COMMUNITY

HEALTH NURSING 2
CONTROL OF COMMUNICABLE
DISEASES
__________
EDNA U. ROBLES, RN MAN
St. Luke’s College of Nursing
 OBJECTIVES
1. Define the basic terms related to communicable and
infectious diseases
2. Discuss the infectious process and the four stages of
an infectious disease
3. Describe the six components of the chain of infection
4. Enumerate 10 strategies for infection control and
prevention
5. Identify the factors that influence the emerging and re
emerging common communicable and infectious
diseases
6. Discuss the role of the public health nurse in the
control of communicable diseases
 INFECTIOUS PROCESS

INFECTION SYMPTOMATIC ASYMPTOMATIC SIGNS

INFECTIOUSS
SYMPTOMS COMMUNICABLE PATHOGENS
DISEASE

NON
VIRULENCE
PATHOGENIC
TERMINOLOGIES IN COMMUNICABLE
DISEASES
COMMUNICABLE CONTAGIOUS
CARRIER CONTACT
DISEASE DISEASE

INFECTIOUS
DISINFECTION( HABITAT HOST
DISEASE

ISOLATION QUARANTINE RESERVOIR SURVEILANCE

 WHY DOES INFECTION OCCURS
1. Some bacteria develop resistance to antibiotics
2. Some viruses such as influenza have so many different strains that a
single vaccine cannot protect against them all
3. New infectious agents occasionally arise such as HIV & corona viruses
4. Most viruses resist antiviral drug
5. Some microbes localize in areas of the body that make treatment
difficult (bones & CNS)
6. Opportunistic organisms can cause infection in immunocompromised
patients
7. Some people have not received immunization
8. The increase in air travel can spread virulent organisms to a heavily
populated area within hours and over great distances
9. The use of biological warfare and bioterrorism with organisms such as
the causative agents of anthrax and plague
EPIDEMIOLOGICAL TRIAD
 INFECTIOUS AGENTS
1. Pathogenicity – ability of an organism to
cause a disease
2. Infectivity – ability of the organism to infect
the host
3. Virulence – ability of the organism to
produce disease
4. Infective dose – the number of organisms
and the amount of toxin released by the
organism to induce a disease
 HOST
1. Patient – is a person who is infected and
manifests the signs & symptoms of the disease
2. Carrier – a person who appears to be healthy
but harbors the organism and is capable of
transmitting the disease but does not manifests
its s/sx
3. Suspect – a person whose medical history, s/sx
suggest that such a person is suffering from that
particular disease
4. Contact – a person who has been in close
association with an infected person, animal or
object
 ENVIRONMENT
1. Physical environment
2. Biologic environment
3. Socio-economic environment
Chain of Infection
 CHAIN OF INFECTION
1. Infectious Agents
a. Bacteria
b. Virus
c. Fungi
d. Protozoa
e. Parasite
2. Reservoir
a. Human reservoir
b. Animal reservoir
c. Environmental reservoir
 CHAIN OF INFECTION
3. Portal of exit
a. Respiratory tract – nasal discharges
b. Genitourinary tract – urethral secretions
c. Gastrointestinal tract – vomitus, stool
d. skin and mucous membrane – skin infections
e. placental
 CHAIN OF INFECTION
4. Mode of Transmission
a. Contact transmission
• Direct
• Indirect
b. Vertical transmission
5. Portal of entry
6. Susceptible host
 KINDS OF INFECTION
1. Subclinical or Asymptomatic
2. Latent infection
3. Exogenous/endogenous infection
4. Health Care Associated Infection
 KINDS OF PRECAUTION
1. Standard Precautions
2. Transmission Based Precautions
a. Airborne Precautions
b. Droplet Precautions
c. Contact Precautions
 IMMUNITY

NATURAL/INHERENT ARTIFICIALLY
ACQUIRED

ACTIVE ACTIVE

PASSIVE PASSIVE
PREVENTIVE & CONTROL
MEASURES
 ENVIRONMENTAL SANITATION
1. Water Supply Sanitation Program
2. Proper Excreta and Sewage Disposal
3. Food Sanitation Program
4. Hospital Waste Management Policies
 NURSES ROLE IN ENVIRONMENTAL
HEALTH
• Health education activities
• Active participants in training/workshops related
to environmental health
• Advocate/facilitator of programs/projects related
to environmental health
• Participate in environmental sanitation
campaigns/projects
• Role model in cleanliness in home/surroundings
• Help in the implementation of PD856 (Sanitation
Code)
 ISOLATION
• is the practice of separating a patient with a
communicable disease from other people to
prevent or reduce the transmission of
infectious agents (directly or indirectly)
 ISOLATION
7 CATEGORIES
1. Strict Isolation
2. Contact isolation
3. Respiratory isolation
4. Tuberculosis Isolation
5. Enteric isolation
6. Drainage/Secretion precaution
7. Universal precaution
 10 STRATEFIES FOR INFECTION
PREVENTION/CONTROL
1. Hand Hygiene
2. Environmental Hygiene
3. Screening & Cohorting Patients
4. Vaccinations
5. Surveillance
6. Antibiotic Stewardship
7. Care Coordination
8. Following the evidence
9. Comprehensive Unit Based Safety Programs
SPECIFIC COMMUNICABLE
DISEASE
 TUBERCULOSIS
• Phtisis, Consumption Disease, Koch’s Disease
• One of the oldest and deadly diseases worldwide
• WHO: 9M new cases in 2012 and 1.4M TB deaths
• WHO: 1B in 2020, 70M deaths
• 75% in Asia according to CDC
• 5th leading cause of mortality in the Philippines
 TUBERCULOSIS
1. ETIOLOGIC AGENTS
– Mycobacerium Tuberculosis
– Mycobacterium Bovis
2. INCUBATION PERIOD
– 2-10 weeks
3. MODE OF TRANSMISSION
– Mycobacerium Tuberculosis - airborne
– Mycobacterium Bovis – GIT
4. SOURCES OF INFECTION
– Mycobacerium Tuberculosis – sputum, blood from hrmoptysis, nasal
discharge & saliva
– Mycobacterium Bovis – unpasteurized milk
5. PERIOD OF COMMUNICABILITY
– Patients are capable of discharging the organism throughout their lifetime if
they remain untreated. Highly communicable during its active phase
CLASSIFICATIONS OF TB
 TUBERCULOSIS – CLINICAL
CLASSIFICATION
1. Inactive (Latent) TB
– Sx of tb are absent
– No evidence of cavity in CXR
– Immune system stops microbs from spreading
– Microbs may reactivate
2. Active
– TB test is positive
– CXR progressive
– Sx present
– Sputum & gastric contents + for TB
– Infectious
3. Activity not determined
 TUBERCULOSIS – QUANTITATIVE
CLASSIFICATION
1. Minimal TB
– Slight lesions without demonstrable excavation
– Confined to a small part of one or both lungs
2. Moderately Advanced Tb
– One or both lungs may be involved
– Volume affected should not extend to 1 lobe
– Diameter of cavity should not exceed 4cm
3. Far advanced TB
– More extensive than moderately advanced
RISK FACTORS
 TUBERCULOSIS – PATHOGENESIS
Mycobacterium Tuberculosis inhaled

Alveoli (Ghon’s Tubercle)

Aggregation of Lymphocytes

Death of cells

Caseous necrosis

CHEESY SECRETIONS
 TUBERCULOSIS – CLINICAL
MANIFESTATIONS
1. Systemic
– Influenza like s/sx
– Hematologic abnormalities: pancytopenia & leukomoid
reactions
2. Pulmonary and Pleural Tuberculosis
– Imperceptible onset of cough, increases in frequency
– Mucopurulent sputum
– Chest tightness
3. Radiographic Examination
– Lesions on upper lobe/s of the lung/
– Cavitation
– Hematogenous (Miliary) TB
 TUBERCULOSIS – CLINICAL
MANIFESTATIONS
4. Extrapulmonary Tuberculosis
– GUT
– Lymph nodes
– Bones/joints
– Meninges
– Peritonium
– Larynx
– Other organs
 TUBERCULOSIS – DIAGNOSTIC
PROCEDURES
1. Medical History
2. Physical examination
3. Diagnostic/Laboratory Examination
– Tubeculin (Mantoux) Test/TB test
– CXR AP lateral
– Sputum AFB X3 days
– Bronchoscopy
– CT San/MRI
 TB DOTS or TUTOK GAMUTAN
• National Tuberculosis Program
• TB-DOTS clinic is a diagnostic and therapeutic
unit that caters patients diagnosed with TB or
suspected of having TB.
• The Directly Observed Treatment Strategy
(DOTS) is the most effective approach in the
diagnosis, treatment, and control of TB.
• The clinic operates by the standard protocol of
the Department of Health and World Health
Organization.
 TB DOTS or TUTOK GAMUTAN
Services Offered:
1. Daily Consultation and follow up check up
2. Diagnostic Work ups for Presumptive TB
3. Treatment Regimen provided for free to admitted TB , and enrolled
TB patients
4. Referral of TB patients to external facilities for registration and
treatment
5. Counselling and Health Education to TB patients and treatment
partners
6. Weekly monitoring and follow up of enrolled TB patients on going
treatment
7. Monthly monitoring and tracing of defaulters
 5 ELEMENTS OF TB DOTS
Political Commitment

Case detection

Standardized treatment

Effective drug supply and management system

Monitoring, evaluation system & impact measurement

ROLES AND RESPONSIBITILIES OF PHN
1. Nurse as administrator
2. Nurse as health educator
3. Nurse as case manager and coordinator
4. Nurse as community organizer
5. Nurse as treatment partner
6. Nurse as TB advocate
TREATMENT
 TREATMENT FOR ADULTS
CATEGORY TYPE OF TB PATIENT TREATMENT REGIMEN

INTENSIVE MAINTENANCE

1 • New smear + PTB HRZE HR

• New smear – PTB w/ extensive parenchymal (2months) (4months)
lesions on CXR
• Extrapulmonary TB

2 • Treatment failure HRZES HRE

• Relapse (2months) + (5 months)
• Return after default HRZE
(1month)

3 • New smear negative PTB w/ minimal HRZE HR

parenchymal lesions on CXR (2 months) (4 months)

4 • Chronic Second line generation

antibiotics based on the
resultsof culture & sensitivity
 TREATMENT FOR PEDIA
TYPE OF TB PATIENT TREATMENT REGIMEN

INTENSIVE MAINTENANCE

• Pulmonary TB HRZ HR
(2months) (4months)

• Extrapulmonary TB HRZS HRE

(2months) (10 months)
TREATMENT

• MYRIN P
FORTE
• MYRIN
 PREVENTION
1. BCG vaccination of newborn infants provides
50% against any TB disease
2. Health education
3. Environmental sanitation
4. Early diagnosis and treatment
5. Respiratory isolation
 LAWS FOR THE CONTROL OF TB
• RA 1136 – Tuberculosis Law of 1954
• Memorandum Circular No. 98-155 – National
TB program as the highestpriority public
health program of the LGUs
• AO 24 s 1996 – DOTS in the management of
TB
• RA 10767 : Comprehensive TB Elimination
Plan Act of 2016
 2017-2022 PHILIPPINE STRATEGIC TB
ELIMINATION PLAN
• Activate communities and patient groups to promptly access quality
TB services
• Collaborate with other government agencies to reduce out-of-
pocket expenses and expand social protection programs
• Harmonize local and national efforts mobilize adequate and
competent human resources
• Innovate TB information generation and utilization for decision
making
• Enforce standards on TB care and prevention and use of quality
products
• Value clients and patients through integrated patient-centered TB
services
• Engage national, regional and local government units/ agencies on
multi-sectoral implementation of TB elimination plan
 ASSIGNMENT
1. Dengue
2. Malaria
3. Filariasis
4. Gonorrhea
5. Syphilis
6. Candidiasis
7. HIV
8. Schistosomiasis
9. Rabies
10. Leptospirosis
11. leprosy
Thank You!