COMMUNICABLE DISEASE PART 2

• Communicable Disease


  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 of Communicable Disease

  • Infectious Disease
  • Contagious Disease
• Infectious Disease


  Not easily transmitted by ordinary contact but require a direct inoculation through a break in the previously intact skin or mucous membrane
• Contagious Disease


  Easily transmitted from one person to another through direct or indirect means
• Terminologies


  • Disinfection
  • Concurrent
  • Terminal
  • Disinfectant
  • Antiseptic
  • Bactericidal
  • Sterilization
• General Principles


  • Pathogens move through spaces or air current
  • Pathogens are transferred from one surface to another whenever objects touch
  • Hand washing removes microorganism
  • Pathogens are released into the air on droplet nuclei when person speaks, breaths, sneezes
  • Pathogens are transferred by virtue of gravity
  • 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 or cellular damage produced by the microbe's intracellular multiplication
• Factors of Severity of Infection

  • Disease producing ability. The number of invading microorganisms
  • The strength of the host's defense and some other factors
• Epidemiological Triad


  • Agent
  • Host
  • Environment
• Classification According to Incidence

  • Sporadic
  • Endemic
  • Epidemic
  • Pandemic
• Causes of Infection


  • Some bacteria develop resistance to antibiotics
  • Some microbes have so many strains that a single vaccine can't protect against all of them
  • Most viruses resist antiviral drugs
  • Opportunistic organisms can cause infection in immunocompromised patients
  • Most people have not received vaccinations
  • Increased air travel can cause the spread of virulent microorganism to heavily populated area in hours
  • Use of immunosuppressive drugs and invasive procedures increase the risk of infection
  • Problems with the body's lines of defense
• Three Lines of Defense

  • First Line of Defense
  • Second Line of Defense
  • Third Line of Defense
• First Line of Defense

  • Mechanical Barriers
  • Chemical Barriers
  • Body's Own Pop. of Microorganism - "microbial antagonism principle"
• Second Line of Defense

  Inflammatory response - Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs
• Third Line of Defense

  Immune response - Natural/Acquired: active/passive
• Risk Factors


  • Age, sex, and genes
  • Nutritional status, fitness, environmental factors
  • General condition, emotional and mental state
  • Immune system
  • Underlying disease (diabetes mellitus, leukemia, transplant)
  • Treatment with certain antimicrobials (prone to fungal infection), steroids, immunosuppressive drugs etc.
• Mode of Transmission


  • Contact transmission
  • Airborne Transmission
  • Vector Borne Transmission
  • Vehicle Borne Transmission
• Contact Transmission


  Direct contact - person to person<|>Indirect - thru contaminated object<|>Droplet spread - contact with respiratory secretions thru cough, sneezing, talking. Microbes can travel up to 3 feet.
• Emerging Problems in Infectious Diseases

  • Developing resistance to antibiotics
  • Increasing numbers of immunosuppressed patients
  • Use of indwelling lines and implanted foreign bodies has increased
• Infection Control Measures


  • Universal Precaution
  • Work Practice Control
  • Control Measures
  • Isolation Precautions
• Universal Precaution


  All blood, blood products and secretions from patients are considered as infected
• Work Practice Control


  • Handwashing
  • Protective Equipment Removal
  • Needle/Sharps Handling
  • Eating/Drinking/Smoking Prohibition
  • Minimizing Splashing/Spraying
• Control Measures


  • Masking
  • Handwashing
  • Gloving
  • Gowning
  • Eye Protection
  • Environmental Disinfection
• Isolation Precautions


  • Strict Isolation
  • Contact Isolation
  • Respiratory Isolation
  • TB Isolation
  • Enteric Isolation
  • Drainage/Secretion Precaution
  • Universal Precaution
• Prevention


  • Health Education
  • Immunization
  • Environmental Sanitation
• Health Education


  Educate the family about immunization, mode of transmission, environmental sanitation, importance of seeking medical advice, preventing contamination of food and water
• Environmental Sanitation


  Water Supply Sanitation Program, Policies on Food Sanitation Program, Policies on Hospital Waste Management
• Nurse's Role in Environmental Sanitation

  Development of materials, providing group counselling, holding community assemblies and conferences, creating programs for sanitation, being a role model
• Types of Immunization


  • Natural - passive (from placenta), active (thru immunization & recovery from diseases)
  • Artificial - passive (antitoxins), active (vaccine, toxoid)
• Cold Chain System


  Maintenance of correct temperature of vaccines, starting from the manufacturer to regional store, to district hospital, to the health center to the immunizing staff and to the client
• Tuberculosis


  A serious infection caused by the bacterium Mycobacterium tuberculosis (MTB) that involves the lungs but may spread to other organs. TB is a contagious disease that can infect anyone exposed to MTB.
• Tuberculosis Pathophysiology


  • Chronic respiratory disease affecting the lungs characterized by formation of tubercles in the tissues---> caseation ---> necrosis ---> calcification
  • Etiologic agent: Mycobacterium tuberculosis
  • Incubation period: 2 – 10 wks
  • Period of communicability: all throughout the life if not treated
  • Mode of Transmission: Droplet
  • Sources of infection: sputum, blood, nasal discharge, saliva
• Policies in Diagnosis of Tuberculosis

  • Rapid Diagnostic Test (RDT) - Xpert MTB/RIF
  • Smear microscopy (brightfield or fluorescence)
  • Loop Mediated Isothermal Amplification (TB LAMP)
  • Tuberculin skin test (TST)
• Treatment Regimens for DS-TB (2020)

  • Regimen 1 (2HRZE/4HR)
  • Regimen 2 (2HRZE/10HR)
• National TB Control Program (NTP)

  Organized in 1978, Vision: A Tuberculosis-Free Philippines, Mission: To reduce TB burden, To reduce catastrophic cost of TB-affected households, To responsively deliver TB service
• March 24 - World TB Day
• h positive
• Patients eligible for Regimen 2 (2HRZE/10HR)

  • EPTB of CNS, bones, joints, provided there is an Xpert result with either MTB, RIF sensitive, or MTB, RIF indeterminate
  • New EPTB of CNS, bones, joints with positive SM/TB LAMP or clinically diagnosed; when Xpert is not done, or MTB not detected on Xpert
• SM/TB LMP or clinically diagnosed;
• when Xpert is not done, or MTB not detected on Xpert