Rhuby P.

Abenoja
BSN I- A

1. CHAIN of INFECTION
Basically, the chain of infection is a model that will guide us to understand the infection
process. This chain tells us how a pathogen is able to spread from, for example person to person.
For an infection to develop, each link of the chain must be connected. Overall, there are six (6)
components 0r 6 links to the chain of infection. A key idea is that this chain can act as a cycle
rotating to all 6 components if not broken. Breaking any link of the chain allows us to stop the
spread, which we do through precautions. By doing so, everyone can promote public health.
Each link of the chain should be present for the infection to happen. Each link represents the
steps in the transmission. The 6 links to the chain include infectious agent, reservoir, portal of
exit, mode of transmission, portal of entry, and susceptible host. The chain spreads in a
clockwise manner, with the first component being the infectious agent which then spreads to the
reservoir then to the portal of exit and so on to the susceptible host. If the chain isn’t broken, the
cycle will continue to repeat itself. The infectious agent, the first link is what is known as the
disease-causing organism which can take form as a virus, bacteria, fungi, protozoa and parasite.
Reasons that the organism will cause an infection are virulence (ability to multiply and grow),
invasiveness (ability to enter tissue), and pathogenicity (ability to cause disease). To prevent
further spread, we need to break the chain. This includes pasteurization of milk, chlorination of
water or disinfection. However, if this chain isn’t broken, the pathogen can spread to the
reservoir, the second link. This is basically the home of the pathogen. It is a place where a
pathogen resides, thrives and can survive but may or may not multiply. The most common
reservoir is the human body. Other examples include animals, food, water, insects, soil, toilet
seat, elevator buttons, human feces, respiratory secretions, etc. To break the chain to prevent
further spread, we use medical treatment/testing, insect/rodent eradication and quarantine. If not
broken, the pathogen will continue to its next link which is the portal of exit, the 3rd link. This is
the method in which the pathogen leaves the reservoir. This can be through saliva, mucus
membranes, feces, blood, etc. Anything that’s secreted from the body are reservoir. We can
break the chain by covering while coughing, proper waste disposal, barrier methods like PPE
which includes things like mask, eye protection and gloves. If not broken, the chain moves to the
mode of transmission, the 4th link. This link is how the pathogen travels. It can be done through
direct contact like handshaking or contact with bodily lesions or it can be done through indirect
contact like respiratory droplets in the air. To break the chain, handwashing, staying at home and
disinfection are essential. Otherwise the chain continues to the next link which is the portal of
entry or the fifth link. This is how the virus enters the body. It is the opening where an infectious
disease enters the host’s body. This can be done through penetration, for example broken skin
and incisions. It can also be done through ingestion, for example using the same water bottle as
someone else or it can be done through inhalation, for example inhaling respiratory droplets from
the air. To break the chain, barrier methods like PPE, hand hygiene and first aid/wound care are
some things that are effective. Without them, the chain continues to the susceptible host, the 6th
link. This is the person who is at risk for developing an infection from the disease. This is
essentially the new host which can be anyone especially those who are immunocompromised.
Several factors make a person more susceptible to disease including age (young people and
elderly people generally are more at risk), underlying chronic diseases such as diabetes or
asthma, conditions that weaken the immune system like HIV, certain types of medications,
invasive devices like feeding tubes, and malnutrition. To break the chain, it is best to boost your
immune system through health promotion which includes getting enough sleep, diet and
exercise, getting immunizations, medical treatment or patient education. However, without
breaking this link, the chain will cycle back to the infectious agent and go to the cycle again and
again until people are able to take the necessary precautions to break the chain and stop the
spread.

2. (at separate paper)

3. Ways to Break the Chain of Infection

The best way to break the chain of infection is to break one or more of the links to
prevent spread or transmission. Break the chain by cleaning your hands frequently, seeking
prompt treatment if you are ill, using the right cleaning solution to disinfect the pathogens you
have identified, keeping a clean environment, handling food properly, proper way of disposing
trash, control airflow and negative pressure rooms, staying up to date on your vaccines
(including the flu shot), covering coughs and sneezes and staying home when sick, following the
rules for standard and contact isolation, using personal protective equipment the right way,
sterilizing medical instruments and equipment, following safe injection practices, and using
antibiotics wisely to prevent antibiotic resistance, practicing aseptic technique during procedures,
taking proper care of wounds.

The CDC describes two tiers of recommended precautions against this vicious chain of infection
that promotes infectious spread. By following these precautions, we can break the chain.
STANDARD PRECAUTIONS FOR ALL PATIENT CARE
- These precautions are the first tier of infection prevention and control. They’re used for
all patient care and are based on risk assessment, common sense and PPE use. The
standard precautions are:

 Execute hand hygiene.

 Make use of personal protective equipment (PPE) when exposure to infection is
possible.
 Observe respiratory hygiene (cough etiquette).
  Practice proper patient placement.
 Handle, clean, and disinfect patient care equipment and environment properly.
 Carefully handle laundry.
 Practice safe injections.
 Handle needles and sharps safely.
TRANSMISION- BASED PRECAUTIONS
- These precautions are the second tier of basic infection prevention and control. These are
meant to be used in addition to first-tier precautions for patients who may be infected
with a certain microorganism whose infection prevention requires extra care. There are 3
different types of transmission-based precautions.
a. Contact precautions are for patients with infections that have a high risk for contact-
transmission. The chain of contact-based infections can be broken by following these
measures:
 Good hand hygiene.
 Practice proper patient placement.
 Use appropriate PPE.
 Move the patient around the facility as little as possible.
 Use disposable or dedicated equipment when working with the patient.
 Make room and shared medical equipment cleaning and disinfection a priority.

b. Droplet precautions are for patients with infections that show a high risk for
transmission by respiratory droplets. The chain of respiratory-based infections can be
broken by following these measures:
 Good hand hygiene.
 Practice proper patient placement.
 Wear a mask to enter the room or patient environment.
 Move the patient around the facility as little as possible (If movement is required, instruct
the patient to wear a mask and practice good respiratory hygiene).
 Mask the patient in the ambulatory setting.

c. Airborne precautions are for patients with infections that show a high risk for airborne-
transmission. The chain of airborne-based infections can be broken by following these
measures:
 Practice proper patient placement in an airborne infection isolation room.
 Limit healthcare staff from entering the room, especially those vulnerable to infection.
 Use appropriate PPE such as N95 or equivalent respirator.
 Move the patient around the facility as little as possible (If movement is required, instruct
the patient to wear a mask and practice good respiratory hygiene).
 When possible, immunize vulnerable people.
4. IMMUNITY

- a specific resistance of the body to infection; it may be natural, or resistance may develop after
exposure to a disease agent
- the ability of an organism to resist a particular infection or toxin by the action of specific
antibodies or sensitized white blood cells
- refers to the body’s ability to prevent the invasion of pathogens

Types of Immunity

1. Innate immunity, or nonspecific

- A type of immunity that protects the body against infections by generating a quick
immune system response once a pathogen attacks it.
- It is a general protection that a person is born with. It protects you against all antigens.
- This type of immunity is considered non-specific because it responds in the same way to
all germs and foreign substances.
- It can respond quickly to defend against any pathogen.
- It is made up of various barriers that defend against viruses, bacteria, parasites as well as
any foreign substances or even block their pathway to spread and move throughout the
body. This entails:
 Physical barriers – This is skin, the gastrointestinal tract, respiratory system, the nose,
the throat, body hair, eyes, eyelashes, etc.
 Defense mechanisms – such as mucous, gastric acid, saliva, tears, sweat, secretions, etc.
 General immune responses – like inflammation that enables the movement of blood to
the site of infection and complement that is an immune response that marks pathogens for
destroying them and then makes a hole in their cell membrane. The innate immune
system always targets foreign or non-self-substances and is activated by the presence of
antigens and their chemical abilities.
Example: The skin acts as a barrier to block germs from entering the body. And the immune
system recognizes when certain invaders are foreign and could be dangerous.
Other examples include:
 Cough reflex
 Enzymes in tears and skin oils
 Mucus, which traps bacteria and small particles
 Stomach acid
 2. Passive immunity
- This type of immunity is “borrowed’ from another source, but it does not last indefinitely.
It lasts only for a few weeks or months.
- It is provided when a person is given antibodies to a disease rather than producing them
through his or her own immune system.
- The major advantage to this immunity is that protection is immediate.
- This immunity is short-lived as the antibodies in this type of immunity are not
continuously replenished, as would occur in an individual whose immune system is
responding directly.
Examples:
 Antibodies that are maternal: The mother has antibodies that protect the unborn and
newborn child. These antibodies are shared by either:
Placenta: When a woman is pregnant, blood circulates throughout the placenta to provide
protection and nourishment to the fetus that is developing. As this blood circulates, the immune
cells and antibodies circulate with it. Although the developing fetus is not exposed to any
pathogens in the uterus, they are exposed to viruses, bacteria, etc. during and after birth, which is
another reason why the types and levels of antibodies in the baby’s blood match those of the
mothers.
Breast Milk. The first few days after birth, the mother produces protein-rich breast milk called
colostrum. This milk contains higher levels of antibodies that protect the intestinal surface as
well as has a lower nutritional value than milk following birth. This exchange of antibodies from
mother to child via breastmilk provides the baby with passive immunity, and suggests its
importance for the baby before it can generate its own protection.

 People can also get passive immunity through antibody-containing blood products such
as immune globulin, which may be given when immediate protection from a specific
disease is needed.
 Immune serum globulin (given for hepatitis exposure)
 Tetanus antitoxin

3. Active immunity
- It is a type of immunity that is created by our own immune system when we come in
contact with a harmful pathogen. We are exposed to these throughout our day, it could be
when we eat, breathe or even what we touch.
- Results when exposure to a disease organism triggers the immune system to produce
antibodies to that disease. It can be acquired through natural immunity or vaccine-
induced immunity.
  Natural immunity is acquired from exposure to the disease organism
through infection with the actual disease.
 Vaccine-induced immunity is acquired through the introduction of a
killed or weakened form of the disease organism through vaccination.
Either way, if an immune person comes into contact with that disease in the future, their immune
system will recognize it and immediately produce the antibodies needed to fight it.
- This type of immunity lasts for a long time.

The importance of active immunity is:

 Quick response to outside invader
 Highly specific, so the immune system is ready when the pathogen is encountered