Copy of Communicable Disease Nursing
Content
COMMUNICABLE DISEASE NURSING COMMUNICABLE DISEASE Infectious Agent or its toxic products - AGENT Directly or Indirectly - MODE OF TRANSMISSION Person, Animal or Intermediate Vector – HOST Environment - ENVIRONMENT ECOLOGIC TRIAD OF DISEASE 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) CONTAGIOUS VS. INFECTIOUS Contagious Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host Infectious 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. NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS 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 A. RESIDENT ORGANISMS deeply seated in the epidermis, not easily removed by simple handwashing, Ex: Staphylococci B. TRANSIENT ORGANISM 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 FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE
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 STAGES OF INFECTIOUS PROCESS 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 2. AIRBORNE - droplet, dust, organisms in env. 3. VECTOR - insects or animals 4. VEHICLE - food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion) PREVENTION OF COMMUNICABLE DISEASE Prevention is worth a pound than cure PREVENTION OF COMMUNICABLE DISEASE 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) CONTROL OF C0MMUNICABLE DIESEASE 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 5. AIDS 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 Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease –frequency of disease occurrence Sporadic 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 Endemic Persistently present in the community all year round Ex: malaria in Palawan
Epidemic An unexpected increase in the number of cases of disease Pandemic 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 Therapeutic/Clinical 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 TERMS 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 FACTORS AFFECTING ISOLATION Mode of Transmission Source Status of the client’s defense mechanism Ability of client to implement precautions ISOLATION EPI 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 EPI
BCG - TB DPT – Diptheria, Pertussis, Tetanu OPV - Poliomyletis Hepatitis B Measles Immunization Contraindications -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 ºC 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 DPT 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 OPV 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 Measles 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 Measles Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) Immunization 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
Infectious Agent Bacteria – heama organism, systemic Virus – nuero organism, systemic Fungi – skin organism, local Protozoa – GI organism, local Infectious Agent FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE
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 STAGES OF INFECTIOUS PROCESS 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 2. AIRBORNE - droplet, dust, organisms in env. 3. VECTOR - insects or animals 4. VEHICLE - food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion) PREVENTION OF COMMUNICABLE DISEASE Prevention is worth a pound than cure PREVENTION OF COMMUNICABLE DISEASE 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) CONTROL OF C0MMUNICABLE DIESEASE 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 5. AIDS 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 Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease –frequency of disease occurrence Sporadic 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 Endemic Persistently present in the community all year round Ex: malaria in Palawan
Epidemic An unexpected increase in the number of cases of disease Pandemic 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 Therapeutic/Clinical 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 TERMS 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 FACTORS AFFECTING ISOLATION Mode of Transmission Source Status of the client’s defense mechanism Ability of client to implement precautions ISOLATION EPI 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 EPI
BCG - TB DPT – Diptheria, Pertussis, Tetanu OPV - Poliomyletis Hepatitis B Measles Immunization Contraindications -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 ºC 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 DPT 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 OPV 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 Measles 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 Measles Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) Immunization 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
