Situation:

An outbreak of a new virus and disease began last December 2019 in Wuhan, China. Later the
virus became known as the coronavirus disease (COVID-19) - an infectious disease caused by
a new strain of coronavirus.

Within the first week of the outbreak. Pablo, a 33-year-old male and a Registered Nurse of
Chicago Medicine Hospital took the vital signs of a patient positive with the Coronavirus. As
Pablo was busy with the multitude of tasks he had that day and with the influx of patients, he
forgot to wear a mask while he was taking the vital signs of the patient. At one point in time, the
patient coughed without covering her mouth, and Pablo was within two feet away from the
patient. After taking her vital signs, he planned to wash his hands but there was no soap to be
found. Upon the great number of incoming patients, he quickly did his other tasks and
accommodated the patients. After a few days without work, he has not experienced any signs or
symptoms. But after approximately two weeks, Pablo started coughing from time to time, was
febrile, and was feeling tired from doing minimal tasks. Similarly, patients who have been in
contact with Pablo that day experienced similar symptoms and were added to patients under
monitoring (PUM) and patients under investigation (PUI) of the hospital.

Related Factors:
Nosocomial Infection
A nosocomial infection, also called “hospital acquired infection,” can be defined as an infection
acquired in hospital by a patient who was admitted for a reason other than that infection. An
infection occurring in a patient in a hospital or other health care facility of whom the infection
was not present or incubating at the time of admission. This includes infections acquired in the
hospital but appearing after discharge, and occupational infections among staff of the facility.
Patient care is provided in facilities which range from highly equipped clinics and technologically
advanced university hospitals to front-line units with only basic facilities. Despite progress in
public health and hospital care, infections continue to develop in hospitalized patients, and may
also affect hospital staff. Many factors promote infection among hospitalized patients:
decreased immunity among patients; the increasing variety of medical procedures and invasive
techniques creating potential routes of infection; and the transmission of drug-resistant bacteria
among crowded hospital populations, where poor infection control practices may facilitate
transmission.

Corona Virus
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered
coronavirus, typically leading to an upper respiratory infection (URI.). Most people infected with
the COVID-19 virus will experience mild to moderate respiratory illness and recover without
requiring special treatment.  Older people, and those with underlying medical problems like
cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to
develop serious illness. The virus is spread through the air by coughing and sneezing, close
personal contact, touching an object or surface contaminated with the virus and rarely, by fecal
contamination. The illness caused by most coronaviruses usually lasts a short time and is
characterized by runny nose, sore throat, feeling unwell, cough, and fever. As of April 2020,
there are no specific vaccines or treatments for COVID-19.

Personal Protection Equipment (PPE)

Personal protective equipment is used to reduce exposure to hazards that cause severe injury
and illness in the workplace. These Injuries and diseases occur from contact with chemical,
radiological, physical, electric, mechanical or other hazards in the working environment. Items
such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, masks or cover-ups,
and bodysuits are included as personal protective equipment.

Environmental control
Hand Hygiene
Aseptic field management
Non touch technique

Questions:
What happened to Pablo?
What caused the patients handled by pablo to experience similar symptoms?
What are the probable causes of infection?
What is the mode of transmission evident?
Show a diagram displaying disease transmission.
What are different precautions to avoid infection in the hospital, specifically COVID-19?

Answers:
What happened to Pablo?       
Having forgotten to put on a mask while attending to a patient positive with COVID-19, it is
evident that he has been infected with the said virus and has also become a transmitter. This is
because medical personnel without the proper protective equipment are highly at risk of getting
infected and infecting others due to the virus’ nature and mode of transmission.

What is the mode of transmission evident?

Coronavirus can be transmitted through droplets of different sizes: when the droplet particles
are >5-10 μm in diameter they are referred to as respiratory droplets, and when then are <5μm
in diameter, they are referred to as droplet nuclei. According to current evidence, COVID-19
virus is primarily transmitted between people through respiratory droplets and contact routes .
Droplet transmission occurs when someone is in close contact with a person (within one m) with
respiratory symptoms (e.g. coughing or sneezing) that may be exposed to potentially to the
respiratory mucosae (mouth and nose) or conjunctiva.

The COVID-19 virus can thus be transmitted by direct contact with infected individuals and
through indirect contact with surfaces in the immediate environment or items used in the
infected individual, i.e. the stethoscope or thermometer.
Show a diagram displaying disease transmission:
Chain of infection
The traditional epidemiologic triad model holds that infectious diseases result from the
interaction of agent, host, and environment. More specifically, transmission occurs when the
agent leaves its reservoir or host through a portal of exit, is conveyed by some mode of
transmission, and enters through an appropriate portal of entry to infect a susceptible host.

What are different precautions to avoid infection in the hospital, specifically COVID-19?
Nosocomial Infection is classified as infections that originate in the Hospital. Asepsis technique
is one of the leading methods to avoid nosocomial infections it aims to prevent the introduction
into susceptible body sites of pathogenic species, by the hands of workers, surfaces or
equipment, insufficient quantities to cause infection. This ensures adequate prevention of
infections and reduces the risk of a patient contracting an infection related to healthcare.
Infection prevention measures include:

1. Environmental control • it is the act of organizing the environment to prevent the spread
or long-term survival of pathogens. This includes making sure that shared spaces
have good airflow which can be done by opening a window or turning on an air filter
or air conditioner. This also includes limiting the number of people who are in an
infected environment. This can be done by postponing visits or small gatherings for
patients who test positive on COVID-19.
2. Hand Hygiene • it is the cleaning of one’s hands in a way that substantially reduces
potential pathogens.
3. Use of Personal Protective Equipment (PPE) • this includes gloves, masks, and special
hospital suits.
4. Aseptic field management • it is the use of practices and procedures to prevent
contamination from pathogens, and it involves applying the strictest rules to minimize
the risk of infection.
5. Non touch technique • it is a method of changing a dressing without directly touching the
wound or any other surface that might come into contact with the wound. It is
essential to ensure that hands, even though they have been washed, do not
contaminate the sterile equipment or the patient.
References:
The burden of health care-associated infection worldwide. (2013, April 23). Retrieved from
https://www.who.int/gpsc/country_work/burden_hcai/en/

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United States Department Of Labor. (n.d.). Retrieved from

https://www.osha.gov/SLTC/personalprotectiveequipment/

Modes of transmission of virus causing COVID-19: implications for IPC precaution

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room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-
precaution-recommendations

“Communicable Diseases Module: 1. Basic Concepts in the Transmission of Communicable

Diseases.” The Open University. Accessed April 3, 2020. Retrieved from
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“Advice for the Public.” World Health Organization. World Health Organization. Accessed April
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Miller, Jonathan M., ed. “Coronavirus (COVID-19): Home Care & Precautions (for Parents) -
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Aseptic technique. (n.d.). Retrieved from Sahealth

https://www.sahealth.sa.gov.au/wps/wcm/connect/public content/sa health internet/clinical
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https://www.cdc.gov/oralhealth/infectioncontrol/faqs/hand-hygiene.html
Nall, K. C. and R. (2018, September 29). Aseptic Technique: Uses, Benefits, and
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