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Tuesday, March 17, 2009


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Infectious Agent or its toxic products - AGENT
Directly or Indirectly - MODE OF TRANSMISSION
Person, Animal or Intermediate Vector – HOST
Environment - ENVIRONMENT

Agent – element, substance, animate or inanimate that may serve as stimulus to initiate a disease process
Host – organism that provides nourishment for another organism
Environment – physical (climate), biological (plants & animals)

Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host
Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane.

What is Infection?
INFECTION - "the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious…"

Infectious Agent
deeply seated in the epidermis, not easily removed by simple handwashing,
Ex: Staphylococci

represent recent contamination,
survive for a limited period of time, acquired during contact with the infected colonized patient or environment,
easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)

Infectious Agent
Bacteria – heama organism, systemic
Virus – nuero organism, systemic
Fungi – skin organism, local
Protozoa – GI organism, local
Infectious Agent

Pathogenicity – ability to cause a disease
Infective dose – no of organism to initiate infection
Virulence – ability to enter or move through tissues
Specificity – ability of the organism to develop antigens

Means of Transmission
1. CONTACT - most common means of transmitting microorganisms from one person to another.
A. Direct Contact (person to person)
occurs when one person touches another
best vehicle is the Hands especially those of the Health Care workers

Indirect Contact (inanimate object)
- occurs when a person touches an inanimate object contaminated by an infected patient

- droplet, dust, organisms in env.
3. VECTOR - insects or animals
- food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion)

Prevention is worth a pound than cure
Health Education – primary role of the nurse
Specific Protection- handwashing, use of protective devices
Environmental Sanitation – clean and conducive for health
Definition of Prevention
“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention”

A Dictionary of Epidemiology, Fourth Edition
by John M. Last

Prevention of Needlestick Injuries
Dispose Used Needles in Puncture Proof Needle Containers
Don’t Recap Needles (Unless using the One-handed Technique)
Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of Transmitting Diseases)

1. Notification
2. Epidemiological Investigation
3. Case finding; early dx and prompt treatment
4. Isolation and Quarantine
5. Disinfection; disinfestation
6. Medical Asepsis
a. Handwashing
b. Concurrent disinfection
c. Personal protective equipments (PPEs)
d. Barrier Cards/Placarding
Objectives of CCD
Restoration of health, reduce deaths and disability
Interpretation of control measures to IFC for practice to prevent spread of CD.
Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring:
1. Acute flaccid paralysis (AFP) polio
2. Measles
3. Severe acute diarrhea (SAD)
4. Neonatal tetanus

Diseases that require reporting w/in 24 hrs
1. Acute flaccid paralysis (AFP) polio
2. Measles

Diseases targeted for eradication
1. Acute flaccid paralysis polio
2. Neonatal tetanus
3. Measles
4. Rabies
Study of the occurrence and distribution of diseases in the population

Patterns of occurrence of disease –frequency of disease occurrence
On and off occurrence of the disease
Most of the time it is not found in the community
One or two cases that occur are not related
Persistently present in the community all year round
Ex: malaria in Palawan
An unexpected increase in the number of cases of disease
Epidemic of a worldwide proportions
Time Related Patterns of Occurrence
cyclical variation
a periodic increase in the number of cases of a disease
a seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular time
hot spot-a rising increase that may lead to an epidemic

Time Related Patterns of Occurrence
Short time fluctuation
A change in the frequency of occurrence of a disease over a short period of time
Maybe (+) or (-)
Secular variation
A change in the frequency of occurrence of a diseae taking place over a long period of time
Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints.
b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today
Types of Epidemiology
Descriptive Epidemiology - concerned with disease frequency & distribution
Analytic Epidemiology
Is a study of the factors affecting occurrence and distribution of the disease.
Ex. Epidemiologic investigation
Study of the efficacy of a treatment of a particular disease
Ex. Clinical trial of a newly proposed therapeutic regimen
Evaluation Epidemiology
Study of the over-all effectiveness of a total/ comprehensive public health program.
Ex. Evaluation of the under five clinic

Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment
Types of Epidemiologic Data
Demographic data
Demography is the study of population groups
Ex. Population size and distribution
Vital Statistics
Environmental data
Health services data
Ex. Ratio between nurse and the population being served
Ex. Degree of utilization of health facility/ service
Epidemiologic Investigation

1st step- Statement of the problem
2nd step- Appraisal of facts – describing the epidemic in terms of time, place, person.
3rd step- formulation of hypothesis
4th step-Testing the hypothesis
5th step- Conclusion and recommendation

Disinfection – pathogens but not spores are destroyed

Disinfectant – substance use on inanimate objects

Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of microorganisms.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his illness is no longer communicable

Mode of Transmission
Status of the client’s defense mechanism
Ability of client to implement precautions
Launched by DOH in cooperation with WHO and UNICEF last July 1976
Objective – reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases
PD No. 996 (Sept. 16, 1076) – “ Providing for compulsary basic immunization for infants and children below 8 y/o
PP No. 6 (April 3, 1996) – “ Implementing a United Nations goal on Universal Child Immunization by 1990”
RA 7846 (Dec. 30, 1994) – immunization hepa B
PD No. 4 (July 29, 1998) – “Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign”

Legislation, Laws affecting EPI

Proclamation No. 46 – “polio eradication project”
Proclamation No. 1064 – AFP surveillance
Proclamation No. 1066 – National Neonatal Tetanus Elimination Campaign

DPT – Diptheria, Pertussis, Tetanu
OPV - Poliomyletis
Hepatitis B
-conditions that require hospitalization
For DPT 2 and 3 – history of seizures/ convulsions within 3 days after the first immunization with DPT
Nursing responsibility: ask how the child reacts to the first dose
For infant BCG – clinical AIDS
The following conditions are NOT contraindications:
Fever up to 38.5 ÂșC
Simple or mild acute respiratory infection
Simple diarrhea without dehydration
Malnutrition (it is indication for immunization)

Schedule of immunization
Infant BCG
0 to 11 months or 0 to 1 year
at birth
0.05 ml (dose) – ID, right arm
School entrance BCG
When the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1

Schedule of immunization
3 doses, 4 weeks or 1 month interval
Target age: 1 ½ to 11 months but child is eligible up to 6 years
If 7 years old and above DT only not P
0.5 ml, IM, vastus lateralis

Schedule of immunization
3 doses, 4 weeks/1 month
Target population: same as above, eligibility until Grade 6
2-3 drops, oral route
*Feb 8-March 8: Oplan Polio Revival Drive
No side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination

Schedule of immunization
Hepa B
3 doses, 4 weeks
Can be given at birth
Target age 1 ½ to 11 months
0.5 ml, IM, vastus lateralis
Patient may experience local tenderness
Schedule of immunization
9 to 11 months
Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine
0.5 ml, subcutaneous, any arm
Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles)

Fully Immunized Child
when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB)
Completely Immunized Child
All vaccines given but went beyond 0ne year of age

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