A​NGELES ​U​NIVERSITY ​FO

​ UNDATION
Angeles City
College of Nursing

Module 3 for Community Health Nursing 1 (Individual and Family as Clients)

1st semester, A.Y. 2020-2021 

MODULE OVERVIEW 
 
Introduction 
A  key  role  of  the  CHN  is  the  prevention  and  treatment  of  communicable 
diseases.  This  module  describes  the  language  of  communicable  disease  and  discusses 
the  goals  nurses  use  in  evaluating  the  success  of  disease  prevention  programs.  It  also 
examines  common  communicable  diseases  that  community  health  nurses  are  likely  to 
encounter in their practices. 
 
Key Points to Review 
Communicable disease​ - a disease or illness in a susceptible host, caused by a 
potentially harmful infectious organism or its toxic byproducts. Communicable disease 
spreads due to contact between an infectious agent and a susceptible host. 
 
Infectious disease​ - a disease or illness caused by an infectious agent entering the body 
of a susceptible host and then developing or growing. 
 
Host​ - a person or other living being that can be infected by an organism 
 
Infectious agent​ - an organism that causes infectious disease. Agents can be bacteria, 
fungi, viruses, metazoa, or protozoa. 
 
Agent​ - something that must be present in the environment for a disease to occur in a 
susceptible host. 
 
Endemic​ - when an infectious agent or disease has a constant presence within a 
defined geographic area. 
 
Epidemic​ - occurrences of an infectious agent or disease that clearly exceed the usual 
expected frequency of the disease in a particular population--for example, an influenza 
epidemic, when a large number of elderly people in a city get the flu. 
 
Pandemic​ - when an epidemic outbreak occurs worldwide. 
 
 
Tuberculosis 
 
Vulnerable populations:  
- Children 
- persons with HIV infection 
- persons  in  congregate  living  such  as  prisons,  shelters,  long-term  care  facilities, 
and dormitories 
- Poor, homeless people without access to health care or follow-up 
- Immigrants from countries where TB is endemic 
- People with HIV infection and compromised immune systems 
- Anyone with poor access to health care for follow-up 
 
Primary prevention strategies include: 
- Health promotion and education 
- Education on behaviors to reduce risk of transmission from infected persons 
- Education  about  environmental  factors  (sunlight,  ventilation)  that  can  reduce 
transmission 
- educating  the  public  about  the  need  to  complete  the  entire  course  of  drug 
treatment 
 
Secondary prevention strategies include: 
- Screening high-risk populations 
- Early diagnosis and treatment 
- minimizing the disease’s ability to spread throughout the community; 
- preventing  treatment  failures  from  individuals  with  poor  compliance  with  the 
lengthy, potentially complicated therapy program 
 
Tertiary prevention strategies include: 
- Monitoring long-term health status 
- Direct observation of therapy to ensure compliance with treatment 
 
Treatment: multidrug regimen with direct observation therapy to ensure compliance.  
 
Community  health  nurses  have  a  key  role  in  tuberculosis  prevention  and  treatment. 
They  can  identify  people  at  risk,  initiate  testing  programs,  do  follow-up  for  compliance 
and provide education. 
 
TB situation in the Philippines 
 
The  incidence  of  TB  is  considered  very  high,  and  an  increase  in  the  prevalence 
of  multidrug-resistant  TB  (MDR-TB)  and  Human  Immunodeficiency  Virus  (HIV)  makes  the 
disease  difficult  to  control.  The  country  ​ranks  4th  in  the  burden  of  TB  worldwide  with an 
estimated  22,000  deaths  in  2017  and  particularly  drug-resistant  (DR)  has  cost  a 
projected loss of 0.31 billion USD in the country’s Gross Domestic Product (GDP). 
 

 
 
  

 
 
 
 
 
You  may  get  the  global  tuberculosis report data in your 
mobile  phones.  You  can  get  current  statistics  and 
trends, compare countries and regions. 
 
  
 
 
 
 
Recent findings about TB 

   
https://doi.org/10.1038/s41598-019-45566-5   
 
Points to know from the study 
- The country has a high incidence of tuberculosis disease. 
- The  increasing  prevalence  of  multidrug-resistant  Mycobacterium  tuberculosis 
(MDR-TB) strains makes it difficult to control. 
- M. tuberculosis “Manila” ancient lineage 1 strain-type 
- Majority of the isolates (80.3%, 143/178) belonged to the lineage 1 Manila clade 
- Minority  belonged  to  lineages  4  (European-American,  18.5%)  and  2  (East  Asian, 
1.1%) 
- A high proportion of the isolates (19.1%) were found to be MDR 
 
The National Tuberculosis Control Program 
 
What is Tuberculosis? 

1. Highly infectious chronic disease caused by tubercle bacilli 

2. Ranks ​4th​
​ in the leading cause of mortality and morbidity (2019) 
3. S/sx​: hemoptysis, significant weight loss, chest/back pain, fever, cough 
4. Infectious agents: Mycobacterium tuberculosis 
5. MOT: Airborne droplet method 

 
Vision:​ A country where TB is no longer a public health problem 
Mission​:  Ensure  that  TB  DOTS  services  are  available,  accessible,  and  affordable  to  the 
communities in collaboration with the LGU’s and other partners 
Objectives: 
A. Improve  access  to  and  quality  of  services  provided  to  TB  patients,  TB 
symptomatic, and communities by health care institutions and providers. 
B. Enhance  the  health-seeking  behavior  on  TB  by  communities,  especially  the  TB 
symptomatic. 
C. Increases and sustain support and financing for TB control activities 
D. Strengthen management of TB control services at all levels. 
 
RA 10767 
AN  ACT  ESTABLISHING  A  COMPREHENSIVE  PHILIPPINE  PLAN  OF  ACTION  TO  ELIMINATE 
TUBERCULOSIS AS A PUBLIC HEALTH PROBLEM AND APPROPRIATING FUND THEREFOR 
 
Points to know about its legal basis: 
A. Comprehensive  Philippine  Plan  of  Action  to  Eliminate  Tuberculosis.  –  The 
Secretary  of  the  Department  of  Health  (DOH)  shall  establish  a  Comprehensive 
Philippine  Plan  of  Action  to  Eliminate  Tuberculosis  in  consultation  with 
appropriate  public  and  private  entities.  The  Philippine Plan of Action shall consist 
of the following: 
(a) The country’s targets and strategies in addressing the disease; 
(b)  The  prevention,  diagnosis,  treatment,  care  and  support,  and  other 
components of the country’s response; 
(c)  The  development  and  application  of  appropriate  technologies  to 
diagnose and treat the disease; 
(d) The strengthening of linkages with local and international organizations 
for  possible  partnership  in  education,  advocacy,  research  and  funding 
assistance; 
(e)  The  establishment  of  a  review  and  monitoring  system  to  gather  data 
and monitor the progress made in the elimination of tuberculosis; and 
(f)  The  immediate  mobilization  of  anti-TB  services  during  and  after  natural 
and  man-made  disasters  through  collaborative  efforts  of  national  and 
local governments and other entities. 
 
B. Strengthening of the Regional Centers for Health Development in the Provision of 
Health Services to Eliminate TB. – The Secretary of Health shall strengthen the 
Regional Centers for Health Development in the provision of health services to 
eliminate TB by undertaking the following activities: 
(a) Provide free laboratory services through the DOH retained hospitals; 
(b)  Provide  reliable  supply  of  drugs  to  patients  for  free  by  ensuring  that 
local  health  centers,  through  coordination  with  local  government  units 
 (LGUs)  concerned,  have  sufficient  supply  of  medicines  for  the 
communities they serve; 
(c)  Undertake  public  information  and  education  programs  to  train  the 
public on basic ways and means to prevent the spread of tuberculosis; 
(d)  Train  and  enhance  the  capability  of  health  providers  in  both  public 
and private hospitals; 
(e) Ensure the proper monitoring of tuberculosis cases in the country; and 
(f)  Ensure  that  monitoring  services  are  extended  as  far  as  practicable,  at 
the lowest local level health unit. 
 
C. Education  Programs.  –  The  Secretary  of  Health,  in  coordination  with  the 
Commission  on  Higher  Education  (CHED),  shall  encourage  the  faculty  of schools 
of  medicine,  nursing  or  medical  technology  and  allied  health  institutions,  to 
intensify  information  and  education  programs,  including  the  development  of 
curricula,  to  significantly  increase  the  opportunities  for  students  and  for 
practicing  providers  to  learn  the  principles  and  practices  of  preventing, 
detecting, managing, and controlling tuberculosis. 
 
D. Inclusion  in  Basic  Education.  –  The  Secretary  of  Health,  in  coordination  with  the 
Secretary  of  the  Department of Education (DepED), shall work for the inclusion of 
modules  on  the  principles  and  practices  of  preventing,  detecting,  managing 
and  controlling  tuberculosis  in  the  health  curriculum  of  every  public  and  private 
elementary and high school. 
 
E. Media  Campaign.  –  The  Secretary  of  Health,  in  coordination  with  the  Philippine 
Information  Agency  (PIA),  shall  encourage  local  media  outlets  to  launch  a 
media  campaign  on  tuberculosis  control,  treatment  and  management, using all 
forms of multimedia and other electronic means of communication. 
 
The  media  campaign  shall  include  materials  that  would  discourage  the 
general  public  from  spitting  in  public  places  and  exhibiting  unhygienic  behavior 
that tend to undermine the overall effort of preventing the spread of the disease. 
 
F. Regulation  on  Sale  and  Use  of  TB  Drugs.  –  The  Food  and  Drug  Administration 
(FDA)  shall  strengthen  its  implementation  of  the  “No  prescription,  No  anti-TB 
drugs”  to  regulate  the  sale  and  use  of  anti-TB  drugs  in  the  market.  It  shall  also 
ensure the quality of TB drugs distributed in the market. 
 
G. Notification  on  TB  Cases.  –  All  public  and  private  health  centers,  hospitals  and 
facilities  shall  observe  the  national  protocol  on  TB  management  arid  shall  notify 
the  DOH  of  all  TB  cases  as  prescribed  under  the  Manual  of  Procedures  of  the 
National TB Program and the Philippine Plan of Action on Tuberculosis Control. 
 
 H. PhilHealth  TB  Package.  –  The  Philippine  Health  Insurance  Corporation,  otherwise 
known  as  the  PhilHealth,  shall,  as  far  as  practicable, expand its benefit package 
for  TB  patients  to  include  new,  relapse  and  return-after-default  cases,  and 
extension of treatment. 
 
The  PhilHealth  shall  enhance  its  present  outpatient  Directly  Observed 
Treatment  Short  Course  (DOTS)  package  to  make  it more responsive to patients’ 
needs.  It  shall likewise increase the number of accredited DOTS facilities to widen 
target beneficiaries who may avail of reimbursements. 
 
Comprehensive Philippine Plan of Action to Eliminate Tuberculosis 
I. Vision = TB -free Philippines 
II. Mission: 
- To reduce TB burden (TB incidence and TB mortality) 
- To achieve catastrophic cost of TB-affected households 
- To responsively deliver TB service 
III. Program Components 
● Health Promotion 
● Financing and Policy 
● Human Resource 
● Information System 
● Regulation 
● Service Delivery 
● Governance 
IV. Target Population / Client = Presumptive TB and TB affected households 
V. Area of Coverage = Nationwide 
VI. Partner Institutions 
● Department of Health : Food and Drug Administration, Bureau of Quarantine 
● Other Government: DepEd, DSWD, DILG (BJMP), DOJ (BuCor) 
● Non Government Organizations: PhilCAT, PBSP 
● International Organizations: WHO, USAID, GFATM, ICRC, HIVOS-KNCV 
VII. Policies and Laws = RA 10767 : Comprehensive TB Elimination Plan Act of 2016 
VIII. Strategies, Action Points and Timeline 
2017-2022 Philippine Strategic TB Elimination Plan 
❏ Activate  communities  and  patient  groups  to  promptly  access  quality  TB 
services 
❏ Collaborate  with  other  government  agencies  to  reduce  out-of-pocket 
expenses and expand social protection programs 
❏ Harmonize  local  and  national  efforts  mobilize  adequate  and  competent 
human resources 
❏ Innovate TB information generation and utilization for decision making 
❏ Enforce standards on TB care and prevention and use of quality products 
 ❏ Value  clients  and  patients  through  integrated  patient-centered  TB 
services 
❏ Engage  national,  regional  and  local  government  units/  agencies  on 
multi-sectoral implementation of TB elimination plan 
 
Definition of Terms 
Active  TB  disease  –  a  presumptive  TB  case  that is  either bacteriologically confirmed or 
clinically diagnosed by the attending physician. 
  
Pulmonary  TB  (PTB)  –  refers  to  a case of  tuberculosis involving  the  lung  parenchyma. 
A patient with  both pulmonary and extrapulmonary tuberculosis should be  classified as 
a case of pulmonary TB. 
  
Extrapulmonary  TB  (EPTB)  – refers to  a case of  tuberculosis involving  organs other than 
the  lungs  (e.g.  larynx,  pleura,  lymph  nodes,  abdomen,  genito-urinary  tract,  skin,  joints 
and bones, meninges). 
  
Bacteriologically  confirmed  TB  (BCTB)  –  refers  to  a  patient  from  whom  a  biological 
specimen,  either  sputum  or  non-sputum  sample,  is  positive  for  TB  by  smear 
microscopy,  culture  or  rapid  diagnostic  tests  (such  as  Xpert  MTB/RIF,  line  probe  assay 
for TB, TB LAMP). 
  
Clinically  diagnosed  TB  (CDTB)  –  refers  to  a  patient  for  which  the  criterion  for 
bacteriological  confirmation  is  not  fulfilled  but  diagnosis  is  made  by  the  attending 
physicians  on  the  basis  of  clinical  findings,  X-ray  abnormalities,  suggestive  histology 
and/or other biochemistry or imaging tests. 
 
New​ – refers to a patient who has never had treatment for TB or who has taken anti-TB 
drugs for less than one month. Preventive treatment is not considered as previous TB 
treatment. 
 
Previously treated for TB​ – refers to a patient who had received one month or more of 
anti- TB drugs in the past. Also referred to as Retreatment. 
 
High risk for multidrug-resistant tuberculosis (MDR-TB)​ – previously treated for TB, new 
TB cases that are contacts of confirmed DR-TB (drug resistant TB) cases or 
non-converter among patients on DS-TB (drug sensitive TB) regimens. 
  
Rifampicin-resistant TB (RR-TB) ​ – resistance to rifampicin detected using phenotypic or 
genotypic methods, with or without resistance to other anti-TB drugs. It includes any 
resistance to rifampicin, whether monoresistance, multidrug resistance, polydrug 
resistance or extensive drug resistance. 
 
Turnaround time (TAT)​ – the time from collection of first sputum sample to initiation of 
treatment for TB. The desired turnaround time is five working days (also referred to as 
Program TAT). 
 
Systematic screening for pulmonary PTB in adults ≥ 15 years old with unknown HIV 
infection status in health facilities 

Systematic screening for the diagnosis of active PTB disease in PLHIV 

 
Systemic screening in health facilities (intensified case finding) 

Systematic  screening  in  facilities  shall  be  done  for  all  clients  visiting  the  facility 
regardless  of  reason  for  consultation.  If  the  patient  consults  due  to  any  of  the  four 
cardinal  signs/symptoms  (i.e.  at  least  two  weeks  of  cough,  unexplained  fever, 
unexplained weight loss and night sweats)  
 
The  following  steps  are  involved  in  screening  for  pulmonary  TB (PTB) in adults ≥ 15 years 
old: 
1.1 Record the patient’s demographic and contact information in a register of consults.  
1.2  Ask  all  patients  consulting  the health facility, if they have the following cardinal signs 
and symptoms that are lasting for ≥2 weeks: 
a. cough  
b. unexplained fever  
c. unexplained weight loss  
d. night sweats.  
1.3  If  any  of  the  above  signs/symptoms  are  present  for  at  least  two weeks, identify as a 
presumptive TB.  
1.4  For  those  who  do  not  have  any  of  the  cardinal  signs/symptoms  above  or 
experienced  it  for  less  than  two  weeks,  offer  chest  X-ray  screening  if  one  has  not  been 
conducted in the past year.  
 
A  ​chest  X-ray  posteroanterior  (PA)  upright  view  should  be  requested  and 
previous  chest  X-rays  should  be  brought for comparison. For ​pregnant women​, a written 
consent  shall  be  taken  and  an  abdominal  protective  shield  shall  be  used  by  the  X-ray 
facility.  The  National  TB  Prevalence  Survey  in  2016  showed  that  “screening  for  TB  cases 
using  symptoms  alone  would  have  missed  one-third  to  two-thirds  of  bacteriologically 
confirmed pulmonary TB cases.” 
If  resources  are  limited,  you  have  the  option  to  prioritize those with TB risk factors 
as primary clients for chest X-ray screening.  
Risk factors include: 
a. contacts of TB patients; 
b. those ever treated for TB (i.e. with history of previous TB treatment); 
c. people living with HIV (PLHIV); 
d. elderly (> 60 years old); 
e. diabetics; 
f. smokers; 
g. health-care workers; 
h. urban and rural poor (indigents); and 
i.  those  with  other  immune-suppressive  medical  conditions  (silicosis,  solid  organ 
transplant,  connective  tissue  or  autoimmune  disorder,  end-stage  renal  disease, 
chronic  corticosteroid  use,  alcohol  or  substance  abuse,  chemotherapy  or  other 
forms of medical treatment for cancer). 
 
NOTE:  If  a  chest  X-ray  is  not  available  and  these  high-risk  patients  have  signs  and 
symptoms  lasting  less  than  two  weeks,  the  physician  may  decide  whether  to  consider 
the patient a presumptive TB case. 
 
 Diagnosis and clinical application of Xpert/MTB RIF 

The following steps are involved in the screening for pulmonary TB (PTB) in children < 15 
years old: 

2.1  Ask  if  the  child  has  TB  signs  and symptoms. Identify as presumptive TB if the child has 

at least one of the three main signs and symptoms suggestive of TB: 
a.  coughing/wheezing  of  two  weeks  or  more,  especially  if  unexplained  (e.g. not 
responding to antibiotic or bronchodilator treatment);  
b.  unexplained  fever  of  two  weeks  or  more  after  common  causes  such  as 
malaria or pneumonia have been excluded; and 
c. unexplained weight loss or failure to thrive not responding to nutrition therapy. 
 
2.2  Ask  if  the  child  is  a  close  contact  of  a  known  TB  case.  If  the  child  is  a  contact,  the 
presence  of  fatigue,  reduced  playfulness,  decreased  activity,  not  eating  well  or 
anorexia  that  lasted  for  two  weeks  or  more  should  also  be  considered  and  identify 
them as a presumptive TB. 
 
2.3  If  the  child  already  has  a  chest  X-ray,  review  the  results.  If  chest  X-ray  findings  are 
suggestive of PTB, identify as presumptive TB. 
 
Screening  by  chest  X-ray  is  not  routinely  recommended  for  children,  except  for  TB 
household contacts who are 5 years old and above. 
 
2.4  For  all  PTB  identified,  ask  about  previous  history  of  treatment  and  exposure  to  TB 
case to determine risk for DR-TB. 
 
2.5  Record  the  patient.  Presumptive  TB  Master  List  and  follow  the  diagnostic  algorithm 
as outlined in the diagnostic section below. 
Approach to diagnosis of TB in children (< 15 years old) 

 
DIAGNOSIS OF TUBERCULOSIS DISEASE 

Once a presumptive TB case is identified,  

● Xpert  
● Smear Microscopy  
● TB LAMP 
 
Xpert 

➢ is a new test that is revolutionizing tuberculosis (TB) control by contributing to the 

rapid diagnosis of TB disease and drug resistance. 
➢ In two hours the test will be done  

Smear Microscopy 

➢ Sputum  smear  microscopy  allows  a  rapid  and  reliable  identification  of  patients 
with  pulmonary  tuberculosis  (PTB)  where  there  are  more  than  5000  bacilli/ml  of 
sputum. 
➢ If  the  sputum  has  less  than  5000  bacilli/ml,  smear  microscopy  is  highly  unlikely  to 
diagnose PTB. 

 
TB lamp 

➢ is a manual assay that requires less than one hour to perform and can be read 
with the naked eye under ultra violet light. 
➢ Following review of the latest evidence, WHO recommends that TB-LAMP can be 
used as a replacement for microscopy for the diagnosis of pulmonary TB in adults 
with signs and symptoms of TB. 
➢ It can also be considered as a follow-on test to microscopy in adults with signs 
and symptoms of pulmonary TB, especially when further testing of sputum 
smear-negative specimens is necessary. 
 
Collection of Sputum 

➔ Prepare  a  sputum  cup  or  50  ml  conical  tube  and  accomplish  Form  2a. 
Laboratory Request and Result Form.  
➔ Instruct  patient  to  expectorate  one  sputum  sample  on  the  spot  for  diagnostic 
testing  with  Xpert  (if  not  available,  SM  or  TB  LAMP).  Collect  1ml  for  Xpert MTB/RIF 
and TB LAMP and 3–5 ml for SM.  
➔ Collect  specimen  in  a  well-ventilated  designated  sputum  collection  area,  or 
outside the health facility.  
➔ Instruct the patient on how to expectorate: 
a. clean mouth by thoroughly rinsing with water  
b.  breathe  deeply,  hold  breath  for  a  second  or  two,  and  then  exhale 
slowly. Repeat the entire sequence two more times;  
c.  cough  strongly  after  inhaling  deeply  for  the  third  time  and  try  to  bring 
up sputum from deep within the lungs; and  
d. expectorate the sputum in the sputum cup or conical tube.  
 
➔ Sputum  induction  for  individuals  unable  to  expectorate  should  be  done  only  in 
facilities  where  the  staff  is  trained,  supplies  and  equipment  are  available,  and 
infection control measures are in place.  
➔ If  the  child  cannot  expectorate  (especially  <  5  years  old),  nasopharyngeal 
aspirate  or  gastric  lavage  may  be  performed  in  facilities  where  trained  staff, 
supply and equipment are available.  
➔ Label  the  body  of  the  sputum  cup/conical  tube,  indicating  patient’s  complete 
name and indicating the specimen for Xpert (or SM/TB LAMP).  
➔ Check quality of the sputum. 
➔ For  Xpert, testing should be performed on any collected spot sputum sample (i.e. 
a coughed-out sample) regardless whether it is sputum or saliva.  
➔ For  SM,  examine  the  specimen  to  see  that  it  is  not  just  saliva.  Mucus  from  the 
nose and throat, and saliva from the mouth are not good specimens. Repeat the 
process if necessary.  
➔ For  SM,  instruct  to  collect  a  second  sample  one  hour  later  or  an  early-morning 
sputum  sample  the  following  day.  Follow-up  within  three  days  if  patient  fails  to 
submit  a  second  specimen  unless  the  first  specimen  already  tests  positive  for 
acid-fast  bacillus  (AFB)  in  which  case  the  second  specimen  will  not  be 
necessary. 
 
 ➔ Seal  the  sputum  cup  or  conical  tube  and  transport  it  to  an  Xpert  site,  TB 
microscopy  laboratory  or  TB  LAMP  site  together  with  the  completed  Form  2a. 
Laboratory Request and Result Form.  
➔ If  the  laboratory  is  in  another  facility,  use  the  triple  packaging  system. 
(Reference:  Manual  on  Collection,  Storage  and  Transport  of  Specimens  for  TB 
testing,  http://bit.ly/CSTSManual)7.1  Place  the  primary  container  in  individual 
plastic bags. 
➔ Place  each  in  a  durable,  leak-proof,  water-tight  and  properly  sealed  container 
(i.e. biological bottles or plastic jars as secondary containers).  
➔ Enclose in the sputum transport box (tertiary container). 
➔ Transport  at  cold  temperature  by  placing  cold  packs  inside  the  tertiary 
container.  
➔ Accomplish a dispatch list. 
➔ Specimens  for  SM  can  also  be  smeared  immediately  by  trained  volunteers  and 
then stored appropriately before transport to the TB microscopy laboratory. 
➔ For  diagnosis  of  EPTB,  facilities  with  the  necessary  capability  can  collect  body 
fluid samples or tissue biopsy sample from the suspicious site. Refer if necessary.  
 

TREATMENT OF TUBERCULOSIS DISEASE 

PROCEDURES 

Initiation  of  treatment  Inform  the  patient  that  they  have  TB  disease.  Provide  key 
messages  for  TB  patients  and  families:  Basic  information  about  TB  disease  covering: 
cause,  transmission,  clinical  signs  and  symptoms;  how  TB  is  diagnosed;  and  how  to 
prevent TB  

● Duration  of  treatment:  six months for DS-TB, 12 months for severe drug susceptible 

EPTB, and 9–20 months for DR-TB cases  
● The  schedule  of  regular  clinical  and  laboratory  follow-up  for  treatment 
monitoring  
● Potential adverse events during treatment and how to address them  
● The relevance of contact investigation and TB preventive treatment (TPT)  
● Tracing mechanism in case of treatment interruption (missed dose)  
● Availability of free-of-charge services for TB diagnosis and treatment and TPT  
● Discuss  with patients their social and financial needs and offer possible sources of 
social  support  to  enable  adherence  to  treatment  (e.g.  Department  of  Social 
Welfare  and  Development,  Social  Security  System,  Government  Service 
Insurance  System,  Employees  Compensation  Commission,  local  government 
units (LGUs), etc.)  

 
  

 
  

 
  

DOTS (Direct Observed Treatment Short Course) 

“TUTOK GAMUTAN” 

supervision  of  patients  undergoing treatment. It is a concept where health care workers 

(treatment  partners)  watch  as  each  patient  takes  the  correct  medication  daily, 
especially  during  the  intensive  phase,  and  conduct  weekly  supervision  during  the 
maintenance phase. 

Two Anti-TB Drug Formulations 

1. Fixed-dose combination – 2 or more first line anti-TB drugs combined in one 

tablet. 
Rifampicin 450mg - red orange colored urine 
Isoniazid (INH) 100mg – peripheral neuritis 
Pyrazinamide 500mg - hyperuricemia 
Ethambutol 400mg – visual problems 
Streptopmycin 1gm - ototoxic 
2. Single drug formulation – each drug prepared individually. 
Myrin P-Forte (RIPE), Myrin P (RIE) 
➔ Quality of FDCs must be ensured. 
➔ PTB  symptomatics  asked  to  undergo  other  tests  only  after  3  consecutive  sputum 
specimens yielding negative results. 
 ➔ No  TB  diagnosis  shall  be  made  on  the  X-ray  results  alone.  PPD  skin  test  is  not  a 
basis for TB diagnosis in adults.  
➔ Implementation of passive case finding. 
➔ Only  trained  medical  technologists  or  microscopists  (and  trained  Brgy.  Health 
Workers) shall perform DSSM 
➔ Patients  recommended  for  Hospitalization  includes  those  with  the  following 
conditions: 
-massive hemoptysis 
-pleural effusion  
-miliary TB 
-TB meningitis 
-TB pneumonia 
-requiring surgical interventions or with complications. 
➔ Management of DS-TB in special situations: 
◆ For  pregnancy  -  Most  anti-TB  drugs  are  safe  for  pregnant  women  except 
Streptomycin – ototoxic for fetus 
◆ For  lactating  mothers,  advise  them  to  breastfed  baby  before  taking  TB 
drugs 
◆ Rifampicin  interacts  with  oral  contraceptive  medications  with  a  risk  of 
decreased protective efficacy against pregnancy.  
 
Sexually transmitted diseases (STDs) 
Although  there  are  many  types  of  communicable  diseases,  a  major  focus  of  a 
community  health  nurses’s  prevention  efforts  are  sexually  transmitted  diseases  (STDs), 
which  are  spread  through  sexual  contact.  This  module  will  review  the  different  types of 
STDs,  their  characteristics,  and  the  role  of  the community health nurse in preventing the 
spread of STDs. 
 
Prevention and Control Program on Sexually Transmitted Infections 

STIs  include  Gonorrhea,  Syphilis,  Chlamydia,  Trichomoniasis,  Gardianella  Vaginitis, 

Hepatitis  B  and  HIV/AIDS.  Among  these  STIs,  the  following  are  treatable:  Chlamydia, 
Gonorrhea, Trichomoniasis and Syphilis (with antibiotics) 
 
Bacterial  sexually  transmitted  diseases​/STDs  in  this  category  are  caused  by  a  bacterial 
infectious  agent.  Many  bacterial  sexually  transmitted  diseases  are  treated  with 
antibiotics,  although  strains  of  drug-resistant  bacterial  STDs  are  becoming  more 
common. 
 
Gonorrhea​ – Neisseria gonorrheae 
s/sx: burning urination and pus discharges 
This  STD  is  a  frequently  occurring  infection  that  affects  over  a  million  Americans  each 
year. It often occurs in tandem with chlamydia. 
Symptoms  include  discharge  and  pain on urination for men. Many women do not have 
symptoms, or infection presents only as mild discomfort during urination. 
Vulnerable populations include: 
 - Sexually active people (gonorrhea can infect the genitals, throat, or anus) 
- Newborns during birth 
- Children who are sexually abused 
- Anyone  who  has  sex  with  a  carrier,  a  person  who  harbors  the  infectious  agent 
without ever showing symptoms of the disease 
Treatment  is  a  course  of antibiotics. Some gonorrhea strains have developed resistance 
to antibiotics. 
 
Syphilis​ – Treponema pallidum 
s/sx: painless chancre (sore) at site of entry of germs, swollen gums 
This STD can lead to serious debilitating disease if left untreated.  
Syphilis has three stages: 
- Primary: characterised by a painless lesion at site of entry of bacterium 
- Secondary: characterised by infectious lesions and flu-like symptoms 
- Tertiary:  if  left  untreated,  syphilis  progresses  to  the  tertiary  stage  which  includes 
mental deterioration and other complications. 
Vulnerable  populations  include  sexually  active  persons,  newborns infected during birth, 
and women (who may not have symptoms). 
Syphilis is treated with penicillin. 
 
Chlamydia​ – Chlamydia tranchomatis 
The  most  frequently  reported  STD  in  the United States. Its symptoms can include vaginal 
discharge,  burning  on  urination,  and  pain  during  intercourse  for  women,  and  itching 
and burning around the penis for men. 
The  most  vulnerable  populations  are  sexually  active  people.  Chlamydia infection often 
has  no  symptoms,  and those with the infection may pass it on to others without knowing 
it. Newborns may also be infected during delivery. 
Treatment  is  a  regimen  of  antibiotics.  Treatment  for  gonorrhea  is  generally  given  at the 
same time, since infection with both diseases often occurs. 
 
Trichomoniasis​ – ​trichomonas vaginalis 
s/sx: Females – white or greenish-yellow odorous discharge 
Males – clear discharge 
 
Commonly  called  “trich,”  this  STD  affects 2 to 3 million Americans each year. Symptoms 
in  women  generally  include  a  greenish-yellow  vaginal  discharge  with  a  foul  odor,  as 
well  as  burning  and  painful  urination.  Men  may  have  mild  irritation  or  tingling  sensation 
in the penis. 
Vulnerable  populations  include  all  sexually  active  people  especially  women. 
Trichomoniasis often occurs along with gonorrhea and may facilitate HIV infection. 
Treatment  is  a  dose  of  metronidazole.  Screening  and  treatment  for  other  STDs  is 
recommended on finding trichomoniasis. 
 
Gardianella vaginitis​ ​– slight grayish or yellow odorous vaginal discharge 
 
Hepatitis B​ ​– most serious (massive liver damage and hepatocarcinoma of the liver) 
 
 
Virally  Sexually  Transmitted  Diseases.  STDs  in  this  category  are  caused  by  a  viral 
infectious  agent.  There  is  no  cure  for  virally  sexually  transmitted  diseases,  although  in 
some cases the virus can be controlled. 
 
HUMAN PAPILLOMAVIRUS. 
The  HPV  infects  the  anal  and  genital  area,  and  is  found  in  an  increasing  number  of 
people in United States. 
- HPV is often asymptomatic. 
- Some people with HIV develop genital warts, which are highly contagious. 
- The  most  vulnerable  population  is  young  people;  they  are  often infected but do 
not know it. 
- People  who  develop  genital  warts  are  at  higher risk of developing cancer of the 
cervix, anus, penis, and vulva. 
- Treatment  of  HPV  consists  of  removing  warts  through  chemical  applications, 
cryotherapy, laser, or electrosurgery to reduce chance of transmission. 
- Removal  of  the  warts,  however,  is  not  a  cure:  an  outbreak  can  reoccur  months 
or years later. 
 
HERPES SIMPLEX VIRUS 2. 
The HSV-2 is also known as genital herpes. 
HSV-2  is  a  contagious,  chronic  infection  that  causes  sores  in  and  around  the  vaginal 
area or anal area, on the penis, and the buttocks or thighs. 
Symptoms  include:  burning  sensation  in  the  genitals,  low  back  pain,  pain  on  urination, 
and flu-like symptoms may accompany the initial outbreak. 
The  most  vulnerable  populations  are  sexually  active  people  and  newborns  infected by 
contact  with  lesions  during  birth.  Cesarean  section  delivery  may  be  used  to  avoid 
exposing the newborn to genital lesions. 
There  is  no  known  cure  for  HSV-2  infection.  Antiviral  medications  can  reduce  duration 
and symptoms of an outbreak. 
 
HIV/AIDS​ ​– Retrovirus – Human T-cell lymphotrophic virus 3 
ACQUIRED IMMUNODEFICIENCY SYNDROME(AIDS) 
 
AIDS  is  caused  by  infection  with  the  human  immunodeficiency  virus  (HIV),  a  retrovirus 
that attacks the body’s infection-fighting cells. The infected person becomes vulnerable 
to a range of diseases. HIV/AIDS ultimately causes destruction of the immune system. 
 
Vulnerable populations:  
- Anyone having unprotected sex or sharing needles with infected persons 
- Babies born to HIV-positive mothers 
- People exposed to blood products or tissues of infected persons 
Primary prevention of AIDS: 
 - Avoid  sexual  intercourse  or  maintain  mutually  monogamous  sexual  relationship 
with uninfected person 
- Avoid sharing needles 
Secondary prevention: 
- Low-cost testing, especially for pregnant women 
- Drug treatment facilities 
- Protecting health care workers from exposure 
Tertiary prevention: 
- Connecting clients with appropriate support agencies 
- Informing clients of new treatments that improve outcomes 
Treatment  of  AIDS  includes  protease  inhibitors  and  reverse  transcriptase  inhibitors, 
designed to keep the virus from reproducing and destroying disease-fighting cells. 
 
Diagnosis: 
Enzyme Linked Immuno-Sorbent Assay (ELISA) – presumptive test 
Western blot – confirmatory test 
 
The NEW law for HIV/STI 
 
20  years  after  the  first  HIV/AIDS  law  in  the  Philippines,  the  President  signed  into  law  the 
Philippine  HIV  and  AIDS  Policy  Act  of  2018  ​(Republic  Act  11166)​.  The  WHO  welcomes 
the  new  law  as  it  helps  elevate  attention  to  HIV/AIDS  and  address  some  of  the  critical 
bottlenecks in the HIV programme in the Philippines.  
 
HIV  continues  to  be  a  serious  health  threat  in  the  country  with  a  record  high  of  32 
reported infections per day. 
 
​Republic Act 11166 
 
1. This will help in expanding access to evidence-based HIV prevention strategies. 
2. Access  to  the  means  to  prevent  sexual  transmission  of  HIV  and  transmission 
associated  with  drug  use  such  as  condoms  and  other  commodities  remains  a 
critical need for curbing the rising epidemic. 
 
HIV/STI PREVENTION PROGRAM 
Objective:  ​Reduce  the  transmission  of  HIV  and  STI  among  the  Most  At  Risk  Population 
and  General  Population  and  mitigate  its  impact  at  the  individual,  family,  and 
community level. 
  
 
Program Activities: 
With  regards  to  the  prevention  and  fight  against  stigma  and  discrimination,  the 
following are the strategies and interventions: 
1. Availability of free voluntary HIV Counseling and Testing Service; 
2.  100%  Condom  Use  Program  (CUP)  especially  for  entertainment 
establishments; 
3. Peer education and outreach; 
 4.  Multi-sectoral  coordination  through  Philippine  National  AIDS  Council 
(PNAC); 
5. Empowerment of communities; 
6. Community assemblies and for a to reduce stigma; 
7. Augmentation of resources of social Hygiene Clinics; and 
8.  Procured  male  condoms  distributed  as  education  materials  during 
outreach. 
 
STI-HIV/AIDS 
HIV  is  the  Human  Immunodeficiency  Virus.  It  is  the  virus  that  causes  Acquired 
Immunodeficiency  Syndrome  or  AIDS.  It  harms  your  immune  system  by  destroying  the 
white  blood  cells  that  fight  infection.  This  puts  you  at  risk  for  serious  infections  and 
certain cancers. 
 
AIDS  stands  for  acquired  immunodeficiency  syndrome.  It  is  the  final  stage  of  infection 
with HIV. Not everyone with HIV develops AIDS. 
HIV  most  often  spreads  through  unprotected  sex  with  an  infected  person.  It  may  also 
spread  by  sharing  drug  needles  or  through  contact  with  the  blood  of  an  infected 
person. Women can give it to their babies during pregnancy or childbirth. 
The  first  signs  of  HIV  infection  may  be  swollen  glands  and  flu-like  symptoms.  These  may 
come  and  go  within  two  to  four  weeks.  Severe  symptoms may not appear until months 
or years later. 
 
A  blood  test  can  tell  if  you  have  HIV  infection.  Your  health  care  provider  can  do  the 
test, or you can use a home testing kit. Or to find free testing sites.  
There  is no cure, but there are many medicines that fight HIV infection and lower the risk 
of  infecting  others.  People  who  get  early  treatment  can  live  with the disease for a long 
time. 
 
A. Overview and Objectives of the Program: 
  According  to  the  World  Health  Organization  (WHO),  nearly  a  million  people 
currently acquire STIs which includes the Human Immunodeficiency Virus (HIV) 
globally.  The  presence  in  a  person  of  other  STIs  greatly  increases  the  risk  of 
acquiring  or  transmitting  HIV.  It  is  initially  seen  among  what  we  call  key 
populations  which  include  Males  who  have  Sex  with  Males  (MSM), 
Transgender (TG), People Who Inject Drugs (PWID) and Freelance Sex Workers 
(FSW).  
 
The  Philippines  is  one  of  the  countries  with  rapidly  increasing HIV/ AIDS cases. 
Here  in  the  Central Luzon, a total of 385 cases has been diagnosed from 1984 
to  October  2017.  Our  prevalence  rate  is  2.06%  which  is  above  the  National 
Health  Target  of  maintaining  a  1%  and  below  prevalence  rate.  Seventy 
percent  (70%)  of  the  diagnosed  cases  are  from  Baguio  City  affecting  mostly 
Men  having Sex with Men (MSM). Looking further, the city has an 8% HIV/ AIDS 
prevalence  rate  from  1984  to  present.  For  the  other  provinces  and  city, 
prevalence rate is below 1% in 2017.  
New Program Thrusts: 
Vision:​ Zero New Infections, Zero Discrimination, Zero AIDS-related Deaths 
Goal:  By  2020​,  the  country  will  have  maintained  a  prevalence of less than 66 HIV cases 
per  100,000  population  by  preventing  the  further  spread  of  HIV  infection  and providing 
treatment  care  and  support  to  reduce  the  impact  of  the  disease  on  individuals, 
families, sectors and communities. 
Purpose  (Outcome)​:  To  contain  and  prevent  the  further  spread  of  HIV  among  key 
populations  with  four  (4)  strategies  that  enabled  strengthened  delivery  of  essential 
services (prevention, treatment and care interventions).  
Objectives National Targets to Achieve from 2015-2020:  
1. Maintain a prevalence rate of less than 1% HIV prevalence.  
2. Reduction of HIV incidence among MSM to <50%.  
3. Reduction to < 1.5% of syphilis among the key population. 
Program Strategies  
1.  Continuum of HIV/ STI prevention, diagnosis, treatment and care services to 
key populations.  
2.  Health promotion and Communication on HIV and STI Prevention and Care 
Services.  
3. Enhanced strategic information systems. 
4. Strengthened health system platform for broader health outcomes. 
ROLES OF THE DEPARTMENT OF HEALTH: 
- Policy dissemination 
-  Capacitate  health  facilities  to  promote  the  continuum  of  HIV/  STI  prevention, 
diagnostic, treatment and care services to key populations 
- Provide information on HIV and STI services promotion 
- Logistics augmentation to health facilities providing STI and HIV/ AIDS services 
- Enhance strategic information campaign regionwide  
-  Conduct  monitoring  and  evaluation  activities  to  identify  gaps  and  propose  tangible 
plans.  
ROLES OF LOCAL GOVERNMENT UNITS (LGUs): 
- Implement policies/ issuances on STI HIV/ AIDS 
- Conduct mapping of affected key populations 
- Support establishment of Local AIDS Council 
- Ensure adequate supply of logistics needed in providing quality STI and HIV services  
- Strengthen advocacy strategies for STI and HIV awareness across key populations 
- Advocate for STI and HIV testing especially among key populations 
-  Network  with  various  agencies  and  NGOs  for  wider  coverage  of  STI  services  and 
advocacy 
-  Capacitate  frontline  heath  workers  in  providing  STI  HIV/  AIDS  awareness,  skills  in 
counseling and testing etc. 
-  Support  HIV  awareness  and  counseling  activities  by  strategically  employing  trained 
peer educators 
FUTURE PLANS/ STRATEGIES (2018-2022)  
1.  Continuum  of  HIV/  STI  prevention,  diagnostic,  treatment  and  care  services  to  key 
populations: (Training- e.g HIV counseling and testing, Reagents and Medicines) 
2.  Expand  the  platform  for  publicizing  STI  services  The  health  services  in  our  trained 
facilities  has  to  be  promoted  to  increase  consultations,  enrollment  to  support and care 
services, thereby decreasing the further spread of STIs and HIV.  
3. Enhance strategic information For the LGU to continuously conduct the following:  
   a.  Monitor  and  prevent  the  spread  of  STI  case  in  their  areas,  and  to  conduct 
mapping of key affected population  
  b.  Organize,  analyze  and  use  their  own  data  to  intensify  and  customize 
strategies 
4. Strengthen health system platform for broader health outcomes  
5. Expansion of STI HIV/ AIDS service delivery spots through the following: 
a. Creation of an STI HIV/ AIDS hotline  
b. Support establishment and operations of HIV/ AIDS support groups  
c. Support to provincial/ city mobile testing initiatives 
d.  Increase  collaboration  with  LGUs  and  NGOs  in the conduct of community HIV 
screening  (community  or  facility  based)  with  emphasis to proper counseling and 
referral to prevent loss to care.  
e. Promotion of the creation of sundown clinics. 
f.  Establishment  of  Rapid  HIV  Diagnostic  (rHIVda  sites)  with  prioritization  per  year 
as per guideline of the DOH-Central Office  
6.  Ensuring  continuous  supply  of  logistics  to  health  facilities  providing  STI  and  HIV 
services.  A  logistics  supply  management  system  or  mechanism  will  be  placed  in  these 
facilities to ensure good flow of supply and demand. 
7.  Expand  tri-media  advocacy  campaigns  on  STI  HIV/  AIDS  prevention  and 
management  (radio  shows,  newsprint,  social  media,  videos,  awarding  of  best 
practices) 
 
=== 
COVID 19 (Novel CoronaVirus) 
 
The  coronavirus  disease  (COVID-19)  is  an  infectious  disease  caused  by  a  new  strain  of 
coronavirus.  This  new  virus  and  disease  were  unknown  before  the  outbreak  began  in 
Wuhan, China, in December 2019. 
 
On  30  January  2020,  the  Philippine  Department  of  Health  reported  the  first  case  of 
COVID-19  in  the  country  with  a  38-year-old  female  Chinese  national.  On  7  March,  the 
first  local  transmission  of  COVID-19  was  confirmed.  WHO  is  working  closely  with  the 
Department of Health in responding to the COVID-19 outbreak. 
 
Out  of  the  total  47,873  confirmed  cases  reported  in  the  Philippines  until  today,  56%  are 
male,  with  the  most  affected  age  group  30-39  years  (23.7%)  followed  by  20-29  years 
(22.6%)  -  47.0%  of  cases  reported  from  National  Capital  Region  (NCR),  followed  by 
Central  Visayas  (20.6%),  CALABARZON  (7.2%),  and  Central  Luzon  (2.5%).  Largest 
increase  in  new  cases  from  Cebu  City  in  Central  Visayas.  -  Out  of  the  1,309  confirmed 
deaths,  62%  are  male, with the most affected age group over 70 years (34.7%) followed 
by 60-69 years (29.2%) - 66.7% of deaths reported from NCR, followed by Central Visayas 
(12.3%), CALABARZON (10.9%), and Central Luzon (2.9%).  
 
Largest  increase  in  new  deaths  from  Central  Visayas.  -  Increasing  number  of  areas 
reporting  first  positive  cases,  with  travel  history  from  areas  with  transmission,  including 
returning  Locally  Stranded  Individuals  (LSI)  -  Department  of  Health  (DOH)  and  WHO 
emphasizing  the  need  for  compliance  of  proper  implementation  of  guidelines  at  LGU 
level,  especially for high risk groups such as LSI - Increasing number of hospitals reporting 
100%  occupancy  rate  for  COVID-19  dedicated  beds,  with  some  no  longer  accepting 
new cases - 83.4% of health facilities daily reporting to DOH’s  
 
Diagnosis for Covid-19 
Two kinds of tests are available for COVID-19: ​viral tests​ and ​antibody tests​. 
● A viral test tells you if you have a current infection. 
● An  antibody  test  might  tell  you  if  you  had  a  past  infection.  An  antibody  test 
might  not  show  if  you  have  a  current  infection  because  it  can  take  1–3  weeks 
after  infection  for  your  body  to  make  antibodies.  Having  antibodies  to  the  virus 
that  causes  COVID-19  might  provide  protection  from  getting  infected  with  the 
virus again. If it does, we do not know how much protection the antibodies might 
provide or how long this protection might last. 
 
Signs and Symptoms 
Most common symptoms: 
1. fever 
2. dry cough 
3. tiredness 
Less common symptoms: 
1. aches and pains 
2. sore throat 
3. diarrhoea 
4. conjunctivitis 
5. headache 
6. loss of taste or smell 
7. a rash on skin, or discolouration of fingers or toes 
Serious symptoms: 
1. difficulty breathing or shortness of breath 
2. chest pain or pressure 
3. loss of speech or movement 
On  average  it  takes  5–6  days  from  when  someone  is  infected  with  the  virus  for 
symptoms to show, however it can take up to 14 days. 
 
Treatment 
To  date,  ​there  are  no  specific  vaccines  or  medicines  for  COVID-19.  Treatments  are Self 
care: 
If  you  feel  sick  you  should  rest,  drink  plenty  of  fluid,  and  eat  nutritious  food.  Stay  in  a 
separate  room  from  other  family  members,  and  use  a  dedicated  bathroom  if  possible. 
Clean and disinfect frequently touched surfaces. 
 
Everyone  should  keep  a  healthy  lifestyle  at  home.  Maintain  a  healthy  diet,  sleep,  stay 
active,  and  make  social  contact  with  loved  ones  through  the  phone  or  internet. 
Children  need  extra  love  and  attention  from  adults  during  difficult  times.  Keep  to 
regular routines and schedules as much as possible. 
 
It  is  normal  to  feel  sad,  stressed,  or  confused  during  a  crisis.  Talking  to  people  you  trust, 
such  as  friends  and  family,  can help. If you feel overwhelmed, talk to a health worker or 
counsellor. 
Protect yourself and others from the spread COVID-19 
 
You  can  reduce  your  chances  of  being  infected  or  spreading  COVID-19  by  taking 
some simple precautions: 
● Regularly  and  thoroughly  clean  your  hands  with  an  alcohol-based  hand  rub  or 
wash them with soap and water.  
● Maintain at least 1 metre (3 feet) distance between yourself and others.  
● Avoid going to crowded places.  
● Avoid touching eyes, nose and mouth.  
● Make  sure you, and the people around you, follow good respiratory hygiene. This 
means  covering  your  mouth  and  nose  with  your  bent  elbow  or  tissue  when  you 
cough  or  sneeze.  Then  dispose  of  the  used  tissue  immediately  and  wash  your 
hands.  
● Stay  home and self-isolate even with minor symptoms such as cough, headache, 
mild  fever,  until  you  recover.  Have  someone  bring  you  supplies.  If  you  need  to 
leave your house, wear a mask to avoid infecting others. 
● If  you  have  a  fever,  cough  and  difficulty  breathing,  seek  medical  attention,  but 
call  by  telephone  in  advance  if  possible  and  follow  the  directions  of  your  local 
health authority.  
● Keep  up  to  date  on  the  latest  information  from  trusted  sources,  such  as  WHO  or 
your local and national health authorities.   
 
Safe use of alcohol-based hand sanitizers 
To  protect  yourself  and  others  against  COVID-19,  clean  your  hands  frequently  and 
thoroughly.  Use  alcohol-based  hand  sanitizer  or  wash  your  hands  with soap and water. 
If you use an alcohol-based hand sanitizer, make sure you use and store it carefully. 
○ Keep  alcohol-based  hand  sanitizers  out  of  children’s  reach.  Teach  them 
how to apply the sanitizer and monitor its use. 
○ Apply  a  coin-sized  amount  on  your  hands. There is no need to use a large 
amount of the product. 
○ Avoid  touching  your  eyes,  mouth  and  nose  immediately  after  using  an 
alcohol-based hand sanitizer, as it can cause irritation. 
○ Hand  sanitizers  recommended  to  protect  against  COVID-19  are 
alcohol-based  and  therefore  can  be  flammable.  Do  not  use  before 
handling fire or cooking. 
○ Under  no  circumstance,  drink  or  let  children  swallow  an  alcohol-based 
hand sanitizer. It can be poisonous.  
○ Remember  that  washing  your  hands  with  soap  and water is also effective 
against COVID-19 
 
REFERENCES 
Books 
Lundy, K. S. & Janes, S. (2016). Communtiy Health Nursing: Caring for the Public’s 
Health. Jones & Bartlett Learning. Burlington, MA. 
Cuevas, F. P. L. (Ed). (2007). Public Health Nursing in the Philippines. Manila: 
Publications Committee, National League of Philippine Government Nurses, Inc. 
Gesmundo, M. H. et al. (2010). The Basics of Community Health Nursing: A Study 
Guide for Nursing Students and Local Board Examinees. Quezon City. 
 Carroll, Patricia L. (2009). Community Health nursing: A practical guide. Thomson 
Learning Inc. New York, USA. 
Bailon-Reyes, S. (2006). Community Health Nursing: The Basics of Practice. National 
Bookstore. Mandaluyong city. 
Web Resources 
National TB Control Program - Philippines 
HIV/STI Prevention Program 
UNAIDS Philippines 
The End TB Strategy 
Emerging respiratory viruses, including COVID-19: methods for detection, prevention, 
response and control 
 
 
Prepared by: 
Shannon Rey P. Pelayo, RN, MAN 
Nadine Victoria L. Layson-Lising, RN 
NCM 104 Instructors 
 
Peer Evaluated by: 
Bianca Margarita E. Tizon, RN, LPT, MSN 
RLE Instructor 
 
Review and Evaluated by: 
 
Hydee M. Pangilinan, RN, MAN 
CHN Coordinator 
 
Jennie C. Junio, RN, MAN 
Level II Academic Coordinator 
 
 
Approved by:  
 
ZENAIDA S. FERNANDEZ, RN, Ph.D. 
Dean, CON