COMMUNICABLE DISEASES GENERAL PRINCIPLES

- It is an illness caused by an infectious agent or its toxic
products that are transmitted directly or indirectly to a
well person through an agent, vector or inanimate object
TWO TYPES:
1. INFECTIOUS DISEASE
- Not easily transmitted by ordinary contact but
require a direct inoculation through a break in the
previously intact skin or mucous membrane
2. CONTAGIOUS DISEASE
- Easily transmitted from one person to another
through direct or indirect means
TERMINOLOGIES
1. DISINFECTION
- destruction of pathogenic microorganism outside
the body by directly applying physical or chemical
means
i. CONCURRENT
- method of disinfection done
immediately after the infected individual
discharges infectious
material/secretions. This method of
disinfection is when the patient is still
the source of infection
ii. TERMINAL
- applied when the patient is no longer
the source of infection.
2. DISINFECTANT
a. Pathogens move through spaces or air current
b. Pathogens are transferred from one surface to another
whenever objects touch
c. Hand washing removes microorganism
d. Pathogens are released into the air on droplet nuclei
when person speaks, breaths, sneezes
e. Pathogens are transferred by virtue of gravity
f. Pathogens move slowly on dry surface but very quickly
through moisture
INFECTION
- invasion and multiplication of microorganisms on the
tissues of the host resulting to signs and symptoms as
well as immunologic response
- injures the patient either by:
> competing with the host’s metabolism
> cellular damage produced by the microbes’
intracellular multiplication
FACTORS OF SEVERITY OF INFECTION
a. Disease producing ability
b. The number of invading micro-organism
c. The strength of the host’s defense and some other
factors
EPIDEMIOLOGICAL TRIAD
Host

- chemical used on non-living objects

3. ANTISEPTIC
- chemical used on living things.
4. BACTERICIDAL
- kills microorganism
5. STERILIZATION
Agent Environment
- complete destruction of all microorganism
SPECIFICATION ACCORDING TO INCIDENCE > Immune Response -
Natural/Acquired:Active/Passive
1. SPORADIC
- disease that occur occasionally and irregularly with
no specific pattern. RISK FACTORS
2. ENDEMIC
a. Age, sex, and genes
- those that are present in a population or community
b. Nutritional status, fitness, environmental factors
at times.
c. General condition, emotional and mental state
3. EPIDEMIC
d. Immune system
- diseases that occur in a greater number than what
e. Underlying disease (diabetes mellitus, leukemia,
is expected in a specific area over a specific time.
transplant)
4. PANDEMIC
f. Treatment with certain antimicrobials (prone to fungal
- is an epidemic that affects several countries or
infection), steroids, immunosuppressive drugs etc.
continents

CHAIN OF INFECTION
CAUSES OF INFECTION

a. Some bacteria develop resistance to antibiotics

Causative Agent
b. Some microbes have so many strains that a single
vaccine can’t protect against all of them. (ex. Influenza)
c. Most viruses resist antiviral drugs Susceptible Host Reservoir
d. Opportunistic organisms can cause infection in
immunocompromised patients
e. Most people have not received vaccinations
f. Increased air travel can cause the spread of virulent
microorganism to heavily populated area in hours Portal of Entry Point of Exit
g. Use of immunosuppressive drugs and invasive
procedures increase the risk of infection Mode of
h. Problems with the body’s lines of defense Transmission

THREE LINES OF DEFENSE

MODE OF TRANSMISSION
a. FIRST LINE OF DEFENSE
> Mechanical Barriers a. Contact Transmission
> Chemical Barriers > Direct Contact
> Body’s Own Population of Microorganism - i. person to person
“Microbial Antagonism Principle” > Indirect Contact
b. SECOND LINE OF DEFENSE i. through contaminated object
> Inflammatory Response ii. droplet spread - contact with respiratory
> Phagocytic cells and WBC to destroy invading secretions thru cough, sneezing, talking.
microorganism manifesting the cardinal signs Microbes can travel up to 3 feet.
c. THIRD LINE OF DEFENSE b. Airborne Transmission
 c. Vector Borne Transmission
d. Vehicle Borne Transmission
EMERGING PROBLEMS IN INFECTIOUS DISEASES
a. Developing resistance to antibiotics (eg: anti tb drugs,
MRSA, VRE)
b. Increasing numbers of immunosuppressed patients.
c. Use of indwelling lines and implanted foreign bodies
has increased
INFECTION CONTROL
> UNIVERSAL PRECAUTION
- All blood, blood products and secretions from
patients are considered as infected.
WORK PRACTICE CONTROL
a. Handwashing
- Before and after using gloves, after hand contact
with patients, patient’s blood and other potentially
infected materials.
b. Protective Equipment shall be removed immediately
upon leaving the work area. Like apron, mask, gloves
etc.
- Place in designated area.
c. Used needles and sharps shall not be bent, broken,
recapped. Used needles must not be removed from
disposable syringes.
d. Eating, drinking, smoking, applying cosmetics or
handling contact lenses are prohibited in work areas.
e. Foods and drinks shall not be stored in refrigerators,
freezers where blood or other infectious materials are
stored.
f. All procedures involving blood or other potentially
infectious materials shall be performed in such a
manner as to minimize splashing, or spraying
CONTROL MEASURES
a. Masking – Wear mask if needed. Patient with infectious
respiratory diseases should wear mask.
b. Handwashing – Practice it with soap and water.
c. Gloving – Wear gloves for all direct contact with
patients. Change gloves and wash hands every after
each patient.
d. Gowning - Wear gown during procedures which are likely
to generate splashes of blood or sprays of blood and
body fluids, secretions or excretions.
e. Eye protection (goggles) – wear it to prevent splashes.
f. Environmental disinfection – Clean surfaces with
disinfectant 70% alcohol, diluted bleach)
> Ex. Normal Clean – clean the room post discharge,
final clean - MRSA and infectious pts.
ISOLATION PRECAUTIONS
- Separation of patients with communicable diseases
from others so as to reduce or prevent transmission of
infectious agents.
7 CATEGORIES RECOMMENDED IN ISOLATION
a. STRICT ISOLATION
- prevent spread of infection from patient to
patient/staff
i. handwashing
ii. infectious materials must be discarded
iii. use of single room
iv. use of mask, gloves and gowns, and
v. (-) pressure if possible
b. CONTACT ISOLATION
- prevent spread by close or direct contact
c. RESPIRATORY ISOLATION
- prevent transmission thru air.
d. TB ISOLATION
- for (+) TB or CXR suggesting active PTB.
e. ENTERIC ISOLATION
- direct contact with feces
f. DRAINAGE/SECRETION PRECAUTION
 - Prevents infection thru contact with materials or B. Artificial
drainage from infected person. - Passive (antitoxins)
g. UNIVERSAL PRECAUTION - Active (vaccine, toxoid)
- for handling blood and body fluids. (Bloods, Pleural
Fluid, Peritoneal Fluid etc.)
Maintain vaccine potency by preventing:

- Heat and sunlight

PREVENTION
- Freezing
HEALTH EDUCATION - Antiseptic/ disinfectants/ detergents lessen the
potency of vaccine. Use water only when cleaning
- educate the family about:
fridge/ref.
> Immunization
- COLD CHAIN SYSTEM – maintenance of correct
> MOT
temperature of vaccines, starting from the
> Environmental sanitation – breeding places of
manufacturer, to regional store, to district hospital, to
mosquito, disposal of feces
the health center to the immunizing staff and to the
> Importance of seeking medical advice for any
client
health problem
> Preventing contamination of food and water

DISEASES ACQUIRED THROUGH RESPIRATORY

ENVIRONMENTAL SANITATION

- Water Supply Sanitation Program – DOH thru EHS

TUBERCULOSIS
(Environmental Health Services)
- Policies on Food Sanitation Program
- Policies on Hospital Waste Management
The CHNurse is in the best position to do health education
such as:
- development of materials for environmental sanitation
- providing group counselling, holding community
assemblies and conferences.
- create programs for sanitation
- be a role model
IMMUNIZATION
- Chronic respiratory disease affecting the lungs
characterized by formation of tubercles in the tissues -->
caseation --> necrosis --> calcification.
- AKA: Phthisis, Consumption, Koch’s, Immigrant’s
disease
- Etiologic Agent: – Mycobacterium tuberculosis
- Incubation Period: 2 – 10 wks.
- Period of Communicability: all throughout the life if not
treated
- MOT: Droplet
- Sources of Infection – sputum, blood, nasal discharge,
saliva

- introduction of specific antibody to produce immunity to

CLASSIFICATION
certain disease
A. Natural 1. INACTIVE – asymptomatic, sputum is (-), no cavity on
- Passive (from placenta) chest X-Ray
- Active (thru immunization & recovery from 2. ACTIVE – (+) CXR, S/S are present, sputum (+) smear
diseases) classification 0-5
 a. MINIMAL – slight lesion confined to small part of
the lung Inhalation

b. MODERATELY ADVANCED – one or both lungs are

involved, volume affected should not extend to one Tubercle Lesions
lobe, cavity not more than 4 cm. (Gohn's Tubercle)

c. FAR ADVANCE – more extensive than B

Granuloma

MANIFESTATIONS
Caseation
> Primary Complex
- TB in children: noncontagious, children swallow
phlegm, fever, cough, anorexia, weight loss, easy Necrosis
fatigability
> Adult TB
- temperature rises in the afternoon Fibrosis
- night sweats
- weight loss
Scarring
- cough dry to productive
- Hemoptysis
- (+) sputum AFB Diagnostic Exams:

> Milliary TB - Tuberculin Testing

- very ill, with exogenous TB likePott’s disease - CXR
> Primary Infection - Sputum AFB
- Asymptomatic
Prevention:
- No manifestations even at CXR, Sputum
> Primary Complex - BCG
- Minimal manifestations - Avoid overcrowding
- Lymphadenopathy - Improve nutritional status

Tx:

- DOTS
- 6months of RIPE
- Respiratory isolation
- Take medicines religiously – prevent resistance
- Stop smoking
- Plenty of rest
- Nutritious and balanced meals

MENINGITIS

- Inflammation of the meninges usually some

combination of headache, fever, stiff neck, and delirium
- Meningococcemia: cerebrospinal fever
> Etiologic Agent: Neisseria Meningiditis
> Incubation period: 2 – 10 days
> MOT: droplet
- Acute Meningococcemia: with or without meningitis
> Waterhouse Friederichsen Syndrome

Direct Contact/Droplet

Colonization

Bacteremia

Meninges