UNIT II

INFECTION PROCESS AND INFECTIOUS DISEASE CONTROL

Infection is a state of diseases or illness caused when an organism inside a person

multiplies to levels where it causes harm.
Classification of Infection:
1. Primary infection: this is the initial infection with organism in a host.
2. Reinfection: is the subsequent infection by same organism in a host.
3. Secondary infection: the host resistance (immunity) could be lowered by the
presence of pre-existing infectious disease allowing the new organism to set up an
infection.
4. Cross infection: when a patient suffering from a disease and a new infection is set
up from another host or external source.
5. Nosocomial infection: it is also cross infection occurring in hospital, it could be
from patient to patient or from Health personnel to patient
6. Subclinical infection: it is one where clinical effects are not apparent, its
asymptomatic. (sign and symptoms are not there)

A. The spread of Infection Occurs when there is breakage in the chain of infection
(source of infectious agent, mode of transmission and a susceptible host) source
of infection is the origin of the infectious agent. This source can be either a living
organism or an inanimate object that provides a pathogen with adequate
conditions for its survival and multiplication and an opportunity for transmission.
Such a source is called a reservoir of infection. These reservoirs may be human,
animal or non-living thing.
- Human Reservoirs: The principal living reservoir of human disease is the human
body itself. Many people harbor pathogens and transmit them directly or
 indirectly to others. Some people can harbor pathogens and transmit them to
others without exhibiting any signs of illness. These people are called carriers.
Human carriers play an important role in the spread of such diseases as AIDs
diphtheria, typhoid fever, hepatitis, gonorrhea, amoebic dysentery and
streptococcal infections.

- Animal Reservoirs: Both wild and domestic animals are living reservoirs of
micros that can cause human diseases and these diseases they cause are called
zoonoses. The transmission of zoonoses to humans can occur via one of many
routes;
i. By direct contact with infected animals e.g. Bats, dogs, foxes, raccoons e.t.c.
causing Rabies (Lyssavirus)
ii. By direct contact with domestic pet waste e.g. cats and other mammals litters,
causing toxoplasmosis (toxoplasma gondii).
iii. By contamination of food and water e.g. poultry, rats, reptiles causing
salmonellosis (salmonella spp)
iv. By air from contaminated hids, fur, or feathers: e.g. domestic livestock causing
Anthrax (Bacillusanthracis).
v. By consuming infected animal products e.g. Domestic livestock causing Brucellosis
(Brucella spp).
vi. By insect vectors e.g. mosquito causing Malaria (plasmodium spp)

- Non-Living Reservoirs: The two major non-living reservoirs of infectious disease

are soil and water. Soil harbors such pathogens as fungi which causes mycoses
example, ringworm and systemic mycosis. Further more. clostridium botulinum
and clostridium tetani are example of bacteria found in soil where animals feces
are used as fertilizer.
 Examples of pathogens found in contaminated water (by feces of animals and
humans) are Vibrio cholerae and Salmonella typhi. Other nonliving reservoirs
includes food that are improperly prepared or stored which may be sources of
diseases like trichinellosis and salmonellosis

B. Mode of Transmission of Disease

The causative agents of disease can be transmitted from the reservoir of infection
through the portal of exit (by excretions, droplets, secretions). Portal of entry (R.T.,
G.I.T, Mucous membrane, skin and Mouth.) to a susceptible host by three principal
routes: Contact, vehicles and vectors.
- Contact Transmission is the spread of an agent of disease by direct contact,
indirect contact or droplet transmission.
i. Direct contact: Is also known as person-to-person transmission. Most common
forms are touching, kissing and sexual intercourse. Among the diseases that can
be transmitted by direct contact are viral respiratory tract diseases (common cold
and influenza) staphylococcal infections, hepatitis A, measles, Scarlet fever and
sexually transmitted diseases (syphilis, gonorrhea and genital herpes).
ii. Indirect Contact: The infections is transmitted by means of nonliving object
formally known as formite e.g. tissues, towels, bedding, diapers, eating utensils,
thermometers, money e.t.c. contaminated syringes serve as formites also in the
transmission of AIDs and Hepatitis B.
iii. Droplet Transmission: Microbes are spread in droplet nuclei (mucus droplets)
that travel only short distances less than 1 inch which are discharged into the air
by coughing, sneezing, laughing or talking. Disease agents that travel short
distances are not regarded as airborne. Examples of diseases spread by droplet
transmission are influenza, pneumonia, and pertussis(whooping cough).
- Vehicle Transmission: Is the transmission of disease agents by a medium such as
water, food or air. Other media include blood and other body fluids, drugs and
intravenous fluids.
i. Water Born Transmission: Pathogens are usually spread by water contaminated
with untreated or poorly treated sewage. Diseases transmitted via this route
include cholera, waterborne shigelloses and leptospirosis.
ii. Food borne Transmission: Pathogens are generally transmitted in foods that are
incompletely cooked, poorly refrigerated or prepared under unsanitary
conditions. Food-borne pathogens cause diseases such as food poisoning and
tapeworm infection.
iii. Airborne Transmission: Refers to the spread of agents of infection by droplet
nuclei in dust that travel more than 1 metre from the reservoir to the host. The
virus that cause measles and the bacterium that causes tuberculosis can be
transmitted via airborne droplets. Dust particles can harbor various pathogens.
Staph-and strep. Can survive on dust and be transmitted by the airborne route.
Spores produced by certain fungi can also be transmitted by the airborne route
and can cause diseases as histoplasmosis, coccidiomycosis and blastomycosis.

- Vectors: Are Animals that carry pathogens from one host to another and the most
important vectors are the Arthropods. Arthropods vectors transmit disease by
two general methods;
i. Mechanical transmission which is the passive transport of the pathogens on the
insect’s feet or other body parts. E.g. housefly can transfer the pathogens of
typhoid fever and bacillary dysentery (shigellosis) from the feces of infected
people to food.
ii. Biological transmission is an active process. It occurs when an arthropod bites
an infected person or animal and ingests some of the infected blood, which then
the pathogens reproduce in the vector and then transmitted to another host by
 defecating or vomiting while biting the host e.g. Anopheles (mosquito) causing
Malaria, Aedes (mosquito) causing yellow fever.

C. General Signs and Symptoms of Infections Process

Each infectious disease has its own specific signs and symptoms common to a
number of infections diseases, which include:
- Fever or chills
- Digestive upset such as nausea, vomiting or diarrhea
- Fatigue
- Muscle aches and pains
- Coughing and sneezing

D. Principles of Control of Infectious Diseases

- Hand washing
- Waste disposal
- Handling and disposal of sharps object
- Decontamination
- Disinfection
- Sterilization

Principles of asepsis and application of sterile procedures in operating theatres:

The fundamental principle of an aseptic technique incorporates protecting key elements of
the equipment that should remain free from micro-organisms, for example.

i. the inside of a sterile dressing or the barrel of a sterile needle.

ii. All articles used in an operation has to be sterilized prior to the time to be
used.
iii. Sterile person touch only sterile articles while unsterile persons tough only
unsterile articles
 iv. If in doubt about the sterility of anything consider it unsterile.
v. Unsterile persons, avoid reaching over sterile field while sterile persons avoid
leaning over unsterile area.
vi. Tables are sterile only at table levels
vii. Gowns are considered sterile only from the waist to shoulder level and the
shleeves.
viii. The edge of anything that encloses sterile contents is not considered sterile.
ix. Sterile persons should strict himself within the sterile area.
x. Non-sterile persons keep away from sterile area.
xi. Sterile persons keep contact with sterile area to a minimum.
xii. Moisture may cause contamination.
xiii. When bacteria cannot be eliminated from a field they must be kept to an
irreducible minimum.
xiv. Destruction of integrity of microbial barriers result in contamination.

- Quarantine: - Is used to separate and restrict the movement of well persons who
may have been exposed to a communicable disease to see if they become ill. These
people may have been exposed to a disease but do not show symptoms.
Quarantine can also help limit the spread of communicable disease.
- Isolation: Is used to separate ill persons who have a communicable disease from
those who are healthy. Isolation restricts the movement of ill persons to help stop
the spread of certain diseases. e.g. hospitals use isolation for patients with
infectious tuberculosis.
- Contact Tracing: Is the process by which the contact of an infected person that
may have passed a serious infection are identified, diagnosed and then treated.
- Case Control and Notification: This is the process of informing the health
authorities about the occurrence of a disease that should be notified.
 - Standard Precautions: Are the minimum infection prevention practices that
apply to all patient care, regardless of suspected or confirmed infection status of
the patient, in any setting where health care is delivered.
Standard precaution on any measures includes:
1. Hand hygiene
2. Use of personal protective equipment (e.g. gloves, masks, eye wear)
3. Respiratory hygiene/cough etiquette
4. Sharps safety (engineering and work practice controls)
5. Safe injection practices (i.e aseptic technique for parenteral medications)
6. Sterile instruments and devices.
7. Clean and disinfected environmental surfaces.

- Functions of the Infectious Control Unit in the Hospital

i. Implementation of infection control policies.
ii. Supervision of standards of professional care in regards to infection.
iii. Education and orientation program for professional staff.
iv. Surveillance of hospital acquired infections.
v. Surveillance of staff health.
vi. Standards of hospital domestic cleaning and food services hygiene.
vii. Management of visitors in isolation circumstances.
viii. Matters of general hospital organization and purchasing where these may affect
infection control.
ix. Establishment and supervision of infections control team.
x. Submit an activity report and statistical data to the central committee every 6
months.