I.

INTRODUCTION

A. The Process of Infection

Infection is a process by which an organism establishes a parasitic relationship with its host. The process
begins with transmission of an infectious organism by microorganisms referred to as agent, pathogen, or
pathogenic agent. These microorganisms cause diseases and microorganisms which do not cause disease are
called nonpathogens.
B. The Chain of Transmission
Infection begins with transmission of a pathogen to a new host. The sequence of events that result in
infection is called the chain of
transmission. Determinants of successful transmission include the
following:
1. Pathogen (Pathogenic Agent)
The ability of pathogens to elicit disease in the host explains why they are also called etiologic agents of
infectious disease. One must remember, however, that pathogens can produce disease only when the host is
susceptible. So the cause of infectious disease is always multicausal even though the term ‘etiologic agent”
may be used to describe a pathogen. Pathogens vary in how they interact with their human host. Means of
interaction includes the following:

a. Mode of action – refers to how the organism produces a pathologic process.

b. Infectivity – refers to the pathogen’s ability to invade and replicate in the host.
c. Pathogenicity – is the ability of the organism to always induce disease.
d. Virulence – refers to the potency of the pathogen in producing severe disease.
e. Toxigenicity- refers to the amount and destructive potential of released toxin.
One additional characteristic of pathogens and their interaction is the adaptability to adapt to new hosts over
time.

2. Reservoir
A reservoir is an environment in which an organism can live and multiply. Both human and animal reservoirs
may be diseases and therefore, also be hosts. If diseased, the host may be asymptomatic, symptomatic or
carrier of the pathogen. A carrier maintains an environment that promotes growth, multiplication, and
shedding of the parasite without exhibiting signs of disease.

3. Portal of Exit from the Reservoir

The portal of exit is the place from which the parasite escapes the reservoir. Generally, this is the site of growth
of the organism and corresponds to the system of entry in to the next host. Ex. The portal of exit for
gastrointestinal parasites is generally the feces, and the portal of entry into a new host is the mouth.

4. Mode ( Mechanism) of Transmission

Organism can have one or more than one route of transmission from the reservoir to a new host.

Two main routes are direct and indirect transmission.

Direct transmission refers to immediate transfer from one person to another as in sexual contact, biting,
touching or direct projection of respiratory mucous droplets.

Indirect transmission implies a vehicle of transmission; a living vector, a common vehicle or a fomite
(inanimate object). Living vectors can carry the pathogen internally as a biologic vector or externally by
mechanical means. Common vehicles include water, soil, food, milk, biologic products and air. Airborne
transmission requires that the pathogen survive in dried forms in the air until it is inhaled. Fomites include
inanimate objects like needles, eating utensils, and urinary catheters.

5. Portal of Entry into a new host

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 A pathogen may enter a new host by ingestion, by inhalation, through contact with mucous membranes
percutaneously or tansplacentally. There is a variation with each infectious disease as to the number of
organisms and the duration of the exposure required to start the infectious process in a new host.

6. Susceptible Host
When it comes to infectious diseases, not all humans are created
equal; some are more susceptible than others.

Biological and Personal Characteristics that plays important roles in

susceptibility These include the following:
1. Age
2. Gender
3. Ethnicity
4. Heredity influence
5. Living conditions
6. Personal behaviors
a. drug use
b. eating habits
c. hygiene
d. sexual practices

7. Anatomic and physiologic defenses ( lines of defense)

Kinds:
a. First - line defenses – external and act to bar invasion of pathogens, such as:
* physical barriers
a.1. intact skin and mucous membranes
a.2. oil and perspiration on skin
a.3. cilia and respiratory passages
a.4. gag cough reflexes
a.5. peristalsis in the gastrointestinal tract
a.6. flushing action of tears, saliva and mucus
The chemical composition of body secretions such as tears and sweat together with the ph of the
saliva, vaginal secretions, urine and digestive juices further prevents or inhibits growth of organisms.
* normal flora of micro-organisms that inhibit the skin and mucous membranes in the oral cavity,
gastrointestinal tract and vagina. These parasites are indigenous to specific tissue. They generally co-exist
with their host in a mutually beneficial relationship as long as they do not wonder from the specific tissue.
b. second- line defense – inflammatory process
c. third – line defense - immune response

Illustration on the infection chain

The Infection Chain

Pathologic
Agents

Susceptible Reservoir for growth and

Host reproduction of
infectious agents

Portal of Entry Portal of Exit

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Reservoir
 Mode of
Transmission

C. Control of Transmission
1. Disinfection
2. Sterilization
3. Use of anti-infective drugs
4. Environmental sanitation
 use of barrier precautions
 proper handling of food, milk and water
 protection from vectors
 personal hygiene
 avoidance of high-risk behaviors ( unsafe sexual practices, intravenous drug use, recapping
needles)
 effective hand washing

D. Standard Precautions
Universal precautions are intended to prevent parenteral, mucous membrane, and non intact skin exposures of
health care workers to blood borne pathogens. Universal precautions apply to blood and to other body fluids
containing visible blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal
fluid, pericardial fluid, and amniotic fluid . Universal precautions do not apply to feces, nasal secretions, sputum,
sweat, tears, urine and vomitus unless they contain visible blood.

Barrier Guidelines
1. Disposable gloves (vinyl, latex) should be worn when in contact or when there is a potential for contact with
blood, body fluids, or other fluids that may contain with human immunodeficiency virus. (HIV). Gloves should
be removed after each client contact. Rubber gloves can be used for equipment cleaning.
2. Hands should be washed between clients, after any exposure, and after removal of gloves.
3. Protective eyewear, face shields, or masks or a combination should be worn during procedures that may
aerosolized blood.
4. Impervious gowns should be worn when there is potential for exposure to large quantities of blood, such as in
the labor and delivery area of emergency room.
5. Use mouthpiece, resuscitation bags, or other ventilation devices for mouth-to-mouth resuscitation.

Needle Precautions
1. Needles should never be recapped after use. Keep in mind that most needle sticks are the result of missed needle
recapping.
2. Do not cut, break or bend needles after use; this may release aerosolized blood from the needle shaft.
3. Do not leave used needles lying around.
4. Do not dispose of needles in ordinary receptacles, instead, use appropriately labeled, impermeable needle
containers.

Dispose Guidelines
1. Put all specimens of blood and listed fluids in moisture- proof
containers with secure lids to prevent leakage during transport. Be sure to
avoid contaminating the outside of the container.
2. Handle soiled linens as little as possible and with minimal agitation to prevent contamination of the air
and of people handling the linen.
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 3. Follow institutional policies in disposing infective waste, cleaning and disinfecting equipment.
4. Strict and contact isolations should be observed accordingly.

Strict isolation is an isolation designed to prevent transmission of highly contagious virulent infections that may be
spread by both air and contact.

Contact isolation is designed to prevent transmission or epidemiologically important infections that do not warrant strict
isolation.

E. Principles of Basic Infection Control

In all aspects of patient care, the following principles should be observed to minimize the spread of microorganisms.

Principles
1. Avoid shaking or tossing linens.
2. Keep your hands away from your own hair
and face keep linens away from your uniform,
and always keep clean items separate from
dirty ones. If you drop anything on the floor,
consider it dirty.
Rationale
Microorganisms move through the space on
air currents.
Microorganisms are transferred from one
surface to another whenever objects
touch. When a clean item touches a less
clean item, it becomes “ dirty”. Because
microorganisms are transferred to it.

3. Avoid passing dirty items over clean items
or areas because it is possible for
microorganisms to drop off onto a clean item
or area.
4. Avoid having a patient breathe directly into
your face, and avoid breathing directly into a
patient’s face.
5. Use a dry paper towel when you turn off
faucets, and dry a bath basin before you return
it to a bedside stand for storage.
6. Wash your hands, therefore, not only when
they are obviously soiled, but whenever you
move from one patient to another or from
patient contact to contact with the general
environment or vice versa.
7. Health care workers can protect themselves
from these blood-borne infections by using
precautions that prevent contact with
blood and body fluids that transmit blood-
borne pathogens.
Microorganisms are transferred by gravity
when one item is held above another.
Microorganisms are released into the air on
droplet nuclei whenever a person breathes or
speaks. Coughing or sneezing dramatically
increases the number of microorganisms
released from the mouth and nose.
Microorganisms move slowly on dry surfaces
but very quickly through moisture.
Proper hand washing removes many of the
microorganisms that would be transferred
by the hands from one item to another.
Blood- born infections may be spread to
another person by contact of blood and body
substances that contain the blood borne
organism with open wounds, sores, or
mucous membranes and through
penetrating injuries (such as those caused by
needle sticks or cuts) with contaminated
items.

II. MAINTAINING ASEPTIC TECHNIQUE

A. Medical Asepsis and Surgical asepsis

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Asepsis is the practice of making the environment and objects free of microorganisms. There are two types of asepsis
practiced within health care agencies.

Medical asepsis or “clean technique” is the practice of reducing the number of organisms present or reducing the risk for
transmission of organisms. It prevents reinfection of the patient and the spread of infection from person to person. It
involves cleanliness and is accomplished by protecting items in the environment from contamination and by disinfecting
items that have been contaminated. Most but not all microorganisms are destroyed. This means free of pathogenic
organisms.

Surgical asepsis or “sterile technique” is the practice of preparing and handling materials in a way that prevents the
patient’s exposure to living microorganisms. It involves sterilization of all instruments and inanimate objects used in
surgery, and use of sterile supplies and technique for procedures that invade the body and for wound care. Sterile means
free of all microorganisms.

B. Hand Washing
The first line of defense in medical asepsis is good hand hygiene. This refers to any method approved by the Center for
Disease Control and Prevention for decontaminating the hands.

Handwashing is the rubbing together of all surfaces and crevices of the hands using a soap or chemical and water. It is
one of the most important ways to prevent transmission of infectious organisms.

Purpose: The hands are most agile parts of the body and are the primary vehicle for transmitting microorganisms.
Correct and frequent hand washing is the easiest and most effective way to prevent and control the transmission of
infectious agents of the hands.

HANDWASHING RD TOOLS

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