Communicable Disease Nursing

Bryan Romulus T. Savellano RN MAN

What is a Communicable Disease?

Is an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agency, and a vector or an inanimate object.

Carriera person who without apparent symptoms of a communicable disease, harbors and disseminates the specific microorganisms 2. Contactany person or animal known to have been in such association with an infected person or animal as to have been presumably exposed to infection 3. Communicable periodthe period which etiologic agent may be transferred directly or indirectly from the body of the infected person to the body of another person

TERMINOLOGIES IN COMMUNICABLE DISEASE

Contamination - invasion of surface (wound) or article (handkerchief) or matter (water and milk) implies the presence of certain amount of undesirable substance which may contain pathogenic microorganisms Disinfection - destruction of the vitality of pathogenic microorganisms by chemical or physical means directly applied. Fumigation - any process by which destruction of insects, fleas, bugs, etc. and is accomplished by the employment of gaseous agents Isolation - the separation for the period of communicability of infected persons, in such places and under such conditions as will prevent the direct or indirect conveyance of infectious agent from infected person to another person.

Quarantine - limitation of freedom of movement of such susceptible persons or animals as have been exposed to communicable diseases Vector - a biting insect or arthropod which conveys the pathogenic organisms from one person to another Pathogenecity - the ability to produce a disease; the ability of microbes to overcome the defensive powers of the host to induce disease Virulence - the vigor with which the organism can grow and multiply; refers to the degree or intensity of disease produced

Nosocomial Infection - infections associated with the delivery of health care services in a health care facility Opportunistic pathogen - causes disease in a susceptible person Resident flora - microorganisms that are always present in specific areas of the body usually in numbers compatible with individuals health

Transient flora - microorganisms that are present episodically in specific areas of the body Colonization - a process by which strains of microorganisms become resident flora, but their presence does not cause disease

ECOLOGIC TRIAD
AGENT
Microorganism that is living and capable of invading and multiplying in the body of the host
Bacteria-autonomously replicating unicellular cell Viruses- are the smallest obligate intracellular pathogens and are incapable of replication outside the living cell Fungi- free-living, eukaryotic saprophytes found in every habitat of the earth Parasites- any organism that derives benefits from its biologic relationship with another organism Protozoa- simplest single-celled organism of the animal kingdom. They absorb nutrients from the body of the host

HOST
is a person, animal or plant capable of supporting the nutritional status and physical growth requirements of another

ENVIRONMENT
The sum total of all external and internal influences that affects the life and development of one disease

Contagious Disease Includes only those which are spread by direct contact with the infectious agents causing the disease. Term to a disease that is easily transmitted from one person to another through direct or indirect means

Infectious disease Is transmitted not only by ordinary contact but requires direct inoculation of the organism through a break on the skin or mucous membrane. Hence all contagious diseases are infectious.

Infection Is produced by the invasion of the body tissues with pathogenic microorganisms which multiply and produce the signs and symptoms of disease The entry and multiplication of a particular pathogen in the body of man or animal

CLASSIFICATION OF INFECTIOUS DISEASES

Based on behavior within the host Communicable Disease Non-Communicable Disease

Based on severity or duration of disease

Acute Disease
Develops rapidly (rapid onset) but lasts only a short time Ex. Measles, Mumps, Influenza Chronic disease Develops more slowly but lasts for a long period Ex. TB, Leprosy

Sub-acute Disease
Intermediate between acute and chronic Develops rapidly and has long duration Ex. Bacterial endocarditis

Latent Disease
Causative agent remains inactive for a time but then becomes active to produce symptoms of the disease an infection held in check by the defensive forces of the body but activated when the body resistance is reduced Ex. Chicken pox- Shingles Zoster

Based on extent of affected hosts body

Local Infection Microbes invade a relatively small area of the body Localization of the disease at one point in the body General (Systemic) Infection Spreads throughout the body by blood or lymph Focal Infection Local infection that spread but are confined to specific areas of the body Ex. tooth abscess Mixed Infection - infection is caused by two or more organisms

Based on state of host resistance Primary Infection Acute infection that causes the initial illness Secondary Infection One caused by an opportunistic pathogen after the primary infection has weakened the bodys defenses Subclinical (Inapparent)Infection an infection that does not cause any detectable manifestations

Recurrent Infection - REAPPEARANCE OF SYMPTOMS after an infectious disease has been treated or subsided and renewed presence of the same infectious agent Reinfection - after an initial infectious agent has been eliminated, a NEW infection occurs caused by the same organism or by another strain of same species Superinfection - during the illness, additional infection occurs by another infectious agent Autoinfection the infected person is his own direct source of the reexposure

PATTERN OF INFECTION (Course of Infectious Process)

Incubation Period Extends from the entry of microorganism into the body to the onset of signs and symptoms Is the phase wherein pathogen begins active replication without producing recognizable symptoms in the host Prodromal Period Extends from the onset of nonspecific signs and symptoms to the appearance of specific signs and symptoms The hallmark of this stage is the appearance of symptoms in the host Period of Illness/ Period of Invasion/ Acute Stage is the period wherein the host experiences the maximum impact of the infectious process Convalescent Period/ Period of Decline stage during which the manifestations subside

CHAIN OF INFECTION
1. CAUSATIVE AGENT/ ETIOLOGIC AGENT Invading microorganisms capable of producing a disease These may be bacteria, virus, fungi, parasites, or protozoa 2. RESERVOIR Refers to the environment and objects on which an organism survives and multiplies. The following are the reservoir of infection: Humans Animals Inanimate objects (Nonliving things)

3. PORTAL OF EXIT Is the path or way in which the organism leaves the reservoir Usually, this portal is the site where the organism grows The common portals of exit are: Respiratory System Genitourinary Tract (GUT) Gastrointestinal Tract (GIT) Skin and mucous membrane

4. MODE OF TRANSMISSION Is the means by which the infectious agent passes through from the portal of exit of the reservoir to the susceptible host This is the easiest link to break the chain of infection

There are four modes by which infectious agents can be transmitted:

1. Contact Transmission- is the most common mode of transmission a. Direct contact- refers to person to person transfer of organism. Example is Droplet Infection. Droplet Spread- transmission through contact with respiratory secretions when the infected person coughs, sneezes or talks. Microbes carried in droplets can travel up to 3 feet or 1 meter. The organism is not suspended in the air but settles on a surface b. Indirect Contact Occurs when the susceptible person comes in contact with a contaminated object.

2. Airborne Transmission Occurs when fine microbial particles or dust particles containing microbes remain suspended in the air for a prolonged period. The infectious disease is spread by air current and is inhaled by a susceptible host.

3. Vehicle Transmission Is the transmission of infectious disease through articles or substances that harbor the organism until it is ingested or inoculated into the host Refers to the spread of the etiologic agent of disease by conveyers such as milk, food, water, air, contaminated hands. Fomites: refers to inanimate objects that can spread the infection (handkerchiefs, linens, glass, etc.)

4. Vector-borne transmission Occurs when intermediate carries, such as fleas, flies, and mosquitoes transfer the microbes to another living organism Types of Vectors: o Mechanical- transfers the disease merely by holding the pathogens on their feet or other parts of the body. Ex: housefly, cockroaches o Biologic- transfer of the disease when the vector bites a person or animal and ingests some of the infected blood. Ex. mosquitoes

5. PORTAL OF ENTRY
Is the venue where the organism gains entrance into the susceptible host. Usually, this path is THE SAME as the portal of exit

6. SUSCEPTIBLE HOST
Final and most important link in the chain of infection A person who is at risk for infection whose own body defense mechanism, when exposed are unable to withstand the invasion of pathogens. The human body has many defenses against the entry and multiplication of organism. When the defenses are good, no infection will take place. However, in a weakened host, microbes will launch an infectious disease.

Risk Factors:
1. Intrinsic Risk Factors- specific to patient (host) o Age o Gender o Ethnic Background o Socioeconomic status o Lifestyle and marital status o Occupation o Overall immune status 2. Extrinsic Risk Factors- external factors in the delivery of care o Devices and procedures o Provider o Environment

EPIDEMIOLOGY
is the study of occurrences and distribution of diseases as well as the distribution and determinants of health states or events in specified population, and the application of this study to the control of health problems.

USES OF EPIDEMIOLOGY
Study the history of the health population and the rise and fall of diseases and changes in their character. Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, prevalence, disability and mortality, to set health problems in perspective and to define their relative importance and to identify groups needing special attention. Study the work of health services with a view of improving them. Estimate the risk of disease, accident, defects, and the chances of avoiding them.

 Identify syndromes by describing the distribution and association of clinical phenomena in the population. Complete the clinical picture of chronic disease and describe their natural history. Search for causes and diseases by comparing the experience of groups that are clearly defined by their composition, inheritance, experience, behavior and environments.

PATTERNS OF DISEASE OCCURRENCE

Sporadic Disease Intermittent occurrence of a few isolated and unrelated cases in a given locality Disease that occurs occasionally and irregularly with no specific pattern Ex. Tetanus, Rabies Endemic Disease Continuous occurrence throughout a period of time, of the usual number of cases in a given locality Constantly present in a population, community or country. They usually involve few people during specific periods Ex. TB, Schistosomiasis (Leyte and Samar), Filariasis (Sorsogon), Malaria (Palawan)

Epidemic disease Occurrence is of unusually large number of cases in a relatively short period of time Example: Mumps Pandemic Disease Epidemic disease that occurs worldwide Simultaneous occurrence of epidemic of the same disease in several countries Ex. AIDS, SARS

ISOLATION PRECAUTIONS
Isolation The separation of patient with communicable disease from others so as to prevent or reduce transmission of infectious agent directly of indirectly Purpose: To confine the infectious agent to a circumscribed areas and to prevent its escape from that area

UNIVERSAL PRECAUTIONS
Introduced in response to the risk of transmission of blood-borne pathogens (Hepatitis B, HIV) to health care workers Blood and body fluid precautions Apply to HIV and Hepatitis B and C Intended to prevent parenteral, mucous membrane and non-intact skin exposure of health care workers to blood-borne pathogens Apply to blood, semen, vaginal secretions, and other body fluids (CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid amniotic fluid), and tissues containing blood.

 These precautions are used in the care of all hospitalized persons regardless of their diagnosis or possible infection status. Primary strategy for reducing risk and controlling nosocomial infection They apply to: Blood All body fluids, secretions, and excretions except sweat (whether or not blood is present or visible) Non-intact skin Mucous membranes Designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources

Tier 1: Standard Precautions

The following are Standard Precautions

1. Handwashing. Wash hands immediately after contact with blood, body fluids, secretions, excretions, and contaminated objects whether or not gloves are worn. 2. Gloves. Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items (e.g. soiled gowns) 3. Mask, eye protection (goggles), face shield. Worn during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.

 4. Gown. Worn also during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. The gown is intended to protect clothing. 5. Client Care equipment. Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to prevent the transfer of microorganisms to others and to the environment. 6. Linens. Handle linens in manner that prevents skin and mucous membranes exposure 7. Sharps. Do not recap needles, do not break, bend, and manipulate used needles. Place them in puncture-resistant containers.

Tier 2: TRANSMISSION-BASED PRECAUTIONS

These precautions are used in addition to Standard Precautions instituted who are known to be suspected of being infected with highly transmissible infection

AIRBORNE PRECAUTIONS
Are used for clients known to have or suspected of having serious illness transmitted by airborne droplet nuclei smaller than 5 microns. Small particles (5 micrometer or smaller) can remain suspended in air and can be dispersed widely by air currents within a room or over a long distance Examples of such illnesses that require Airborne Precautions: o Active pulmonary or laryngeal TB not adequately treated o Chicken pox (varicella) o Measles (Rubeola) o Small pox o SARS

DROPLET PRECAUTIONS
Are used for clients known or suspected to have serious illnesses transmitted by particle droplet larger than 5 microns. Large droplets do not remain suspended in the air and do not travel greater than 3 feet from the patient. Examples of such illnesses that require droplet precautions: o Diptheria o Pneumonia o Pertussis o Mumps o German measles o Meningitis o Influenza

CONTACT PRECAUTIONS
Are used for clients known or suspected to have serious illnesses easily transmitted by direct client contact or contact with items in the clients environment. Diseases that require Contact Precautions: o Enteric infections with low infectious dose or prolonged environmental survival (Clostridium difficile) o Enterohemorrhagic E. coli, Shigellosis, Hepatitis A, Rotavirus for patients wearing diapers ot those who are incontinent o Respiratory syncytial virus, enteroviral infections in infants and children o Skin infections that are highly contagious that may occur on dry skin including: Herpes simplex virus Impetigo Pediculosis Scabies