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Communicable Disease Basics


Describe three ways infectious agents can be transmitted Describe at least three ways to decrease risk of infections in public settings List three examples of common infectious diseases and how to reduce risk of infection

Chain of Infection

Chain of Infection
Model used to understand the infection process Each link represents step in transmission of infection Each link has to be present and in order for an infection to occur

1 - The Infectious Agent

-any disease causing microorganism (pathogen)

Infectious agents are:



2 - The Reservoir
-Where a microorganism normally lives and reproduces

Examples of reservoirs:
Humans Animals Water Food

3 - The Portal of Exit -route of escape of the pathogen from the


Examples of portals of exit:

Flu or cold - mucous secretions West Nile Virus - when the mosquito bites and feeds on the birds blood Hepatitis A - stool SARS - droplet, contact

4 - The Route of Transmission (Spread) -the way the pathogen gets from the
reservoir to the new host

Transmission: Respiratory Droplets

From respiratory tract (i.e., nose, mouth) secretions of infected person

E.g. cough, sneeze

Do not circulate in air for long time or travel far (mostly < 3 feet) Many diseases spread by respiratory droplets; e.g. flu, cold, pertussis, SARS Can spread germs directly or indirectly

Droplet Transmission

Agent is coughed or sneezed out into the air and floats on droplets

Direct Spread by Droplets

Close contact with infected person (<3 ft) Infected person coughs, sneezes, talks, sings Droplets land directly on mucous membranes (eyes, nose, mouth) of susceptible person

Indirect Spread by Droplets

Droplets with the infectious agent land on a table, doorknob etc.

Indirect Spread by Droplets

Someone touches contaminated object

Indirect Spread by Droplets

Touch nose, mouth, eyes with contaminated hand

Airborne Transmission

Germs stay suspended in air on small particles Uncommon method of transmission Only occurs for certain germs, such as tuberculosis
Less commonly for flu, SARS

Airborne - This Needs to be Breathed in to be Infectious

Airborne Transmission

Germs stay suspended in air on small particles Uncommon method of transmission Only occurs for certain germs, such as tuberculosis
Less commonly for flu, SARS

Other Methods of Transmission

Food/water/hands contaminated with stool from infected person; e.g., norovirus Blood exposures, sexual contact
a.k.a. blood-borne; e.g. HIV, hepatitis B and C

E.g. Mosquitoes and West Nile virus, malaria

Unlikely methods of spread in courtroom

What Do You Need to Do?

Make sure that you have available for staff and patient use an adequate supply of:
surgical masks tissues alcohol hand rub trash cans with foot pedals to lift lid for disposing of tissues/masks

5 - The Portal of Entry -route through which the pathogen enters its new host

Respiratory System

Inhale germs

Other Portals of Entry

Ingestion Sexual contact

Breaks in Protective Skin Barrier

6 - The Susceptible Host -A person who can get sick when they
are exposed to a disease causing pathogen

How to Break the Chain of Infection

What Is the Purpose of Respiratory Hygiene?


reduce the transmission of airborne diseases

Hand Hygiene

Wash hands frequently with soap and warm water for at least 20 seconds
Alcohol hand gels

Use gloves where contact with body secretions and excretions is taking place

Cover Your Cough!

Cough Etiquette

Limit close contact (<3 feet) with coughing clients Cover cough/sneeze with tissue Offer mask to coughing clients

Keep a clean environment

Clean contaminated surfaces with commercial germicidal cleanser or wipes

Maintain vaccinations for employees

Flu shot- every year for age >50 and high-risk groups Tetanus shot every 10 years Hepatitis B for persons who may contact objects contaminated with blood Pneumovax (pneumonia vaccine) for age 65 Hepatitis A

What Are Some of the Airborne Diseases of Concern?

Pertussis Tuberculosis Influenza Common


Pertussis (Whooping Cough)

Droplet and contact transmission Runny nose and prolonged severe cough A bacterial infection Most dangerous for babies Vaccine preventable for children aged 7 and under

Agent Caused by bacterium, Mycobacterium tuberculosis Reservoir Humans

TB in King County
180 160 140 120 100 80 60 40 20 0 1998 1999 2000 2001 2002 2003

Number of Cases


Latent TB Infection vs. Active TB Disease

Latent TB Infection

Person infected with TB bacteria Bacteria kept dormant by persons immune system Not sick or contagious 10% develop TB disease over life time Infection detected by TB skin test

TB Skin Test (PPD)

Active TB Disease

Usually involves lung infection Cough >3 weeks, fevers, weight loss, night sweats Can cause serious illness but is treatable with antibiotics Contagious until appropriately treated

Preventing Spread of TB

Patients with TB disease should delay court appearance until appropriate duration of therapy Patients with active TB are no longer contagious after 2-3 weeks of appropriate therapy
should be cleared by doctor

Influenza (Flu)
Agent Virus Reservoir Humans Animals (e.g. birds, pigs)
Generally different strains

Flu Transmission: Respiratory Droplets

Direct: Close contact (<3 feet)

Droplets from cough/sneeze enter mouth, nose, eyes of susceptible person

Indirect: Contaminated surfaces Cases peak each winter in U.S.

How Do I Protect Myself From the Flu?

Flu Vaccine
Recommended for:
Persons >50 years old Anyone with a chronic illness, such as asthma or diabetes Children age 6-23 months Women who will be pregnant during flu season

Habits for Good Health

Avoid close contact with people who are sick Stay home when sick Cover mouth/nose with tissue when coughing/sneezing Avoid touching nose, mouth, eyes Wash hands often with soap/water or alcohol rub

What Can You Do to Reduce Your Chances of Getting Sick?

Encourage coughing clients to wash their hands (or use alcohol hand rub) Wash your own hands frequently Wipe down counters, pens, phones, computer keyboards, etc. with disinfectant cleaner as needed Cough etiquette- cover with tissue Offer mask to coughing clients


Staff and clients should have access to:

Hand washing facilities Tissues Trash cans for disposing of tissues

Consider having alcohol hand rub available