Care patients with communicable disease

1. Care of Patients with
Communicable Diseases
V. Atputhavadivel
Nursing Tutor
College of Nursing
Batticaloa

2. Communicable Diseases
⚫ Communicable disease are disease
caused by an infectious agent, which is
transmitted through direct contact with
an infected individual or indirectly
through a vector or inanimate.
⚫ e.g. measles, mump, hepatitis, AIDS,
brucellosis, toxoplasmosis, tetanus.

3. Communicable Disease Nursing
⚫ The comprehensive nursing care given
to a patient with a communicable
disease.

4. Classifications of communicable diseases
⚫ Infectious : a disease which is not easily transmitted
from one person to another.
Example : Malaria, dengue, tetanus
⚫ Contagious : a disease which can be easily transmitted
from one person to another.
Examples : 1. By droplets / direct contact :Tuberculosis
2. Through sex : HIV, gonorrhea
⚫ All communicable diseases are infectious but not all are
contagious

5. Epidemiology - definition
⚫ Generally seen as a study of scientific method
to investigate disease
⚫ Def: Scientific studies the patterns of disease,
its occurrence and distribution, prevention and
control of diseases in human populations.
⚫ The study of the nature, cause, control, and
determinants of the frequency and distribution
of disease, disability, and death in human
populations

6. Purposes of Epidemiology
⚫ To explain the etiology (cause) of a
single disease or group of diseases
using information management
⚫ To determine proposed hypothesis
⚫ To provide a basis for developing control
measures and prevention procedures for
risk populations

7. Uses of Epidemiology
1. To study the history of the disease
2. Community diagnosis
⚫ What diseases, conditions, injuries, disorders,
disabilities, defects causing illness, health problems,
or death in a community or region
3. Look at risks of individuals as they affect
populations
⚫ What are the risk factors, problems, behaviors that
affect groups

8. Uses of Epidemiology
4. Assessment, evaluation and research
5. Determine the causes and sources of diseases

9. Patterns of Disease Occurrence
⚫ Sporadic : on and off, occasional occurrence of a
disease.
⚫ Endemic : continuous or constant occurrence
Ex- the case of malaria, which is always present in the
Philippine community.
⚫ Epidemic : sudden increase in the number of cases in a
short period of time. Example : the rise of dengue.
⚫ Pandemic : worldwide epidemic

10. Terms to know
⚫ Disease : disease is Latin word mean dis = lack,
ease = power, mean lack of power or discomfort.
Def: Disease defines as abnormal state in which
body physiology can't restore body comfort.
⚫ Pathogens : organisms or substances such as
bacteria, viruses, or parasites that are capable of
producing diseases (agent or causative organism)
⚫ Pathogenesis : The process of disease develops

11. Terms to know
⚫ Contamination : pathogenic microorganisms on
the outer surface of human, soil, vegetable, food.
⚫ Outbreak : Increase in number of infected
individual (increase endemic incidence) in short
period at time. e.g. Gastrointestinal outbreak.
⚫ Spore : a specialized reproductive cell by
organism.
⚫ Toxic : poisonous.
⚫ Chemotaxis : Movement of an organism in
response to chemical in the environment.

12. Terms to know
⚫ Etiology: causation of a disease
⚫ Toxins: a poisonous substance.
⚫ Antibiotics: a substance produced by a
microorganism and able to inhibit or kill another
microorganism
⚫ Generation time : The time required for one cell
to divide into two cells bacteria.

13. Terms to know
⚫ Incidence: the extent that people, within a
population who do not have a disease, develop
the disease during a specific time period
⚫ Fomites: inanimate objects that serve as a
role in disease transmission
⚫ Pencils, pens, doorknobs, infected blankets
⚫ Vector: any living non-human carrier of
disease that transports and serves the process
of disease transmission

14. Terms to know
⚫ Prevalence: the number of people within a
population who have a certain disease at a given
point in time.
⚫ Host : The person who is at risk for developing
an infection from the disease
⚫ Reservoirs: source of a disease – producing
organism, humans, animals, plants, soils or
inanimate organic matter (feces or food) in which
infectious organisms live and multiply
⚫ Humans often serve as reservoir and host
⚫ Zoonois: when a animal transmits a disease to
a human

15. Occurrence of Communicable Disease
⚫ Three factors are involve occurrence of a
communicable disease.
⚫ Agent
⚫ Environment
⚫ Host

16. 1. Agent
⚫ May be virus, bacteria or fungi
⚫ A disease may occur the following factors involve of the
causative agent
1. Infectability : ability to enter into the host’s body and
move into the tissues of the body.
2. Infective dose : the number of causative organism
present.
3. Pathogenicity : ability to cause a disease.
4. Virulence : strength of different causative organisms
5. Antigenicity : ability to stimulate an antibody response.

17. 2. Environment
⚫ Help to spread of communicable disease
because :
1. It provides a medium for culture or multiplication
and survival of the microorganism.
Ex : Ascaris thrives in a moist, humid and dark
environment.
2. It provides a mode for transmitting and spreading
of the causative organism.

18. 3. Host
A host could either be :
1. Resistant - immune to the pathogenic effect of
a causative agent
2. Susceptible - may be influenced by the host’s
following characteristics :
a) Age – The very young infants are very susceptible
because non- fully developed immune system.
The very old : because they may be compromised
with disease or old age

19. 3. Host …
2. Susceptible….
b) Sex : some disease are gender-related such as the case
of leprosy which is more common in males (females are
more meticulous with hygiene).
c). Diet/ Nutrition : poorly nourished people are normally less
resistant to disease and are in fact predisposed to illnesses.
d). Skin : an intact skin is our first line of defense to any
infection.
e). Immune system : a strong immune system is the BEST
defense to disease.

20. Transmission of Communicable Disease

21. Mode of Disease Transmission

22. Mode of Disease Transmission…

23. CHAIN OF INFECTION / Infectious
Cycle
Breaking any link of the
chain can stop the
transmission of infection.
Causative
agent

24. Causative agent :
⚫ Toxins produced by these causative agents as their waste
products ;
⚫ Endotoxins : the toxins are produced inside the body of the
causative agent when they are dead.
Ex : Typhoid, Lepra Reaction
⚫ Exotoxins : the toxins are produced outside the cell and
released by the causative agent while alive.
Ex : Tetanus
CHAIN OF INFECTION

25. CHAIN OF INFECTION
⚫ Reservoir/ Source of Infection :
⚫ The environment, area or body where the organism can
be found and dependent for survival.
⚫ Human reservoirs
⚫ Animals
⚫ Plants
⚫ Soil
⚫ Fomites - inanimate objects

26. CHAIN OF INFECTION
Portal of Exit (from reservoir)
⚫ Usually the causative organism will escape in an opening
nearest its breeding place
⚫ Respiratory tract
⚫ Gastrointestinal tract
⚫ Genitourinary tract
⚫ Wounds/lesions
⚫ Mechanical :
a. incision / drainage
b. needle aspiration : as in Hepatitis B
c. bites / stings of insects : dengue, malaria

27. CHAIN OF INFECTION
Mode of Transmission :
cutting the chain of transmission is BEST done by
interfering in the modes of transmission.
⚫ Contact Transmission
⚫ Vehicle Transmission
⚫ Vector Transmission

28. CHAIN OF INFECTION
Portal of Entry :
Causative agents usually use the same opening (portal of exit)
when they enter a host’s body
1. Respiratory system : through inhalation.
2. Gastrointestinal tract : through ingestion
3. Genitourinary system : sex
4. Skin : through tattoos, ear / body piercing and needle prick.
5. Blood entry : through blood transfusion, needle sharing
6. Placental entry : from the mother to the fetus in utero
placental transfer - measles, HIV, syphilis and Hepatitis B.

29. CHAIN OF INFECTION
Susceptible host
⚫ The person who is at risk for developing an infection from
the disease.
⚫ Several factors make a person more susceptible to
disease
⚫ age
⚫ underlying chronic diseases
⚫ conditions that weaken the immune system
⚫ certain types of medications,
⚫ invasive devices like feeding tubes, and malnutrition.

30. Immunization
⚫ The process of giving an individual resistant to a specific
disease
Antigen
⚫ An antigen is any substance that causes your immune
system to produce antibodies against it.
⚫ An antigen may be a foreign substance from the
environment, such as chemicals, bacteria, viruses, or
pollen.
⚫ An antigen may also be formed inside the body, as with
bacterial toxins or tissue cells

31. Immunization
Antibody
⚫ An antibody is a protein, produced by the body's immune
system (lymphocytes) when it detects (response) harmful
substances, called antigens eg- bacteria, viruses and other
antigenic substances.
Immunity
⚫ The power or ability to resist a specific disease.

32. Types of immunity

33. Types of immunity
1.Innate immunity (Natural)
Inherent and inborn to the individual
2. Acquired or Adaptive immunity
Developed throughout the individual’s lifetime
a. Natural
a.1. Natural Active : developed through exposure and
having experienced the disease yourself; effect is
long-term, even for life.
Ex: you will have lifetime immunity to measles
and chicken pox after contracting these diseases.

34. Types of immunity…
a.2. Natural Passive : immunity developed after
receiving maternal antibodies through placental
transmission (IgG) or through breastfeeding
(IgA); effects are short term only.
Ex. Maternal immunity for tetanus is passed by
the mother to the fetus.
b. Artificial :
b.1. Artificial Active : immunity developed
through introduction of antigens that
will stimulate the body to produce antibodies
against them.

35. Types of immunity…
b.2. Artificial Passive : developed through the
introduction of antibodies that comes from other
sources such as human serum (immunoglobulins)
or from animals (antisera or antitoxins); effect is
short term.
Eg -
1. Live weakened antigens : BCG, measles, OPV,
MMR
2. Killed antigens : DPT : the pertussis portion of
DPT vaccine, Typhoid vaccine, and Hepa B
vaccine

36. Stages of a Disease
1. Incubation period : the time interval from the first exposure
to the appearance of the first signs and symptoms of the
disease.
2. Prodromal Stage : the time from the appearance of the
first signs and symptoms of the disease to the appearance
of the specific symptoms of the disease.
3. Acute Period: period when the characteristic symptoms of
the disease are manifested by the patient and observed by
others.
4. Convalescence : the period of recovery : when the signs
and symptoms are gradually disappearing

37. Levels of Disease
Diseases have a range of seriousness, effect, duration,
severity, and extent
Classified into 3 levels
⚫ Acute: relatively severe, of short duration and often
treatable usually the patient either recovers or dies.
⚫ Subacute: intermediate in severity and duration, patient
expected to heal
⚫ Chronic: less severe but of long and continuous duration,
lasting over a long time periods.
⚫ Patient may not fully recover and the disease can get
worse overtime, life not immediately threatened, but
may be over long term

38. Prevention and Control Activities of
Communicable Diseases
Prevention
Three levels of prevention
I. Primary level
1. Health teachings :
a. Bedside health teachings
b. Community assemblies
c. Use of tri-media
2. Giving of specific protection :
EPI for those below 8 yrs old :
a. tuberculosis e. Hepatitis B
b. Tetanus f. Diphtheria
c. Polio g. Pertussis
d. Measles
3. Environment sanitation

39. Prevention and Control Activities of
Communicable Diseases …
II. Secondary Level : is given to those :
1. who are early sick
2. who had been exposed or in contact with an infected individual.
The following are necessary undertakings :
a. Case finding
b. Screening
c. Early diagnosis
d. Early treatment
e. Prophylaxis
III. Tertiary Level : those who had recovered from disease but have some
complications for :
1. Rehabilitation and
2. Limitation of disability

40. Prevention and Control Activities of
Communicable Diseases …
Control
The following measures are done :
1. Notifying /reporting of health incidents
2. Epidemiological investigation - observe, collect
specimen for laboratory analysis
3. Case finding - early diagnosis, prompt treatment/
prophylaxis
4. Isolation & Quarantine
5. Disinfection & Disinfestations :
6. Asepsis :

41. Isolation / Quarantine
⚫ Isolation
Separation of the infected person
1. Strict isolation : highly contagious diseases such as
diphtheria – strict proper asepsis should be done.
a. Move patient away from the main wards.
b. Use of personal protective equipments (PPE’s)
by the health team such as masks, gloves,
goggles etc.

42. Isolation / Quarantine…
2. Reverse isolation : immunocompromised
patients Ex - leukemia, AIDS, burn patients
and those undergoing chemotherapy : they
have to protect themselves bec of weakened
immune system.
3. Respiratory isolation : for the respiratory
diseases : to prevent the spread of
microorganisms by droplet.

43. Isolation / Quarantine…
4. Enteric isolation : those with diseases affecting
the GIT like typhoid fever, dysentery, to prevent
spread of diseases by vomitus/ feces.
5. Wound isolation : those with wounds or lesions
(inflammatory exudates are coming out such as
in scabies).
6. Blood an secretions : universal precaution or
standard precaution is done.

44. Isolation / Quarantine…
Quarantine
Limitation of freedom of movement of
exposed animals, persons/individuals in
contact with an infected person based on
the longest incubation period of the disease.

45. Disinfection
Killing the pathogenic organisms
Disinfection : destruction of pathogenic organisms
excluding spores
Sterilization : destruction of pathogenic organisms
including spores.

46. Disinfection
Two ways to kill pathogenic organisms
1. Mechanical :
a. by boiling
b. by burning
c. by autoclaving : kills all kinds of infectious pathogens.
2. Chemical :
a. Antiseptics : used on human beings to inhibit the growth of pathogenic
organisms. Ex. : betadine, alcohol and Lactacyd
b. Disinfection : used on inanimate objects such as bed pans, linens -
to kill pathogenic organisms. Ex. : Lysol, cidex, purex.
Two disinfection techniques :
i. concurrent : disinfection is ongoing while the patient is the sole
source of infection.
ii. terminal : the final, the end; when the patient is discharge or died

47. Disinfestations
Destruction of insects, rodents or animals that are
living in human habitat and can transmit diseases to
man.
This is done by :
a. Fumigation/fogging
b. Spraying

48. Asepsis
Absence of disease-producing microorganisms
1. Surgical asepsis : taken action to an area free of
pathogenic organisms. This is done by
sterilization and autoclave etc.
2. Medical asepsis / clean technique : to reduce the
number of and prevent the transfer of
microorganisms in the environment.

49. Asepsis…
Asepsis achieved by :
a. Hand washing : the single most important technique of reducing
the number of pathogenic organisms.
The quality of hand washing is important rather than the length of hand
washing :
1. Apply friction
2. Pay attention to the inter-digital areas (between fingers and toes)
3. Fingernails : should be cleaned well : underneath may be pathogens
4. Direction of hand rinsing : from cleanest to dirtiest (elbow to fingers)
b. Concurrent disinfection

50. Asepsis…
c. Use of PPE’s :
1. Caps
2. Goggles
3. Face shields
4. Masks : N95 (95% efficient surgical masks; brassieres
may be used as substitute in its absence)
5. Gloves
6. Gowns
7. Protective boots/shoes
d. Placard/ Barrier cards :
bold notices used as precaution.

51. Current Sri Lankan Disease
Notification System
Notificable Diseases
Group A: Internationally Notifiable Diseases
Cholera
Plague
Yellow Fever

52. Notificable Diseases…
Group B:
Polio Myelitis / Acute Flaccid Paralysis
Diphtheria
Dysentery
Pertussis
Enteric Fever
Food Poisoning
Tetanus/ Neonatal tetanus

53. Notificable Diseases…
Group B…
Measles
Malaria
Rubella/Congenital Rubella Syndrome
Viral Hepatitis
Leptospirosis
Dengue Fever/ Dengue Haemorragic Fever

54. Notificable Diseases…
Group B…
Encephalitis (including Japanese Encephalitis)
Human Rabies
Mumps
Meningitis
Chicken Pox
Simple continued fever of over 7 days or more
Typhus Fever
Severe Acute Respiratory Syndrome (SARS)
Tuberculosis

55. Who can do notification
Quarantine and Prevention of Disease Surveillance
Ordinance – all medical practitioners (In government
and private medical institutions)
- Intern House Officers
- Grade Medical Officers
- Any other Medical Officers
- Consultants
- General Practitioners
- Family Physicians

56. Authorities
⚫ Group A - Director General of Health Services,
Deputy Director General (Public Health Services),
Epidemiologist, Regional Epidemiologist,
Divisional Director of Health Services and
Medical Officer of Health using form I (H-544)
⚫ Group B - Divisional Director of Health
Services/Medical Officer of Health using form I
(H-544).

57. Authorities…
⚫ Severe Acute Respiratory Syndrome (SARS) - Director
General of Health Services,Deputy Director General (Public
Health Services), Director/Quarantine, Air Port Health
Officer, Port Health Officer, Epidemiologist, Regional
Epidemiologist, Divisional Director of Health Services and
Medical Officer of Health using form I (H-544)
⚫ Tuberculosis - Director/National Program for Tuberculosis,
Tuberculosis Control and Chest Diseases using form II
(H-816)

58. FLOW CHART ON THE NOTIFICATION SYSTEM IN SRI LANKA

59. H-544 FORM

60. H-411 FORM

61. H-411 a FORM

62. H-399 FORM

63. WEEKLY EPIDEMIOLOGICAL REPORT

64. Epidemiology Unit in Sri Lanka

65. Epidemiology Unit Ministry of Health
Brief History
⚫ The Epidemiology Unit was established in
1959 with assistance from the World
Health Organization (WHO) to strengthen
surveillance of communicable diseases.

66. Functional Organogram of the Epidemiology
Unit, Ministry of Health, Sri Lanka

67. Epidemiology Unit, Ministry of Health, Sri Lanka
VISION
Healthy people in a healthy Sri Lanka
MISSION
To promote health and quality of life by
preventing and controlling disease,
injury and disability

68. Epidemiology Unit, Ministry of Health, Sri Lanka
⚫ Chief Epidemiologists
⚫ Provincial Epidemiologists to the Provinces
⚫ Regional Epidemiologists to all Districts and.
⚫ All 26 RDHS divisions are now served by a Regional
Epidemiologist.
⚫ Epidemiology Unit team work and involved in outbreak
investigations and in special epidemiological studies.

69. Epidemiology Unit, Ministry of Health, Sri Lanka
⚫ Address -
Epidemiology Unit, Ministry of Health, #231, De
Saram Place, Colombo 10.
Tel : +94-001-2695112, +94-001-2681548 | Fax :
+94-001-2696583
E-mail : chepid@sltnet.lk (ChiefEpidemiologist),
epidunit@sltnet.lk (Epidemiology Unit)

70. THANK YOU