HISTORICAL BACKGROUND AND TRENDS IN THE TREATMENT OF INFECTIOUS DISEASES

Prior to the 18th century, people commonly believed that infectious diseases were caused by supernatural forces. God punished evil individual with disease for being disobedient and sometimes a malicious God struck good people with illness Today some people continue to believe that supernatural being cause disease Since the discovery of antimicrobials and prevention techniques the morbidity and mortality rate from infectious disease has decreased especially in developed countries. In industrialized nations more people die from ailments such as heart disease and cancer.

EARLY THEORY OF COMMUNICABILITY

They dont believe in the communicability of a certain disease They dont believe in hospitalization
They dont isolate the patient and just wait for the time of his death.

COMMON TERMINOLOGIES RELATED TO INFECTION

is an illness caused by an infectious agent or its toxic products that are transmitted directly o indirectly to a well person through an agency and a vector or an inanimate object. - it is a term given to a disease that is easily transmitted from one person to another through direct or indirect means. ( e.g. colds and flu/measles, mumps and chicken pox )
- it is transmitted not only by ordinary contact but requires direct inoculation of the organism through a break on the skin or mucous membrane.

it is the implantation and successful replication of an organism in the tissue of the host resulting to signs and symptoms as well as immunologic response. It is a condition in which the body or part of the body is invaded by an infectious agent which grows, multiplies and causes illness it is an infection acquired after admission to a health care facility. Hospital acquired infection. - it is an individual who harbors the organism and is capable of transmitting it to a susceptible host without showing manifestations of the disease.

is any person or animal who so close association with an infected person, animal or freshly soiled materials.
it is the separation from other persons of an individual suffering from a communicable disease

 it is a process by which all microorganisms including spores are destroyed. is the destruction of pathogenic microorganism outside the body by directly applying physical or chemical means: is a method of disinfection done immediately after the infected individual discharges infectious materials/secretions. is applied when the patient is no longer the source of infection.

it is the absence of disease producing microorganism. Being free of infection.

it is a practice designed to reduce the number and transform of pathogens from on person or place to another person or place. a Clean technique.

 it is a practice that render and keep objects and areas free from microorganism. Sterile technique. it is a substance usually intended for use on persons that inhibits the growth of pathogens but does not necessarily destroy them. it is a substance usually intended for use in animate objects that destroys pathogen but generally not spores. it is any microorganism too small to be visible to the naked eye. ( e.g. bacteria, viruses, fungi, chlamydiae ) it is composed of one or more species of animal or plant in which an infectious agent lives and multiplies for survival and reproduces itself in such a manner that it can be transmitted to man. - a place where an organism lives or where an organism is usually found a person, animal or plant on which a parasites depends for its survival

INFECTION CONTROL
WHAT IS INFECTION ? is defined as the invasion and multiplication of microorganisms on the tissues of the host resulting to signs and symptoms as well as immunologic response.

WHY INFECTION OCCURS:

There are many reasons that cause infectious disease are so difficult to overcome : Some bacteria develop resistance to antibiotics Some microbes such as influenza have so many different strains that a single vaccine cannot protect against all of them. Most viruses resist antiviral dugs New infectious agents occasionally arise such HIV Some microbes localize in areas of the body that make treatment difficult ( e.g. bones, CNS ) Most people have not received immunization.

MEASURES TO PREVENT SPREAD OF INFECTION TO OTHERS

1. Wash hands immediately after contact with each patient and after every contact with materials that may be contaminated a potentially infectious a) Wash hands even if sterile gloves are use b) Wear gloves for direct exposure to blood drainage or secretions. 2. Plan what you are going to do before the initial patient contact 3. Carry out isolation precautions is required to prevent spread of microorganisms among patient, personnel and visitors.

4.
5.

Observed asepsis as indicated

Use high-efficiency disposable mask, nose and mouth when indicated
Use mask only once and discard appropriate receptacle Refrain from handling mask while in use.

6.

Use gown hen required to prevent soiling of clothing.

Use gown once and discard appropriate receptacle Use sterile gown in certain instances extensive burns, wounds Collect linen in water soluble bag, double bag and mark isolation

7.

Use gloves when indicated by the patients condition

Disposable, single-use gloves should be worn Use once and discard in appropriate receptacle

8.

Handle needles and syringes with extreme care because it is not usually known which patients blood is contaminated with hepatitis virus or other microorganisms.
Place used needles in a labeled puncture-resistance container, do not bend or break by hand Blood spills should be cleaned up properly with a solution of 9.25 % sodium hydrochloride solution diluted 1:10 with water

9.

Disinfect and handle wastes with all precautions

10. Handle bed linens and fomites with care. 11. Carry out current disinfection of fomites

12. Control dissemination of infectious droplets..

Encourage the patient to cover nose and mouth when coughing and sneezing Wrap contaminated tissues and articles in paper before disposal

13.

Control dust
Avoid breathing aerosols (e.g. shaking bed linens ) Require dump dusting of furniture and vacuum cleaning of floors Maintain cleanliness of surroundings, wash soil from walls as it appears Reduce to a minimum activity of personnel in the patients room

14. Ventilate the patients room properly with system that directs from room air to the outside. Keep the door closed.

ESSENTIAL CONCEPTS OF INFECTIOUS DISORDERS

PATHOGENS OF INFECTIOUS AGENTS Definition : Invasion of the body by pathogenic microorganisms (pathogens ) and the reaction of the tissues to their presence and to the toxins generated by them.

TYPES OF INFECTION
one in which the etiologic agent is limited to one locality of the body, such as a boil, often a local infection may have systemic repercussions such as fever and malaise. local infection in which the organisms themselves spread throughout the body ( e.g. tooth abscess ) the infectious agent is spread throughout the body (e.g. typhoid fever ) ACUTE and severe sickness one that develops slowly with mild but longer-lasting symptoms and sometimes acute infection may become chronic.

 initial infection, unrelated to other health problems

SECONDARY of the weakened defenses resulting from the primary infection ( e.g. staphylococcai pneumonias a sequel of measles. ) the presence of bacteria in the circulating blood

it is a systemic infection in which pathogenic organism or their poisonous products are present within the blood stream.
it is the presence of poisonous substances in the blood stream usually released by an organism.

CHAIN OF INFECTION
Causative Agent Susceptible Host Reservoir

Portal of Entry Mode of Transmission

Portal of Exit

Causative Agent

is any microbe capable of producing a disease.

1.
2. 3. 4.

produce rapidly and they are considered as the most common cause of fatal infection.
SE - is a bacterium with flexible, slender, undulating spiral rods that possess cell wall. ( e.g. leptospira ) are the smallest known microbes. RIA small, gram negative (-) bacteria and can induce life-threatening infections. Usually transmitted though a bite of arthropod carriers .( e.g. lice, fleas, ticks and through waste products ) FU are found almost everywhere and live in organic matter, soil, water, animals and plants PAS live on or within other organism. They dont usually kill their host but take only the nutrients they need.

5. 6.

Reservoir

refers to the environment and objects on which organism survives and multiplies.

The following are reservoir of infection:

Human reservoir Animals Nonliving things

Portal of Exit

is the path or way in which in the organism

leaves the reservoir. The common portals of exit are the :

Respiratory system Genitourinary tract (GUT) Gastrointestinal tract (GIT) Skin and mucous membrane Placenta ( in transplacental transmission)

Mode of Transmission

is the means by which the infectious gent 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:

Contact transmission is the most common mode of transmission. It can be in the following modes:
Direct Contact refers to a person to person transfer of organism Indirect Contact occurs when the susceptible person comes in contact with a contaminated object Droplet spread is a transmission through contact with respiratory secretions when infected person coughs, sneezes or talks. Microbes carried in droplets can travel up to three feet or one meter. The organism is not suspended in the air but settles on a surface.

 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.
is the transmission of infectious disease through articles or substances that harbor the organism until it is ingested or inoculated into the host. occurs when intermediate carriers, such as fleas, flies ad mosquitoes transfer the microbes to another living organism.

Portal of Entry

is the venue where the organism gains entrance into the susceptible host. The infective microbes use the same avenues when they exit from reservoir

Susceptible Host

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 weakened host, microbes will launch an infectious disease.

ILLNESS FOLLOWING AN ENTRANCE OF ORGANISM INTO THE BODY DEPENDS ON THE HOSTS

Age, sex, genes and constitution Nutritional status, fitness, environmental factors General condition, physical, emotional and mental state Absence of or abnormal immunoglobulin Underlying disease (diabetes mellitus, lymphoma, leukemia, neoplasm or uremia) Treatment with certain antimicrobials, corticosteroids, radiation or immunosuppressive drugs

EMERGING PROBLEMS IN INFECTIOUS DISEASES

1. There are increasing numbers of different organisms that are developing resistance to increasing numbers of available antimicrobials Increasing numbers of persons in the state of immunosuppression. These are the persons who could formally have died of cancer, leukemia and the like who are now surviving but are susceptible to invasion by any type of organisms including the nonpathogenic ones Persons with serious diseases who survive longer and are expected to undergo more extensive surgical procedures are prone to infectious diseases. The use of indwelling lines and implanted foreign bodies has increased. Persons rendering care to patients who have these are more susceptible to infection. 2.

3.

4.

INFECTION CONTROL MEASURES

GENERAL Universal precaution shall be observed to prevent contact with blood and other potentially infectious materials. UNIVERSAL PRECAUTION means that all patients shall be assumed infected with HIV/AIDS and other blood-borne pathogens.

B.ENGINEERING AND WORK PRACTICE CONTROL 1. Employees shall wash their hands as soon as possible after the removal of gloves or other personal protective equipment and after hand contact with blood or other potentially infectious materials. 2. 3. 4. 5. All personal protective equipment shall be removed immediately upon leaving the work area or as soon as possible if the work is overtly contaminated. Used needles and other sharps shall not be sheared, bent, broken, recapped or re-sheathed by hand. Eating, drinking, smoking applying cosmetics or lip balm or handling contact lenses are prohibited in work areas. Food and drinks shall not be stored in refrigerators, freezers or cabinets where blood or other potentially infectious materials are stored.

Suggested control measures for primary care clinics in the community setting emphasize the use Of barrier apparel, personal hygiene and environmental cleaning in addition to universal precautions.

1. MASKING
All staff should wear mask Patients with respiratory problems should be asked to wear mask

1. HANDWASHING
Practice hand washing with the use of soap and water Wash hands before and after patient contact and after removing the gloves

2. GLOVING
Wear gloves for all direct contact with patients Change gloves and wash hands every after each patient

3. GOWNING
Wear gown during procedures which are likely to generate splashes or sprays of blood and body fluids, secretions or excretions.

6. EYE PROTECTION (goggles)

Wear goggles for aerosol/splashes generating procedures Avoid aerosols

7. Environmental disinfection
Clean surfaces with disinfectant (diluted household bleach, 70 percent alcohol)

Aspects of Care of Patients with Communicable Disease

I. Prevent Aspect
A. Health Education Educate the family and the client with respect to: 1. Availability and importance of prophylactic immunization 2. Manner in which infectious illness is spread and methods of avoiding the spread. 3. Importance of seeking medical advice for any sign of health problem; 4. Importance of environmental cleanliness and personal hygiene; and 5. Means of preventing contamination of food and water supply.

B. Immunization is the introduction of specific protective antibodies in a susceptible person or animal, or the production of cellular immunity in such person or animal. Immunity is a condition of being secure against any particular disease.

Types of Immunity
1. Natural a. Passive acquired through placental transfer b. Active acquired through immunization and/or recovery from a certain disease. 2. Artificial a. Passive acquired through the administration of antitoxin, antiserum, convalescent serum, and gamma globulins b. Active acquired through the administration of vaccine and toxoid. 3. Sub clinical an immunity acquired through constant exposure to a particular disease or organism.

Types of Antigen
1. Inactivated (Killed organism)
a. Not long lasting b. Multiple doses needed c. Booster dose needed

2. Attenuated (Live organism)

a. Single dose needed b. Long lasting immunity

All vaccines lose their potency after a certain time. Expiry date should be noted on the label or printed on the vaccine.

What Damages Vaccines?

1. Heat an sunlight damage vaccines, especialy the live vaccines 2. Freezing damages the killed vaccines and toxoids 3. Use water only in cleaning the refrigerator /freezer. Antiseptics, disinfectants and detergents or alcohol may lessen the potency of vaccines. The safest thing to do is to keep all vaccines at the correct cold temperature (0 8C).

The Cold Chain System

Maintenance of correct temperature for vaccines starts from the manufacturer, to the airport, to the Central Vaccine Store, to the Regional Store, to the District Hospital, to te Health Centers or Outreach Service, to the Dispensary, to the Immunizing Staff, and to the Cient.

Environmental Sanitation
Environmental sanitation is still a health problem in the country today. Diarrheal disease still ranks second among the leading causes of morbidity of the population. Other sanitation related diseases are intestinal parasitism, infectious hepatitis, and dengue/hemorrhagic fever which can be controlled or eradicated by health programs with environmental health situation. The Department of Health, through the Environmental Health Services (EHS), has the authority to act in all issues and concerns in environmental health including the Code of Sanitation of the Philippines (PD 856, 1978) (DOH 2000 pp 314 321).

1. Water Supply Sanitation Program. The DOH through the EHS sets some policies in the following areas:
a. Approved types of water facilities such as:

Level I (Point of Source) a protected well or a developed spring with an outlet but without a distribution system generally adoptable to rural areas. Level II (Communal Faucet System or Stand Posts) composed of a source reservoir, a piped distribution network, and communal faucets. Level III waterworks system or individual house connection.

b. Unapproved type of water facility or water coming from doubtful source such as open dug well, unimproved spring, and wells that need priming are not allowed for drinking unless treated through proper container disinfection. c. Access to safe and potable drinking water all households should be provided with safe and adequate water supply.

d. Water quality and monitoring

Examination of drinking water shall be performed only in private and government laboratories duly accredited by the DOH. Certification of potability of an existing water source is done by the Secretary of Health or his duly authorized representative. The following water supply sources need to be disinfected: Newly constructed water supply facilities Water supply facility that has been repaired or improved Water supply sources found to be bacteriological positive through laboratory analysis.

e. Waterworks / water system and well construction

Well site shall require approval of the Secretary of Health of his duly authorized representative. Well construction shall comply with the sanitary requirements of the DOH. Water supply system shall supply safe and potable water in adequate quantity Water shall be made readily available to consumers / users.

2. Policies on proper excreta and sewage disposal a. Approved types of toilet facilities
Level I Non-water carriage toilet facility (pit latrines, reed odorless earth closet) toilet facility requiring small amount of water to wash the waste into receiving space (pour flush, aqua privies) Level II Water sealed and flush type with septic vault / tank disposal facilities Level III Water carriage toilet connected to septic tanks or to sewerage system to treatment plant b. In rural areas blind drainage type of waste water collection and disposal facility.

3. Policies on Food Sanitation Program a. Food establishments shall be appraised as t the following sanitary conditions:

Inspection / approval of all food sources, containers, transport vehicles Compliance to sanitary permit requirements for all food establishments Provision of updated health certificates for food handlers, cook, and cook helpers Destruction / banning of food unfit for human consumption Training food handlers and operators on food sanitation

b. Ambulant food vendors shall also comply with the requirements as to the issuance of health certificate. c. Household food sanitation is to be promoted and monitored and food hygiene sanitation needs to be intensified.

4. Policies on Hospital Waste Management a. All newly constructed/renovated government and private hospitals shall prepare and implement a Hospital Waste Management (HWM) Program as requirement for registration / renewal of licenses. b. The use of appropriate technology and indigenous materials for HWM shall be adopted. c. Training of hospital personnel involved in waste management shall be an essential part of hospital training program. d. Local ordinances regarding the collection and disposal techniques, especially incinerators shall be institutionalized.

Nursing Responsibilities and Activities

1. Health Education. The community health nurse is in the best position to do health education activities such as:
a. Development and dissemination of IEC materials and messages, their utilization and distribution; b. Providing individual and group counseling , and holding of community assemblies and bench conferences; and c. Working with other nursing staff and personnel in other government and private agencies who can also be responsible for imparting the need for an effective and efficient environmental sanitation in their place of work.

2. Active participation in training /workshops related to environmental health 3. Acting as advocate or as facilitator to families in the community in matters pertaining to programs/projects or activities on environmental health 4. Effective and efficient participation in environmental sanitation campaigns and projects in the community 5. Being role model for others in the community in terms of cleanliness in the home and surrounding 6. Helping in the integration and implementation of P.D. 856 commonly known as Code on Sanitation of the Philippines.

II. CONTROL SYSTEM

A. Isolation and quarantine B. Disinfection (Concurrent and terminal) C. Disinfection or killing of undesirable small animals by physical or chemical means D. Fumigation / disinfectant fogging application of gaseous agent to kill or drive organisms and insects

III. CURATIVE ASPECT

A. Medical Management B. Nursing Management

IV. REHABILITATIVE ASPECT

A. Activity B. Nutrition

Means of Controlling the Spread of Communicable Diseases

1. Elimination of the source of infection 2. Interruption of transmission 3. Protection of susceptible host