a. Direct contact – person-person transfer of more specific manifestations.
microorganism During this time microorganisms grow and multiply,
b. Indirect contact- occurs when the susceptible and client may be more capable of spreading to
host comes in contact with a contaminated object others.
c.Droplet spread- transmission through contact 3. Illness stage – time when client manifests signs
with respiratory secretions when the infected and symptoms specific to type of infection
person coughs, sneezes or talks. 4. Convalescent stage – containment of infection,
2. Air-borne transmission – occurs when fine progressive elimination of the pathogen
microbial particles or dust particles containing (RECOVERY STAGE)
microbes remain suspended in the air for a
prolonged period. SPECTRUM OF DISEASE OCCURRENCE
3. Vehicle transmission- the transmission of 1. Sporadic – diseases that occur occasionally and
infectious disease through articles or substances irregularly with no specific pattern
that harbor the organism until it is ingested by or - Isolated/rare cases (eg, leprosy)
inoculated into the host. 2. Endemic – constant presence of a disease or
4. Vector-borne transmission – occurs when a infectious agent within a geographical area (eg,
reservoir such as fleas, flies, mosquitoes, ticks, cough and colds)
3. Epidemic – occur in greater number than what is individuals who have a known or suspected
expected in a specific area over a specific time infection with certain organisms. (SPECIFIC)
- “OUTBREAK” (eg, dengue) SEVEN CATEGORIES RECOMMENDED IN
4. Pandemic – epidemic that affects several ISOLATION
countries or continents 1. Strict Isolation – to prevent highly contagious or
- “WORLDWIDE” virulent infections.
● Wash hands after every contact with the
IMMUNITY- refers to the body’s ability to resist patient or potentially contaminated articles
infection afforded by the presence of circulating and before taking care of other patient.
antibodies and WBC. (fights infection) ● Articles contaminated with infectious
TYPES OF IMMUNITY materials should be appropriately discarded
1. Natural > inherent to the body; not brought by or bagged and labeled before they are sent
immunization for decontamination and processing.
a. Passive – acquired through placental transfer ● The healthcare worker may use a private
b. Active – acquired through recovery from a room.
certain disease ● Negative pressure to surrounding areas is
2. Artificial > man-made (science) desirable. - prevent microorganisms to be
a. Passive – acquired through the administration of distributed in the air
antitoxin, antiserum, and/or gammaglobulins 2. Contact Isolation - to prevent spread of infection
(ANTIBODY) primarily by close or direct contact
b. Active – acquired through the administration of 3. Respiratory Isolation- to prevent transmission
vaccine and toxoid (IMMUNIZATION) of infectious diseases over short distances through
3. Sub-clinical- acquired through constant air
exposure to a particular disease or organism 4. Tuberculosis Isolation - for TB patient with
positive smear or with chest X-ray which strongly
TYPES OF ANTIGEN suggest active TB
1. Inactivated – killed microorganism 5. Enteric Isolation - for infections that are spread
a. Not long lasting through direct contact with feces. (eg, HEPA A)
b. Multiple doses needed 6. Drainage/Secretion Precaution - to prevent
c. Booster doses needed infections that are transmitted by direct or indirect
contact with purulent materials or drainage from an
2. Attenuated – live microorganism infected body site. (eg, pus)
- Stimulate natural immune system (antibody) 7. Universal Precaution - applied when handling
a. Single dose needed blood and body fluids.
b. Long–lasting immunity ● This is applied for patients with HIV/ HCV
***What damages vaccines? ● It is intended to prevent parenteral, mucous
● Heat and sunlight damages vaccines, membrane, and non-intact skin exposure of
especially the live ones. healthcare workers to blood-borne
● Freezing damages killed vaccines and pathogens
toxoids. ● This isolation is necessary to prevent
● Use water only in cleaning the infections that are transmitted by direct
refrigerator/freezer. contact with infected blood, semen, vaginal
secretions, and other body fluids (CSF,
ISOLATION PRECAUTIONS synovial fluid, pleural fluid, peritoneal fluid,
The most current isolation system recommended pericardial fluid, amniotic fluid) and tissues
for use in hospitals consists of two levels of containing visible blood.
precautions
a. The first level is standard precautions, which STANDARD PRECAUTIONS
apply to all patients at all times because signs and A. Hand Hygiene
symptoms of infection are not always obvious and Good hand hygiene, including use of alcohol-based
therefore may unknowingly pose risk for a hand rubs and handwashing with soap and water, is
susceptible person. critical to reduce the risk of spreading infections in
b. The second level is known as transmission ambulatory care settings.
based precautions, which are intended for
KEY RECOMMENDATIONS FOR HAND HYGIENE ● Preparation of medications in close
IN AMBULATORY CARE SETTINGS: proximity to contaminated supplies or
1. Key situations where hand hygiene should be equipment.
performed include:
❑ Before touching a patient, even if gloves will be KEY RECOMMENDATIONS FOR SAFE
worn INJECTION PRACTICES IN AMBULATORY CARE
❑ Before exiting the patient’s care area after SETTINGS:
touching the patient or the patient’s immediate 1. Use aseptic technique when preparing and
environment administering medications
❑ After contact with blood, body fluids or 2. Cleanse the access diaphragms of
excretions, or wound dressings medication vials with 70% alcohol before
❑ Prior to performing an aseptic task (e.g., placing inserting a device into the vial
an IV, preparing an injection) 3. Never administer medications from the
❑ If hands will be moving from a same syringe to multiple patients, even if the
contaminated-body site to a clean-body site during needle is changed or the injection is
patient care administered through an intervening length
❑ After glove removal of intravenous tubing
2. Use soap and water when hands are visibly 4. Do not reuse a syringe to enter a medication
soiled (e.g., blood, body fluids), or after caring for vial or solution
patients with known or suspected infectious 5. Do not administer medications from
diarrhea (e.g., Clostridium difficile, norovirus). single-dose or single-use vials, ampules, or
Otherwise, the preferred method of hand bags or bottles of intravenous solution to
decontamination is with an alcohol-based hand rub. more than one patient
6. Do not use fluid infusion or administration
B. Personal Protective Equipment sets (e.g., intravenous tubing) for more than
PPE refers to wearable equipment that is intended one patient
to protect HCP from exposure to or contact with 7. Dedicate multidose vials to a single patient
infectious agents. Examples include gloves, gowns, whenever possible.
face masks, respirators, goggles and face shields. 8. Dispose of used syringes and needles at the
The selection of PPE is based on the nature of the point of use in a sharps container that is
patient interaction and potential for exposure to closable, puncture-resistant, and leak-proof.
blood, body fluids or infectious agents. Hand 9. Adhere to federal and state requirements for
hygiene is always the final step after removing and protection of HCP from exposure to
disposing of PPE. bloodborne pathogens.

C. Injection Safety D. Environmental Cleaning

Injection safety includes practices intended to ● Cleaning refers to the removal of visible soil
prevent transmission of infectious diseases and organic contamination from a device or
between one patient and another, or between a environmental surface using the physical
patient and healthcare provider during preparation action of scrubbing with a surfactant or
and administration of parenteral medications. detergent and water, or an energy-based
UNSAFE PRACTICES THAT HAVE LED TO process (e.g., ultrasonic cleaners) with
PATIENT HARM INCLUDE appropriate chemical agents.
● Use of a single syringe, with or without the ● Disinfection is generally a less lethal
same needle, to administer medication to process of microbial inactivation (compared
multiple patients, (1 syringe = 1 patient) to sterilization - ALL) that eliminates
● Reinsertion of a used syringe, with or virtually all recognized pathogenic
without the same needle, into a medication microorganisms but not necessarily all
vial or solution container (e.g., saline bag) to microbial forms (e.g., bacterial spores).
obtain additional medication for a single - object/materials
patient and then using that vial or solution ***Disinfectant products should not be used as
container for subsequent patients, cleaners unless the label indicates the product is
suitable for such use.
* ANTISEPTIC - human being
E. Medical Equipment - Post signs at entrances with instructions to
MEDICAL EQUIPMENT IS LABELED BY THE patients with symptoms of respiratory
MANUFACTURER AS EITHER REUSABLE OR infection to:
SINGLE-USE; ● Cover their mouths/noses when coughing or
● Reusable medical equipment (e.g., sneezing
endoscopes) should be accompanied by ● Use and dispose of tissues
instructions for cleaning and disinfection or ● Perform hand hygiene after hands have
sterilization as appropriate. been in contact with respiratory secretions
● Single-use devices (SUDs) are labeled by - Provide tissues and no-touch receptacles for
the manufacturer for only a single use and disposal of tissues
do not have reprocessing instructions. - Provide resources for performing hand
Reusable Medical Equipment Classification hygiene in or near waiting areas
● Critical items (e.g., surgical instruments) are - Offer masks to coughing patients and other
objects that enter sterile tissue or the symptomatic persons upon entry to the
vascular system and must be sterile prior to facility
use. - Provide space and encourage persons with
● Semi-critical items (e.g., endoscopes used symptoms of respiratory infections to sit as
for upper endoscopy and colonoscopy) far away from others as possible. If
contact mucous membranes or non-intact available, facilities may wish to place these
skin and require, at a minimum, high-level patients in a separate area while waiting for
disinfection prior to reuse. care -SOCIAL DISTANCING
● Noncritical items (e.g., blood pressure cuffs,
thermometer) are those that may come in TRANSMISSION-BASED PRECAUTIONS
contact with intact skin but not mucous In addition to consistent use of Standard
membranes and should undergo low- or Precautions, additional precautions may be
intermediate-level disinfection depending on warranted in certain situations as described below.
the nature and degree of contamination. A. Contact Precautions
● Environmental surfaces (e.g., floors, walls) ● Apply to patients with any of the
are those that generally do not contact the following conditions and/or disease:
patient during delivery of care. Cleaning - Presence of stool incontinence (may include
may be all that is needed for the patients with norovirus, rotavirus, or
management of these surfaces but if Clostridium difficile), draining wounds,
disinfection is indicated, low-level uncontrolled secretions, pressure ulcers, or
disinfection is appropriate. presence of ostomy tubes and/or bags
F. Respiratory Hygiene/Cough Etiquette draining body fluids
● Respiratory Hygiene/Cough Etiquette is - Presence of generalized rash or exanthems
an element of Standard Precautions that ● Prioritize placement of patients in an exam
highlights the need for prompt room if they have stool incontinence,
implementation of infection prevention draining wounds and/or skin lesions that
measures at the first point of encounter with cannot be covered, or uncontrolled
the facility/ambulatory settings (e.g., secretions
reception and triage areas). ● Perform hand hygiene before touching
● This strategy is targeted primarily at patients patient and prior to wearing gloves
and accompanying family members or ● PPE use:
friends with undiagnosed transmissible - Wear gloves when touching the patient and
respiratory infections, and applies to any the patient’s immediate environment or
person with signs of illness including cough, belongings
congestion, rhinorrhea, or increased - Wear a gown if substantial contact with the
production of respiratory secretions when patient or their environment is anticipated
entering the facility. ● Perform hand hygiene after removal of PPE;
● KEY RECOMMENDATIONS FOR note: use soap and water when hands are
RESPIRATORY HYGIENE/COUGH visibly soiled (e.g., blood, body fluids), or
ETIQUETTE IN AMBULATORY CARE after caring for patients with known or
SETTINGS:
 suspected infectious diarrhea (e.g., - Measles
Clostridium difficile, norovirus) - Chickenpox (until lesions are crusted over)
● Clean/disinfect the exam room accordingly. - Localized (in immunocompromised patient)
● Instruct patients with known or suspected or disseminated herpes zoster (until lesions
infectious diarrhea to use a separate are crusted over)
bathroom, if available; clean/disinfect the ● Have patient enter through a separate
bathroom before it can be used again entrance to the facility (e.g., dedicated
B. Droplet Precautions isolation entrance), if available, to avoid the
● Apply to patients known or suspected to be reception and registration area
infected with a pathogen that can be ● Place the patient immediately in an airborne
transmitted by droplet route; these include, infection isolation room (AIIR)
but are not limited to: ● If an AIIR is not available:
- Respiratory viruses (e.g., influenza, - Provide a facemask (e.g., procedure or
parainfluenza virus, adenovirus, respiratory surgical mask) to the patient and place the
syncytial virus, human metapneumovirus) patient immediately in an exam room with a
- Bordetella pertussis closed door
- For first 24 hours of therapy: Neisseria - Instruct the patient to keep the facemask on
meningitidis, group A streptococcus while in the exam room, if possible, and to
● Place the patient in an exam room with a change the mask if it becomes wet
closed door as soon as possible (prioritize - Initiate protocol to transfer patient to a
patients who have excessive cough and healthcare facility that has the
sputum production); if an exam room is not recommended infection-control capacity to
available, the patient is provided a facemask properly manage the patient
and placed in a separate area as far from ● PPE use:
other patients as possible while awaiting - Wear a fit-tested N-95 or higher level
care. disposable respirator, if available, when
● PPE use: caring for the patient; the respirator should
- Wear a facemask, such as a procedure or be donned prior to room entry and removed
surgical mask, for close contact with the after exiting room o If substantial spraying of
patient; the facemask should be donned respiratory fluids is anticipated, gloves and
upon entering the exam room gown as well as goggles or face shield
- If substantial spraying of respiratory fluids is should be worn
anticipated, gloves and gown as well as ● Perform hand hygiene before and after
goggles (or face shield in place of goggles) touching the patient and after contact with
should be worn respiratory secretions and/or body fluids and
● Perform hand hygiene before and after contaminated objects/materials; note: use
touching the patient and after contact with soap and water when hands are visibly
respiratory secretions and contaminated soiled (e.g., blood, body fluids)
objects/materials; note: use soap and water ● Instruct patient to wear a facemask when
when hands are visibly soiled (e.g., blood, exiting the exam room, avoid coming into
body fluids) close contact with other patients , and
● Instruct patient to wear a facemask when practice respiratory hygiene and cough
exiting the exam room, avoid coming into etiquette
close contact with other patients, and - Once the patient leaves, the exam room
practice respiratory hygiene and cough should remain vacant for generally one hour
etiquette before anyone enters; however, adequate
● Clean and disinfect the exam room wait time may vary depending on the
accordingly ventilation rate of the room and should be
C. Airborne Precautions determined accordingly*
● Apply to patients known or suspected to be ● If staff must enter the room during the wait
infected with a pathogen that can be time, they are required to use respiratory
transmitted by airborne route; these include, protection
but are not limited to:
- Tuberculosis