THE INFECTIOUS PROCESS

THE CHAIN OF INFECTION

Prepared by: Jobel A.

Nuval, RN, MAN
 Six Elements of Infection

 (1) a causative organism

 (2) a reservoir of available organisms,

 (3) a portal or mode of exit from the

reservoir,
 (4) a mode of transmission from reservoir

to host,
 (5) mode of entry to the host
 (6) a susceptible host
 Causative Organism

 The types of microorganisms that cause

infections are bacteria, rickettsia,
viruses, protozoa, fungi, and helminths.
 Present in sufficient number and
virulence to damage tissue.
 Reservoir
 Reservoir is the term used for any
person, plant, animal, substance, or
location that provides nourishment for
microorganisms and enables further
dispersal of the organism.
 is the habitat in which the agent

normally lives, grows, and multiplies.

 When a reservoir of microorganisms

occurs in the tissues of a human, the

human is called a host.
 Mode of Exit
 Refers to the route by which the
infectious agent leaves one host and
travels to another.
 Organisms exit through the:

respiratory tract,
gastrointestinal tract,
genitourinary tract,
blood.
 In humans, the main portals of exit
include:

 Alimentary: vomiting, diarrhea, saliva

 Genitourinary: sexual contact
 Respiratory: secretions from coughing,

sneezing, or talking
 Skin: open wounds
 Route of Transmission
 Refers to the means by which a microorganism is
transported to a host.
 Organisms may be transmitted through sexual

contact, skin-to-skin contact, percutaneous

injection, or infectious particles carried in the
air.
 A person who carries or transmits an organism

but does not have apparent signs and symptoms

of infection is called a carrier.
 Portal of Entry
Are the ways in which the
infectious agent enters a host.
Ex: open wounds, IV Access

Devices, urinary catheters, and

drains- can be portal of entry
for bacteria.
 Susceptible Host
 For infection to occur, the host must be
susceptible (not possessing immunity to
a particular pathogen).
 Previous infection or vaccine
administration may render the host
immune (not susceptible) to further
infection with an agent.
 Eliminated, inactivated or cannot
survive in the reservoir (rapid
Reducing the susceptibility identification & management,
of patients receiving care cleaning & disinfecting of the
(treatment of underlying environment)
diseases, recognizing high
risk patients

Protected (aseptic Managed through

non-touch technique, good infection
safe catheter care, prevention & control
wound care practices (HW, PPE,
Good infection & control
safe packaging &
practices (HW, isolation,
disposal of waste
airflow control
 Signs & Symptoms
Localized Infection Generalized Infection
 Redness  Pain-mild to severe
 Pain  Warmth-fever
 Warmth  Malaise
 Swelling  Anorexia
 pus  Prostration-extreme
weakness/emotional
exhaustion
COLONIZATION, INFECTION,
AND DISEASE
Colonization
 Colonization is when microorganisms, including those
that are pathogenic, are present at a body site (E.g. on
the skin, mouth, intestines or airway) but are doing no
harm and are not causing symptoms of infection. The
person colonized is also called ‘a carrier’. For
example, the skin is normally colonized by coagulase
negative Staphylococci and can also be colonized by
pathogenic Staphylococcus aureus. Colonization occurs
in some 30% of the population and whilst the
microorganisms cause no harm if they remain on the skin,
if transferred to another site e.g. a wound, or another
person it can cause an infection.
Infection
 Infection is the process where an
infectious agent (microorganism) invades
and multiplies in the body tissues of the
host resulting in the person developing
clinical signs and symptoms of infection
(E.g. Increased temperature, rigors,
rash).
Disease
 When the condition of the body gets

altered from normal and functional state

of the organisms to the abnormal and
dysfunctional state, associated with
certain different kinds of signs and
symptoms is called as disease.
INFECTION CONTROL AND
PREVENTION
ORGANIZATIONS INVOLVED IN
INFECTION PREVENTION
 The World Health Organization (WHO) and
the Centers for Disease Control and
Prevention (CDC) and the Occupational
Safety and Health Administration (OSHA) are
the principal agencies involved in setting
guidelines about infection prevention.
 Types of Infection
 A. Community Acquired Infection
• Acquired in day to day contact with the public
• Childhood illnesses, tuberculosis, HIV/AIDS, food-borne
illnesses, sexually-transmitted infection
• Prevention and Control
Immunizations
Educating food handlers
Screening & early treatment
Isolation of infected person
Control vectors
Personal measures (condom use, proper hygiene, handwashing)
Preventing Infection in the
Hospital (Health Care-
Associated Infections)

B. Nosocomial Infections
 Occur within a healthcare facility;
may affect patient and healthcare
worker
Medical Asepsis
 Limitthe spread of microorganisms
 Often called clean technique

Change bedlinen, sanitize the bedpans,

frequent handwashing
 Handwashing

Soiled hands is the main transmission of

nosocomial infection
 Surgical Asepsis or Sterile
Technique
 Includecare techniques that prevent
unsterile surfaces from coming into
contact with the patient such as during
dressing changes
Standard Precautions
a uniform level of caution should be used
in the care of all patients with or w/o s/s.
 Use when you have contact with a

patient’s blood, bodily fluids, secretions

(except sweat), excretions, broken skin,
and mucous membranes.
Elements of Standard Precautions
 hand hygiene
 use of PPE (masks, eye protection, glove

use and cover gowns)

 proper handling of patient care equipment

and linen, environmental control,

 prevention of injury from sharps devices,
 Needle stick prevention,
 Avoidance of splash or spray of body

fluids
Isolation Precautions
 The Hospital Infection Control Practices
Advisory Committee (HICPAC) of the CDC
recommends two tiers of isolation
precautions.
1. Standard Precautions – all patients –
HAI
2. Transmission-Based Precautions – only
patients with infectious disease.
Isolation Precautions
 Airborne Precaution
• Used with diseases that are spread through the air
 Droplet Precaution
• Used with infections that are spread by droplets or
dust particles containing the infectious agent
 Contact Precaution
• Used when caring for patients who are infected by
microorganisms that are transmitted by direct (skin-
to-skin) or indirect contact with contaminated
equipment
Glove Use
 Gloves provide an effective barrier for hands
from the microflora associated with patient
care.
 Gloves should be worn when a health care

worker has contact with any patient

secretions or excretions and must be
discarded after each patient care contact.
 Hands must be washed or disinfected after

gloves are removed.

 Needlestick Prevention
 The most important aspect of reducing the risk
of blood-borne infection is avoidance of
percutaneous injury.
 Extreme care is essential in all situations in

which needles, scalpels, and other sharp objects

are handled.
 Used needles should not be recapped. Instead,

they are placed directly into puncture-resistant

containers near the place where they are used.
Avoidance of Splash and Spray
Goggles, face shield and a
face mask
Prevent contamination of mouth, nose, & eyes
when risk exists of facial exposure to infectious
materials
Protect the patient during sterile procedure from
infectious materials carried in the HCW’s mouth
or nose
Cover/Isolation Gown

 Protects HCW’s exposed skin and

clothing from contamination by infected
materials.
 Donned before other PPE
 Should be discarded in the patient care

area to prevent contaminating the

environment.
 Transmission-Based Precautions
 Theisolation categories are Airborne,
Droplet, and Contact Precautions
 Airborne Precautions
 airborne pathogen [PTB, Varicella, SARS, Rubeola
(Measles)]
 patients should be in airborne infection isolation rooms
(AIIR), where the ventilation system provides a (-)
pressure & exhausts directly to the outside or through
high-efficiency particulate absorption (HEPA) filtration
 Health care providers should wear an N-95 respirator (ie,
protective mask) at all times while in the patient’s room.
 Patient must wear surgical masks when leaving their
rooms
 Surgical Mask= filter expired air
 Respirators= filter inspired air
 Droplet Precautions
 are used for organisms that can be transmitted by close
respiratory or mucous membrane contact with respiratory
secretions. [ Rubella, mumps, diphtheria, influenza]
Examples of illnesses caused by droplet transmission are:
 Strep Throat
 Influenza
 The common cold
 COVID-19
 The nurse & visitors should wear a face mask when within
3 feet of the patient.
 Patients should be placed in a private room.
 but because the risk of transmission is limited to close
contact, the door may remain open.
 Contact Precautions

 are used for organisms that are spread by skin-to-

skin contact, such as antibiotic-resistant organisms
or Clostridium difficile or indirect contact with
contaminated equipment.
 Is placed in a private room to facilitate hand hygiene
and decreased environmental contamination.
 Masks are not needed, and doors do not need to be
closed
 Ex.: fecal incontinence, infections of the GI Tract and
skin [impetigo or scabies] or wound infections w/
significant drainage (resistant to multiple antibiotics)
Preventing Infection in the
Community
 Methods of infection prevention include:
 sanitation techniques (e.g., water
purification, disposal of sewage and other
potentially infectious materials)
 regulated health practices (eg, the
handling, storage, packaging, and
preparation of food by institutions), and
immunization programs.
Vaccination Programs
 The most successful vaccine programs
have been ones for the prevention of
smallpox, measles, mumps, rubella,
polio, diphtheria, pertussis, and tetanus.
 Common Vaccines
 Hepatitis B vaccine (HepB).
 Diphtheria, tetanus, and acellular pertussis (DTap) vaccine
 Haemophilus influenzae type b (Hib) conjugate vaccine.
 Measles, Mumps, and Rubella Vaccine (MMR)
 Varicella (Chickenpox) and Zoster (Shingles) Vaccine
 Pneumococcal vaccine
 Hepatitis A vaccine
 Influenza Vaccine
 Polio Vaccine
 5-in-1 Vaccine
(Pentavalent Vaccine)

 For diphtheria (barking cough), tetanus

(lockjaw) , whooping cough
(pertussis), polio(irreversible paralysis)
and Hib disease (Haemophilus
influenzae type b)- bacterial meningitis
in children
 Nursing Care of Patient with
Infection:
 Urge patient to consume adequate fluids
 Encourage to consume high-protein, high

vitamin diet
 Isolation, if required

 Laboratory Tests

CBC, erythrocyte sedimentation rate, iron

levels, Cultures
 Administer antibiotic therapy

 Oxygen therapy
 NURSING PRACTICE:1/4 sheet of
paper( RECORDED)

1. If an infectious disease is
transmitted directly from one person
to another, it is known as:
A) A susceptible host
B) A communicable disease
C) A portal of entry to a host
D) A portal of exit from the reservoir
2. The most effective way to break the
chain of infection is by:
 A) Practicing good hand hygiene
 B) Wearing gloves
 C) Placing clients in isolation
 D) Providing private rooms for clients
 3. There are 6 links in the Chain of
Infection. These include each of the
following except:
 A. Susceptible host
 B. Portal of entry
 C. Mode of transmission
 D. Personal protective device
4. Area where the causative agent can live
is called what?
A. Mode of transmission
B. Reservoir
C. Portal of exit
D. Portal of entry
 5. There are 3 recently added elements to
Standard Precautions that focus on
protection of patients. These are: 1)
Respiratory Hygiene/Cough Etiquette, 2)
Safe Injection Practices, and 3) Use of
Masks for Insertion of Catheters.
Respiratory Hygiene/Cough Etiquette
includes all of the following except:
 A. Education of healthcare facility staff,
patients, and visitors
 B. Posted signs, in language(s) appropriate

to the population served, with instructions to

patients and accompanying family members
or friends
 C. Covering the mouth/nose with a tissue

when coughing and prompt disposal of used

tissues, using surgical masks on the
coughing person when tolerated an
appropriate
 D. Spatial separation, ideally >3 feet, of
persons with respiratory infections in
common waiting areas
 E. Healthcare workers wear a gown and

gloves for all interactions that may

involve contact with the patient
6-8
 GIVE3 Examples of Portal of Entry in
which the infectious agent enters a host.
9-10: DISEASE CONDITIONS THAT
REQUIRES AIRBORNE PRECAUTION
  11.-13:
DROPLET
PRECAUTIONS(DISEASE CONDITION)

 14-15. CONTACT PRECAUTIONS(DISEASE

CONDITION)