COMMUNICABLE DISEASE NURSING

By: Tomas C. Cornelio, RN

Common Terms:

Infection the implantation and successful replication of an organism in the tissue of the host
Carrier individual who harbors the organism and is capable of transmitting to a susceptible
host but does not show manifestations of the disease
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 inaminate object
Contact any person or animal that is in close association with an infected person, animal or
freshly soiled materials
Contagious disease one that is easily transmitted from one person to another throught direct
or indirect means
Disinfection destruction of pathogenic microorganisms outside of the body through direct
physical or chemical burns
o Concurrent Disinfection method done immediately after the infected individual
discharges infection material or secretions; is done while the patient is still the source of
infection
o Terminal Disinfection applied when the patient is no longer the source of infection
(either the patient has died or has been discharged); everything the patient used
including his/her room is disinfected
Habitat a place where an organism is usually found/lives
Host a person, animal or plant which a parasite depend for its survival

Isolation the separation of an individual suffering from a communicable disease from other
persons
Quarantine the limitation of freedom of movement of persons or animals which have been
exposed to communicable disease/s for a period of time equivalent to the longest incubation
period of that disease
Reservoir composed of one or more specie of animal or plant in which an infectious agent lives
and multiply for survival and reproduce itself in such a manner that it can be transmitted to man
Surveillance the act of watching

Infectious Disease are those that are transmitted not only by ordinary contact but require direct
inoculation of the organism through a break on the skin or mucous membrane; hence all contagious
diseases are infectious

Communicable Disease a disease that can be transmitted from one person to the other either by
direct or indirect method of transmission

Contagious Disease a communicable disease that is easily transmitted from one person to the other

All communicable diseases are infectious but, not all infectious diseases are contagious or
communicable

The Components of Epidemiological Triad: Agent, Host and Environment
The development of infection depends on the interplay between the three components of the
epidemiologic triad.

Severity of Infection depends on:
1. Microbial characteristics and virulence
a. Virulence pertains to the capacity of the pathogens to produce an infection
2. Number of pathogens that enter the body
3. The way in which the microbes enter the body and spread
4. The host resistance to infection

AGENT: The organism (or etiologic agent) that causes the disease. Has two types based on origin.
1. Endogenous found on the skin and other body substances like feces, sputum, and saliva
2. Exogenous originate from outside the body

Modes of Action:
1. Colonization presence of the organisms in the surface of the tissues (does not penetrate the
tissues)
2. Invasion penetrates the tissues layer by layer

CLASSIFICATION OF ETIOLOGICAL AGENTS:

A. CAUSATIVE AGENT:
1. Virus
- the smallest form of organism
- they can pass through filters of the body
- they multiply in living host only
- usually has longer incubation period
- usually gives lifetime immunity
- self-limiting
2. Bacteria
- Cant pass through filters of the body
o Example: Placenta: Except T. pallidum that can gain entrance only after the 6
th

week of pregnancy
- Usually has shorter incubation period
- Temporary immunity is acquired
- Can multiply both in living and non-living things
- Disease is easy to treat due to the advent of antibiotics
3. Rickettsia
- Usually transmitted by anthropods (lice, fleas, ticks); transfer the organism by their bites
or waste products
4. Spirochete
- Spiral chaped bacteria that can move in helical, or inch-worm manner
5. Chlamydia
- Usually transmitted through sexual contact
6. Fungi
- Are found almost anywhere, some are beneficial and some are harmful
7. Protozoa
- Parasitic protozoa usually absorb blood from the body of the host
8. Parasites
- Usually dont kill their host
- Only take the nutrients they need from the host

B. Host
- Susceptible population


Types of Human Host:
1. Patient (case) is a person who is infected manifesting the signs and symptoms of the disease
2. Carrier a person who appears healthy but harbors the organism, capable of transmitting the
disease but does not manifest the signs and symptoms of the disease
3. Suspect a person whose medical history, and signs and symptoms suggest that such person is
suffering from that particular disease
4. Contact a person who has been in close association with an infected person, animal or thing

Types of Carriers:
1. Incubatory carrier with organism can pass to others
2. Convalescent carrier one who is recovering from the infection; body still releasing salmonella
3. Intermittent carrier one who releases organism in an on and off manner depending on his
level of immunity
4. Chronic or sustained carrier releases the organism steadily

C. Environment anything that supports the survival and replication/reproduction of the organism

CHAIN OF INFECTION
There are six components in the infectious disease process, known as the Chain of Infection.

1. The Causative Agent any microorganism capable of producing a disease

1.1 Bacteria:
- Simple, one-celled microbe with double cell membrane that protect them from harm
- Reproduced rapidly and considered as the most common cause of fatal infectious disease
- Classified According to:
o Cell morphology (shape, size)
Cocci round or spherical
Bacilli rod-shape
Spirillae spiral shape
o Atmospheric requirements based on their relationship to oxygen and carbon dioxide
Aerobic requires oxygen in concentration comparable to room air
Anaerobic organism that do not require oxygen for life and reproduction
o Response to staining
Blue stain gram (+) bacteria
Rod shape gram (-) bacteria
o Motility (motile, non-motile)
o Tendency to capsulate (encapsulated, capsulated)
o Capacity to form spores (spore forming, non-spore forming

1.2 Spirochete
- Bacteria with flexible, slender, undulating spiral rods that possess the wall
- 3 forms:
o Treponema (syphilis)
o Leptospira (leptospirosis)
o Borrelia (lyme disease)

1.3 Mycoplasma
- Also depends on the host cell for replication
- Does not contain a cell wall
- Only has membranes
- The absence of cell wall makes it resistant to penicillin and other antibiotics that work by inhibiting
cell wall formation or synthesis

1.4 Viruses
- Smallest known microbe
- Cant replicate independently in the hosts cells
- Invades a host cell and stimulate it to participate in producing additional viruses

1.5 Rickettsiae
- Small, gram negative (-) bacteria-like microbe that can induce life-threatening infections
- Require a host cell for replication
- Transmitted through a bite of anthropod carriers like lice, fleas, ticks, as well as through waste
products
- Rickettsial Diseases are:
o Rocky mountain spotted fever
o Typhus fever
o Q fever

1.6 Chlamydia
- Smaller than rickettsia but larger than a virus
- Common cause of infections of the urethra, bladder, fallopian tubes, and prostate gland
- Most common chlamydial infection is transmitted through sexual contact

1.7 Fungi
- Found almost everywhere
- Live in organic matter, soil, water, on animals and plants; can live inside and outside the body
- Maybe harmful and beneficial
- Beneficial in cheese, yogurt, beer, wine and certain drugs

1.8 Protozoa
- Much larger than bacteria
- Simplest single-celled organism of animal kingdom
- Parasitic protozoa absorb nutrients from the body of the host

1.9 Parasites
- Live on or within other organisms; live on the expense of others
- They dont kill their host but take only the nutrients they need
2. Reservoir of Infection the environment and objects on which an organism can survive and multiply

2.1 Non-living
2.2 Animals
2.3 Human Reservoir
2.3.1 Frank cases or the very ill
2.3.2 Sub-clinical or ambulatory
2.3.3 Carriers
2.3.3.1 Incubatory carrier one who is incubating the illness
2.3.3.2 Convalescent carrier the recovery stage of illness but continue to shed the
pathogenic organism
2.3.3.3 Intermittent carrier occasionally shades the pathogenic organism
2.3.3.4 Chronic or sustained carrier always has infectious organism in his system

3. The Portal of Exit the path or way in which the organism leaves the reservoir; usually were the
organism grows
3.1 Common portals of Exit:
3.1.1 Respiratory
3.1.2 Genitourinary tract (GUT)
3.1.3 Gastrointestinal tract (GIT)
3.1.4 The skin and mucous membrane
3.1.5 The placenta ( transplacental or vertical transmission)
4. Mode of Transmission
- The means by which the infectious agents passes from the portal of exit from the reservoir to the
susceptible host.
- Easiest link to break the chain of infection
- Infectious agents can be transmitted through the four models:
4.1 Contact Transmission most common mode of transmission
a. Direct Contact person to person transfer of organism
Direct skin to skin contact by headshaking
Direct mucous membrane to mucous membrane contact by kissing or sexual
intercourse
b. Indirect contact occurs when the susceptible person comes in contact with a
contaminated object
Indirectly via contamination of food and water by fecal materials
Indirectly by transfusion of contaminated blood or blood products from ill
persons or by parenteral infections
c. Droplet spread contact with respiratory secretions, when the infected person coughs,
sneezes, or talks.
Microbes carried in droplets can travel up to 3 feet or one meter
The organism is not suspended in the air but settle on a surface
4.2 Air-borne transmission occurs when fine microbial particles or dust particles containing
microbes remain suspended in the air for a prolong period (spread by air current and inhaled)
4.3 Vehicular transmission articles or substances that harbour the organism until it is ingested or
inoculated into the host, transmission by inanimate objects, such as food, water, dust, fomites
4.4 Vector-borne transmission occurs when an intermediate carriers, such as flea, flies, mosquitoes,
transfer the microbes to another living organism; brought about by bites of anthropods.
5. Portal of Entry the venue where the organism gain entrance into the susceptible host. The
infective microbes use the same avenues when they exit from the reservoir.
6. Susceptible host the human body have many defences against the entry and multiplication of
organism; defenses are good, no infection will take place; weakened host, the microbes will launch
an infectious disease

Factors Affecting the Entrance of Organism into the body:
1. Age, Sex, genetic, constitution of the host
2. Nutritional status, fitness, environmental factors
3. General condition, physical, emotional, mental state
4. Absence of or abnormal immunoglobulin
5. Presence of underlying disease (Diabetes mellitus, lymphoma, leukemia, neoplasm or uremia)
6. Patients treated with certain antimicrobials, corticosteroids, irradiation, or immunosuppressive
drugs

INFECTION CONTROL MEASURES

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

B. Infectious Control Measures Requires that:
1. Employees shall wash their hands immediately as soon as possible after removal of gloves or
other personal protective equipment and after hand contact with blood or other potentially
infectious materials
2. All personal protective equipments shall be removed immediately upon leaving the work area
or as soon as possible if overtly contaminated and place in an appropriately designated area or
container for storage, washing, decontamination or disposal
3. Used needles and other sharps shall not be sheared, bent, broken, recapped, or re-sheathed by
hand. Used needles should not be removed from disposable syringes
4. Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses are
prohibited in work areas where there is potential for occupational exposure
5. Food drinks shall not be stored in refrigerators, freezers, or cabinets where blood or other
potentially infectious materials are stored or in other areas of possible contamination
6. All procedures involving blood or other potentially infectious materials shall be performed in
such so as to minimize splashing these substances
7. Mouth pipetting or suctioning is prohibited

Suggested control measures for primary care clinics:
1. Masking
All staff should wear mask
Patients should be asked to wear mask if they have respiratory problems
2. Handwashing
Practice proper handwashing with the use of soap and water
Before and after patient contact and after removing gloves
3. Gloving
For all direct patient contact
Change gloving in between patient and wash hands
4. Gowning
During procedures likely to generate splashes or sprays of blood and body fluids,
secretions, or excretions
5. Eye protection (googles)
For aerosol/splashes generating procedures
Avoidance or aerosols
6. Environmental disinfection
Clean surfaces daily with disinfectant (diluted household bleach, 70% alcohol)

Aspects of Care for Patients with Communicable Disease:

I. Preventive aspect
A. Health Education educate the family and the client with respect to:
Availability and importance of prophylactic immunization
Manner in which infectious illness are spread and methods in avoiding the spread
Importance on seeking medical advice in any sign of health problem
Importance of environmental cleanliness and personal hygiene
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 a condition of being secured or protected against any particular
disease
Acquired immunity immunity that results from the active production or
receipt of antibodies during ones lifetime
Types of Acquired Immunity:
1. Active Immunity results if antibodies are actually produce within the persons
body
a. Natural Active Immunity immunity that is acquired in response to the
entry of a live pathogen into the body (i.e. in response to an actual
infection); immunity of this types is usually lifelong
b. Artificial active immunity immunity that is acquired in response to
vaccines, like Tetanus toxoid
2. Passive Acquired Immunity the person receives antibodies that were produced
by another person or by animals. Protection is usually temporary.
a. Natural Passive immunity that is acquired by a fetus when it receives
maternal antibodies in utero or by an infant when it receives maternal
antibodies contained in colostrum
b. Artificial passive immunity that is acquired when a person receives
antibodies contains antisera or gamma globulin

Types of Antigen:
1. Inactivated (killed organism)
Not long lasting
Multiple dose needed
Booster dose needed to acquire lifetime immunity
2. Attenuated (live organism)
Single dose needed
Long lasting immunity
Note: All vaccines lost their potency after a certain time. Expiry date should be noted on
the label

What Damages the Vaccines?
1. Heat and sunlight damage vaccine, especially the live ones
2. Freezing damages the killed vaccines and toxoids
3. In cleaning the refrigerator/freezer use water only because antiseptics, disinfectants
and detergents or alcohol may lessen the potency of vaccines
Safest thing to do is to keep all vaccines at the correct cold temperature (0-8 C)

The Cold Chain System

Maintenance of the correct temperature for vaccines starts with the
manufacturer and followed by the airport, the central vaccine store, regional store,
district hospital, health centers or outreach service units, dispensary, immunizing staff,
and the client.

C. Environmental Sanitation
Environmental sanitation is still a health problem in the country
Diarrheal disease still ranks second among the leading causes of morbidity in the
population
Others sanitation-related diseases: intestinal parasitism, infectious hepatitis,
dengue/hemorragic fever
DOH-EHS (DOH-Environmental Health Services) has the authority to act on all
issues and concerns in environment health, in accordance with the Code on
Sanitation of the Philippines (PD 856, 1978)

1. Water Supply Sanitation Program
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
adaptable 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 types of water facility or water coming from doubtful
sources such as open dug wells, unimproved springs, and wells that
need priming, are not allowed for drinking unless treated through
proper container disinfection
c. Access safe and potable drinking water all households should be
provided with a 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/her 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 bacteriologically
positive through laboratory analysis
e. Waterworks/water system and well construction
The well site shall require approval of the Secretary of Health or
his duly authorized representative
Well construction shall comply with the sanitary requirements
of the DOH
The water supply system shall supply safe and potable water in
adequate quantity
Water shall be made readily available to consumer/users
2. Policies on proper excreta and sewage disposal
a. Approved Type of toilet facilities
Level I Non water carriage toilet facility (pit latrines, reed
odourless 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 a septic tank or
sewerage system and treatment plant
b. In rural areas, a blind drainage type of waste water collection and
disposal facility
3. Policies on Food Sanitation Program
a. Food establishments shall be appraised as to the following sanitary
conditions:
Inspection/approval of all food sources, containers, and
transport vehicles
Compliance to sanitary permit requirements
Provision of updated health certificates for food handlers, cook,
and kitchen 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 certificates
c. Household food sanitation is to be promoted and monitored and food
hygiene sanitation is 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 a requirement for the 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 the hospitals training program
d. Local ordinances regarding the collection and disposal techniques,
especially incinerators, shall be institutionalized
5.