Epidemiology and

Public Health
LESSON 7

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

MELODIE CLAIRE W. JUICO, LPT, MAED

Outline

• Epidemiology
• Interactions Among Pathogens, Hosts and the Environment
• Chain of Infection
• Reservoirs of Infection
• Modes of Transmission
• Public Health Agencies
• Bioterrorism and Biological Warfare Agents
• Water Supplies and Sewage Disposal
• Healthcare-Associated Infections
• Infection Control
 Epidemiology
• Healthcare epidemiology: the study of the occurrence, determinants,
and distribution of health and disease within healthcare settings
facilities
• The primary focus of healthcare epidemiology is on infection control
and the prevention of healthcare-associated infections
• Epidemiologists study the factors that determine the frequency,
distribution, and determinants of diseases in human populations.
• Infectious diseases can be divided into 2 categories:

1. Those acquired within healthcare facilities (healthcare-

associated infections)
2. Those acquired outside of healthcare facilities (community-
acquired infections)
 Epidemiologic Terminology

• A communicable disease is an infectious disease that can be transmitted

from one person to another
• A contagious disease is a communicable disease that is easily transmitted
from person-to-person.
• Zoonotic diseases are diseases that humans acquire from animal sources.
• The incidence of a particular disease is the number of new cases of that
disease in a defined population during a specific time period.
• The morbidity rate is the number of new cases of a particular disease
that occurred during a specified time period per a specifically defined
population (usually per 1,000, 10,000 or 100,000 population).
cont.

• Prevalence
– Period prevalence is the number of cases of a disease existing in a given
population during a specific time period (e.g., during the year 2009).
– Point Prevalence is the number of cases of a disease existing in a given
population at a particular moment in time (e.g., right now).

• Mortality rate is the ratio of the number of people who died of a

particular disease during a specified time period per a specified
population
 cont.

• A sporadic disease is one that occurs only occasionally within the

population of a particular geographic area; ex: tetanus.
• An endemic disease is one that is always present within the population of
a particular geographic area; ex: Malaria (Plasmodium spp.)
• An epidemic disease is defined as a greater than usual number of cases of
a disease in a particular region, usually within a short period of time;
ex: the Polio, measles
 cont.

•A pandemic is a disease that is occurring in

epidemic proportions in many countries
simultaneously.
Ex:
– Influenza
•Examples: (1) the Spanish flu pandemic of 1918 during
which more than 20 million people were killed worldwide
(500,000 in the U.S.); (2) the H1N1 (“swine flu”) pandemic
of 2009-2010; (3) Coronavirus pandemic of 2019 to present
 Interactions Among Pathogens, Hosts, and the Environment
• Whether an infectious disease occurs depends on:
– Factors pertaining to the pathogen (e.g., virulence of pathogen, mode
of entry, number of organisms)
– Factors pertaining to the host (e.g., health status, nutritional status,
hygiene, age, travel, lifestyle, etc.)
– Factors pertaining to the environment (e.g., physical factors such as
climate, season, geographic location; availability of appropriate
reservoirs; sanitary and housing conditions; and availability of
potable water
 The Chain of Infection
• There are 6 components in the infectious disease process:
• 1. a pathogen
• 2. a source of the pathogen (a reservoir)
• 3. a portal of exit
• 4. a mode of transmission
• 5. a portal of entry
• 6. a susceptible host
 Reservoirs of Infection

•The sources of microorganisms that cause infectious

diseases are many and varied; they are known as
reservoirs of infection or simply reservoirs.
– Living reservoirs – humans, pets, farm animals, insects,
arachnids
– Human carriers:
•Passive carriers
•Convalescent carriers
•Active carriers
cont.

•Animals
– Infectious diseases that humans acquire from animal
sources are called zoonotic diseases or zoonoses.
– Zoonoses may be acquired by direct contact with an
animal, inhalation or ingestion of the pathogen, or
injection of the pathogen by an arthropod.
•Examples:
• Rabies
• COVID 19
 Reservoirs of Infection, cont.

• Arthropods
– Many different types of arthropods serve as reservoirs of infection,
including insects (e.g., fleas, mosquitoes, lice) and arachnids (e.g.,
mites and ticks)
– When arthropods are involved in the transmission of infectious
diseases they are referred to as vectors.
• Examples of arthropod-borne diseases:
• Dengue fever
• Malaria
 cont.

• Nonliving Reservoirs
– Air, soil, dust, contaminated water
and foods, and fomites
– Fomites - inanimate objects capable
of transmitting pathogens (e.g.,
bedding, towels, eating and
drinking utensils, hospital
equipment, telephones, computer
keyboards, etc.)
Inanimate Vectors of Infection (Fomites)
 Most Common Modes of Transmission
of Infectious Diseases

• Direct skin-to-skin contact

• Direct mucous membrane-to-mucous membrane contact by kissing or sexual intercourse

• Indirect contact via airborne droplets of respiratory secretions, usually produced by sneezing or
coughing

• Indirect contact via food and water contaminated by fecal matter

• Indirect contact via arthropod vectors

• Indirect contact via fomites

• Indirect contact via transfusion of contaminated blood or blood products or by parenteral injection
using nonsterile syringes or needles
Modes of Disease Transmission
 Pathogens Most Often Involved in Hospital
Acquired Infections

• The most common bacterial causes of HAIs:

– Gram-positive cocci: Staphylococcus aureus, coagulase-negative
staphylococci, and Enterococcus spp.
– Gram-negative bacilli: Escherichia coli, Pseudomonas aeruginosa, Enterobacter
spp., and Klebsiella spp.

• The sources of these pathogens are healthcare professionals and

healthcare workers, visitors, and the patients themselves.
• Approximately 70% of HAIs involve drug-resistant bacteria.
 Most Common Types of HAIs

1. Urinary tract infections (UTIs)

2. Surgical site infections (also referred to as postsurgical wound
infections)
3. Lower respiratory infections (primarily pneumonia)
4. Bloodstream infections (septicemia)
 Patients Most Likely to Develop HAIs

• Elderly patients
• Women in labor and delivery
• Premature infants and newborns
• Surgical and burn patients
• Diabetic and cancer patients
• Patients receiving treatment with steroids, anticancer drugs,
antilymphocyte serum, and radiation
• Immunosuppressed patients
• Patients who are paralyzed or are undergoing renal dialysis or
catheterization
 Major Factors Contributing
to HAIs
1. An ever-increasing number
of drug-resistant pathogens
2. The failure of healthcare
personnel to follow infection
control guidelines
3. An increased number of
immunocompromised
patients
 Additional Factors Contributing to HAIs

• Overcrowding of hospitals and shortages of healthcare staff

• The indiscriminate use of antimicrobial agents
• Lengthy and more complicated types of surgery
• Increased use of less-highly trained healthcare workers
• Increased use of anti-inflammatory and immunosuppressant agents
• Overuse and improper use of indwelling devices
 Infection Control
• Infection control – the numerous measures taken to prevent
infections from occurring in healthcare settings.
• Asepsis means “without infection”; there are 2 types:
– Medical asepsis
• Precautionary measures necessary to prevent direct transfer of pathogens
from person to person and indirect transfer of pathogens through the air or on
instruments, bedding, equipment, and other inanimate objects (fomites)
– Surgical asepsis or sterile technique
• Practices used to render and keep objects and areas sterile
• Surgical aseptic techniques are practiced in operating rooms, labor and
delivery areas, and during invasive procedures (e.g., drawing blood, injecting
medications, urinary and cardiac catheterization, lumbar punctures)
cont. • Standard Precautions – are to be applied
to the care of ALL patients in ALL
healthcare settings, regardless of the
suspected or confirmed presence of an
infectious agent
– It provides infection control guidelines
regarding hand hygiene; wearing of gloves,
masks, eye protection, and gowns;
respiratory hygiene/cough etiquette; safe
injection practices; lumbar puncture;
cleaning of patient-care equipment;
environmental control; handling of soiled
linens; resuscitation devices; patient
placement; and disposal of used needles
and other sharps
Healthcare Professional Donning Personal Protective
Equipment (PPE) - sterile gown (A), mask (B), and gloves (C)
Proper
Procedure for
Glove Removal

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Transmission-Based Precautions are used for patients who
are known or suspected to be infected or colonized with
highly transmissible or epidemiologically important
pathogens for which additional safety precautions beyond
Standard Precautions are required to interrupt transmission
within healthcare settings

• The three types of Transmission-Based Precautions are:

1. Contact Precautions
2. Droplet Precautions
3. Airborne Precautions
Contact transmission is
divided into 2 subgroups:
(1) direct-contact (i.e.,
transfer of microorganisms
by body surface-to- body
surface), and (2) indirect
contact (i.e., transfer of
microorganisms by a
contaminated intermediate
object).
 Airborne Infection Isolation Room (AIIR)
• The preferred placement for patients
who are infected with pathogens that
are spread via airborne droplet nuclei
(5 m or less in diameter), and
therefore require Airborne Precautions,
is an airborne infection isolation room

• An AIIR is under negative pressure to

prevent room air from entering the
corridor

• The air evacuated from an AIIR passes

through a filter
 Protective Environments
• Patients who are especially
vulnerable to infection are placed in a
Protective Environment - patients
with severe burns or leukemia,
transplant or immuno-suppressed
patients, patients receiving radiation
treatment, leukopenic patients,
premature infants

• The room is under positive pressure

and air entering the room passes
through filters.
 Handling Food and Eating Utensils

– Using high-quality, fresh food

– Properly refrigerating and storing food
– Properly washing, preparing, and cooking food
– Properly disposing of uneaten food
– Covering hair and wearing clean clothes and aprons
– Thoroughly washing hands and nails before handling
foods
– Keeping all cutting boards and other surfaces
scrupulously clean
– Washing cooking and eating utensils in a dishwasher with
a water temperature > 80oC
 Handling Fomites
• Fomites are nonliving, inanimate objects, other than food, that
may harbor and transmit microbes. Examples: patients’ gowns,
bedding, towels, hospital equipment, telephone, computer
keyboard, etc.
• Transmission of pathogens by fomites can be prevented by
observing certain rules:
– Use disposable equipment and supplies whenever possible
– Disinfect or sterilize equipment soon after use
– Use individual equipment for each patient
– Use disposable thermometers or thermometer covers
Medical Waste Disposal
– Sharps should be
handled and disposed of
properly
– Dispose of sharps in
specifically designed
puncture-resistant
containers (“sharps
containers”)
 Role of the Clinical Microbiology Laboratory (CML)
in Hospital Epidemiology and Infection Control

• CML personnel participate in infection control by:

– Monitoring the types and numbers of pathogens isolated from hospitalized
patients
– Notifying the appropriate infection control person should an unusual
pathogen or an unusually high number of isolates of a common pathogen
be detected
– Processing environmental samples, including samples from hospital
employees, that have been collected from within the affected ward(s)
 Public Health Agencies

• World Health Organization (WHO)

– A specialized agency of the United Nations founded in 1948;
www.who.org
– Missions: to promote technical cooperation for health among
nations; to carry out programs to control and eradicate diseases; to
improve the quality of human life
• Investigates outbreaks of Ebola virus, etc.
• Eradicated smallpox
• Attempting to eradicate polio and dracunculiasis
cont.

• Centers for Disease Control and Prevention (CDC)

– A federal agency administered by the U.S. Department of Health and Human

Services; located in Atlanta, GA; established in 1946; www.cdc.gov
– Mission: “to collaborate to create the expertise, information, and tools that
people and communities need to protect their health …”
– Certain infectious diseases, known as nationally notifiable diseases must be
reported to the CDC.
cont.

Measures for prevention and control of epidemics:

– Increase host resistance through the development and

administration of vaccines that induce active immunity and
maintain it in susceptible persons
– Ensure that persons exposed to a pathogen are protected against the
disease
– Segregate, isolate and treat those who have contracted a contagious
infection to prevent the spread of the pathogen to others
– Identify and control potential reservoirs and vectors of infectious
diseases
 Bioterrorism and Biological
Warfare Agents
• Microbes purposely used to harm others in wartime are called
biological warfare agents.
• Pathogens used to create fear, chaos, illness, and death in situations
other than war are called bioterrorism agents. Examples:
– Bacillus anthracis (the cause of anthrax)
– Clostridium botulinum (the cause of botulism)
– Smallpox virus (Variola major)
– Yersinia pestis (the cause of plague)
 Water Supplies and Sewage Disposal
• Water is the most essential resource necessary
for the survival of humanity!
• The 2 general types of water pollution:
– Chemical pollution
– Biological pollution (e.g., fecal material
and garbage)
• The 1993 cryptosporidiosis epidemic in
Milwaukee, WI, was the largest waterborne
epidemic in the U.S.
cont.
• Water Treatment
– The major steps in water treatment are sedimentation,
coagulation, filtration, and chlorination
– Water is tested for fecal contamination by checking for the
presence of coliform bacteria (coliforms), such as E. coli and
other members of the family Enterobacteriaceae
• Sewage Treatment
– Raw sewage consists mainly of water, fecal material, garbage,
and bacteria
– Includes primary, secondary, and tertiary sewage treatments
Steps in Water Treatment
All healthcare workers must fully comprehend
the problem of Hospital Acquired Illnesses
and Infections from the Environment. He/She
must be completely knowledgeable about
infection control practices, and must
personally do everything in their power to
prevent diseases from occurring!
 Reference:
Burton’s Microbiology for the Health Sciences, 9th Edition.
Lippincott, Williams and Wilkins. USA.

The End

Thank you for listening!

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