PREVENTING THE

SPREAD OF
COMMUNICABLE
DISEASES
 INTRODUCTION

A. Community acquired infection

-- infections present or incubating at the
time of admission

Nosocomial Infection
-- an infection that develops during the
course of a hospital stay and was not present
at the time the patient was admitted.
 FACTORS FOR NOSOCOMIAL
INFECTIONS

1. Microorganisms in the Hospital Environment

Most common causes:
-- Staph. aureus, E. coli, Pseudomonas,
Enterobacter, Klebsiella, Clostridium
difficile,
-- Fungi (C. albicans)
-- other gram negative bacteria
-- 70% are drug resistant bacteria
2. Compromised Host
-- one whose resistance to infection is impaired by broken
skin or mucous membranes and a suppressed immune
system.

a. Skin and mucous membranes

-- physical barriers
-- ex. Burns, surgical wounds, trauma, injections, invasive
diagnostic procedures, ventilators, intravenous therapy and
urinary catheters

b. Suppressed immune system

-- drugs, radiation therapy, steroid therapy, burns,
diabetes, leukemia, kidney disease, malnutrition, AIDS
3. Chain of Transmission
a. Direct contact transmission
-- hospital staff to patient
-- from patient to patient

b. Indirect contact transmission

-- fomites (inanimate objects or substances
capable of absorbing or transmitting a pathogen)
--ex. Clothing, bed linens, towels, eating
utensils

c. Hospital’s Ventilation System

-- airborne transmission
 GENERAL CONTROL MEASURES

A. PREVENTION OF AIRBORNE CONTAMINATION

1. Cover the mouth and nose (coughing and sneezing)

2. Limit the number of persons in a room
3. Remove the dirt and dust
4. Open the room to fresh air and sunlight
5. Roll linens together
6. Remove bacteria from the air (air filters)
GENERAL CONTROL MEASURES

B. HANDLING OF FOOD AND EATING

UTENSILS

Organisms:
Staphylococcus (from skin and dust)
Clostridium botulinum (from dust and dirt)
Clostridium perfringes (dust, dirt and hands)
Salmonella, Shigella, Campylobacter, Proteus
(feces, hands, flies and/or pets)
Pseudomonas sp. (dirt, hands and contaminated
equipment)
 HANDLING OF FOOD AND EATING UTENSILS
1. Use high quality food
2. Proper refrigeration and storage of food
3. Proper washing, preparing and cooking of food
4. Proper disposal of uneaten food
5. Proper hand washing
-- before food handling
-- after visiting a restroom
6. Proper disposal of nasal and oral secretions
7. Cover hair and wear clean clothes and apron
8. Provide periodic health exam for kitchen workers
9. Prohibit anyone with respiratory or GIT disease from food
handling
10. Keep cutting boards clean
11. Rinse and wash utensils with a temperature above 80C
 C. HANDLING OF FOMITES
FOMITES: any article/substance that may
harbor/transmit microbes
Ex. Eating utensils, bedpans, urinals,
thermometers, washbasins, bed linen, clothing

1. Use disposable equipment

2. Disinfect or sterilize equipment
3. Use individual equipment for each patient
4. Use single use thermometers
5. Empty bedpans and urinals, wash with hot water
and store in clean cabinets
6. Place bed linen and soiled laundry in a bag
 D. HANDWASHING
-- Single most important measure to reduce the
risks of transmitting microorganisms
-- Ignaz Semmelweis – father of handwashing

Handwashing Guidelines:
Wash hands before:
a. Preparing or eating food
b. Treating or tending to a patient
c. Inserting or removing contact lenses
 HANDWASHING GUIDELINES
-- Wash hands after:
a. Using the restroom e. pet handling
b. handle uncooked food f. garbage handling
c. Change a diaper g. Tend to a patient
d. Cough, sneeze or blow nose

-- Ideal handwashing:
a. use warm or hot, running water
b. use soap
c. wash all surfaces
d. rub hands together for at least 10-15
secs. e. when drying begin with
forearms
--- hands (pat dry)
III. INFECTION CONTROL PROCEDURES
(ASEPSIS)
A. MEDICAL ASEPSIS
-- clean technique
-- involves procedures and practices that reduce the
number and transfer of pathogens
-- exclude pathogens only
1. Frequent and thorough handwashing
2. Personal grooming
3. Proper cleaning of supplies and equipment
4. Disinfection
5. Proper disposal of needles, contaminated
materials and infectious waste
6. Sterilization
 B. SURGICAL ASEPSIS
-- Sterile technique
-- practices used to render and keep objects and areas
sterile
-- exclude all microorganisms
1. Use strict aseptic precautions for invasive
procedures
2. Scrub hands and fingernails before entering OR
3. Use sterile gloves, masks, gowns and shoe covers
4. Use sterile solutions and dressings
5. Use sterile drapes and create a sterile field
6. Heat sterilized surgical instruments
C. UNIVERSAL PRECAUTIONS (STANDARD
PRECAUTIONS)
- Defined by Center for Disease Control (CDC) in 1996
- Used for care of all hospitalized patients, regardless of
diagnosis and presumed infection status
- protect healthcare professionals from becoming infected with
HIV, HBV and other pathogens

1. Handwashing
-- routine: plain (non-antimicrobial soap) for outbreak
control:
antimicrobial or antiseptic agent
-- wash after: touching blood and other body fluids
--- touch contaminated items
--- removal of gloves
--- between patient contacts, tasks and procedures
 UNIVERSAL PRECAUTIONS (STANDARD
PRECAUTIONS)
2. Gloves
-- must be worn when touching blood, body fluids, secretions,
excretions and contaminated items, mucous membranes and
non-intact skin
-- change gloves between tasks or procedures
-- remove gloves after use and before going to another patient
3. Masks, Eye Protection, Face Shields, Gowns
-- wear protections that can protect splashes or sprays of blood,
body fluids, secretions, or excretions or cause soiling of clothing
4. Patient-Care Equipment
-- prevent contaminating yourself or transfer microbes to
others
-- properly clean, disinfect or sterilize
--dispose single-use items
 UNIVERSAL PRECAUTIONS (STANDARD
PRECAUTIONS)

5. Environmental Control
--routine care, cleaning and disinfection of environmental
surfaces
6. Linens
--handled, transported and processed to prevent
contamination and transfer of microorganisms
7. Occupational Health and Blood-borne Pathogens
-- never recap used needles
-- puncture-resistant containers
8. Patient placement
 IV. ISOLATION OF PATIENTS

A. SOURCE ISOLATION
B. REVERSE ISOLATION
---protective or neutropenic isolation
---used for patients with severe burns, leukemia,
transplant, immunodeficient persons, receiving
radiation treatment, leukopenic patients
--- those that enter the room must wear masks and
sterile gowns to prevent from introducing MO to
the room
 V. SPECIMEN COLLECTION
A. COMPONENTS OF SPECIMEN QUALITY
1. Proper specimen selection
-- correct type of specimen must be submitted
2. Proper collection of specimen
3. Proper transport of specimen to the laboratory
B. PROPER COLLECTION OF SPECIMEN
1. Use sterile container to prevent contamination
2. Site collection
--find suspected pathogen
--least contamination
3. Collect before antimicrobial treatment
4. Appropriate time: acute stage of disease
 B. PROPER COLLECTION OF SPECIMEN

5. Perform with care and tact

-- to avoid harming patient, causing discomfort and
causing undue embarrassment
6. Sufficient quantity
7. Protect from heat and cold and promptly delivered to
the laboratory
8. Extra care in handling of hazardous specimen.
9. Sterile, disposable specimen containers must be used
10. Properly labeled
 C. TYPES OF SPECIMENS USUALLY
REQUIRED

1. Blood
-- disinfect skin with 70% isopropyl alcohol
-- blood is usually sterile
2. Urine
-- sterile while in the urinary bladder
-- techniques:
a. clean catch midstream
b. catheterized specimen
c. suprapubic aspiration technique
-- process within 1 hour or refrigerate at 4 C within 5 hours
3. Cerebrospinal fluid
-- must be cultured immediately
4. Techniques:
a. coughed up specimen
b. transtracheal aspiration
c. needle biopsy
--- may be refrigerated for several hours without loss of
pathogens
5. Mucous membrane swabs
--- throat, nose, ear, eye, urethra, rectum, wounds,
operative sites and ulcerations
6. Feces
--- process it immediately
 VI. ANTIMICROBIAL SUSCEPTIBILITY
TESTING

--Tests the pathogens to B. Macro Broth Dilution Method

determine what drugs they -- uses many test tubes
are sensitive to and are -- impractical
resistant to.
C. Micro Broth Dilution Method
-- uses small plastic, microtiter
A. Agar Dilution Method trays
-- most accurate (gold D. Disk-Diffusion Method
standard)
-- Kirby-Bauer Method
-- uses many agar plates
-- not practical
 VII. ENVIRONMENTAL DISEASE CONTROL
MEASURES

A. Source of Water Contamination

B. Water Treatment
C. Sewage Treatment

A. Source of Water Contamination

1. Biological Pollution
-- contamination by soil microbes and fecal material
2. Chemical Population
-- industrial and agricultural chemicals that are
usually non-biodegradable
B. Water Treatment

1. Filtration
--remove large pieces of debris ex. Twigs, leaves
2. Sedimentation– allow particles to settle
3. Coagulation
--add alum (aluminum potassium sulfate)----flocculant
--flocculation---removal of colloidal material
4. Filtration
--particulate filter
--sand filters
--remove remaining bacteria and other small particles
5. Chlorination
-- chlorine gas or sodium hypochlorite (0.2 to 1.0 ppm)
--kills most remaining bacteria
C. Sewage Treatment
-- to return to lake and rivers

1. Filtration
--filter out large debris
2. Sedimentation
--activated sludge --- solid matter and bacteria
(fertilizer)
--remaining liquid (effluent)
3. Filtration and Chlorination
 Quiz time
Please prepare 1/8 paper
and number it 1 to 5
1. Contain Effluent in Sewage treatment
Filtration
sedimentation
chlorination

2. Contain flocculant in water treatment

filtration
coagulation
sedimentation
3. Must be cultured immediately
urine
blood
CSF

4. Used for immunodeficient patients

reverse isolation
source isolation
5. Organisms found on food and eating utensils
EXCEPT
Clostridium
Streptococcus
Pseudomonas