CDN DAY 1
generalized.
TYPES OF INFECTIOUS DISEASES INFECTIOUS
DISEASES
 Localized infectious may be superficial
or deep seated.
 Circulation of bacteria in the blood is
known as bactermia (viruses-virusemia)
 Septicemia is the condition where
bacteria circulate and multiply in the
blood, from toxic products and cause
swinging type of fever.
 Pyemia is a condition where pyogenic
bacteria products septicemia with
multiple abscesses in the internal
organs such as the spleen, liver and
kidney.
DEPENDING ON THE SPREAD OF THE
INFECTIOUS DISEASES IN THE COMMUNITY
THEY MAY BE CLASSIFIED INTO DIFFERENT
TYPES:
 Endemic diseases are ones that are
constantly present in a particular
area, malaria is endemic is most
parts of palawan.
 An epidemic disease is a one that
spreads rapidly, involving many
persons in an area at the same
time. Influenza causes annual
winter epidemics in the cold
countries.
 A pandemic is an epidemic that
spreads through many areas of the
world involving very large numbers
of persons within short period
(influenza, cholera, plaque)
 Epidemics vary in the rapidity of
spread waterbone disease such as
cholera and hepatitis may cause
explosive outbreaks, while disease,
which spreads by a person-to-
perosn contact evolve more slowly.
 Incubation period – no symptoms.
 Prodromal period- mild and
 (symptoms (fever. Weakness,
headache).
 Invasive stage – symptoms specific
to the disease.
 Decline stage- symptoms subside.
 Convalescence – no symptoms,
health returns to normal.
 Isolation- separation of persons
with CD from other persons so that
either direct or indirect
transmission to susceptible persons
is prevented EX. Measles,
chickenpox etc.
 Reverse isolation
 Quarantine- limitation of the
freedom of movement equivalent
longest IP of the disease.
THE CHAIN OF INFECTION
ETIOLOGIC/INFECTIOUS AGENT
Bacteria, fungi, virus, parasites
Reservoir (SOURCE)
Human beings, animals, inanimate
object, plants, general environment
Such as air, water and soil.
Portal of exit
Sputum, emesis stool, blood
Modes of transmission
Contact, vehicle airborne, vector-
borne
Portal of entry
 Mucous membrane, non intact skin,  Produced by lymphocytes in response
GI tract, GU, tract, respiratory tract. to antigen

ANTIGEN

 Triggering agent of the immune system.

Susceptible host
Immunosuppressed children, IMMUNOGLOBULINS
elderly, chronically ill, those with  IgG
trauma or surgery.
Most prevalent antibody 80%, produce later
INFECTION in the immune response, only Ig that can
 Condition caused by the entry and cross the placenta
multiplication of the pathogenic
 IgA
microorganism within the host
Found in colostrum, Tears, Saliva, sweat.
body.
 IgM
 Invasion, helminth, fungi, parasite,
Principal antibody of blood, quickly
rickettsia and prion)
produced in response to an antigen,
FACTORS AFFECTING RISK OF INFECTION responds to artificial immunization.
 IgE
 AGE Allergic reaction
 HEREDITY  IgD
 LEVEL OF STRESS Unknown, antigen receptor, found in
 NUTRIONAL STATUS the surface of B cells.
 CURRENT MEDICAL THERAPY
 PRE-EXISTING DISEASE IMMUNIZATION
 IMMUNIZATION STATUS  A process by which resistance to an
infectious disease is induced or
IMMUNITY augmented.
 the quality of being insusceptible to or  Active and passive immunization.
unaffected by a particular disease. EPI
 Hepa B 3 shots, 0-1-6 mo, IM, 0.5 ml,
TYPES OF IMMUNITY vastus lateralis
 INNATE = within the HOST immune  BCG 1 at birth, ID, 0.05 ml, right arm
system  BCG 2 at 6 y/o, ID, 0.1 ml, left arm
 ACQUIRED = inoculation and disease  DPT 3 shots, 6 weeks old, 4 weeks
active interval im, 0.5 ml, vastus lateralis
 Passive  OPV 3x, same with DPT, oral drops 2-3,
IMMUNE SYSTEM 4 weeks interval
 Measles 1x, 9 mo, SC, 0.5 ml, right arm
 Protection against antigen or diseases
by a system or antibody production ACTIVE IMMUNITY

ANTIBODY:  Antibodies, are produced by the body

response to infection.
  ANTIGEN is introduced, long duration
 EXAMPLE:
 - NATURAL ACTIVE = DISEASE
 - ARTIFICIAL ACTIVE = VACCINES
ARTIFICIAL ACTIVE
 ANTIGENS (VACCINES OR TOXOIDS)
Are administered to stimulate antibody
production
Reinforced by booster dose to increase
immunity
 KILLED VACCINES
Pertussis vaccine, typhoid vaccine
 LIVE VACCINES
Attenuated, weakened
Sabin, measles
 TOXOID
Inactivated bacterial toxin-tetanus
diphtheria
PASSIVE IMMUNITY
 Antibodies are produced by another
source
GENERAL NURSING CARE IN CD
 Antibodies are introduced, short
duration
 Example:
 NATURAL PASSIVE = MOTHER
 ARTIFICIAL PASSIVE = GLOBULINS
ARTIFICIAL PASSIVE
 Immune serum (antibody) from animal
or human is injected provide immediate
protection (diphtheria
antitoxin, tetanus antitoxin)
 Skin testing is a must.
CONDITIONS BEFORE AN INFECTION DEVELOP
 Sufficient number of microorganisms.
 Virulence of microorganisms
 Resistance of the host
 Immunity of the host
 Cycle of infection must be completed.
EPIDEMIOLOGY
 Sporadic – occurs occasionally and
irregularly with no specific patterns
 Epidemic- occur in a greater number
than what is expected in a specific area
over a specific time.
 Pandemic- epidemic that affects several
countries or continents.
 Endemic- present in a population or
community at times.
STAGES OF AN INFECTIOUS PROCESS
 Incubation period
 Prodromal period
 Illness period (pathognomonic sign)
 Convalescent period
1. Preventive aspect
A. Health education
B. Immunization
C. Environmental sanitation
D. Proper supervision of the food
handlers.
2. Control aspect
 Isolation-separation of the
period of communicability
of infected persons
 Quarantine-limitation of
freedom of movement of
person exposed to CD
during the longest IP.
 Disinfection-killing of
pathogenic agent by
chemical or physical means.
 FUMIGATION- process of
killing of animal forms
accompanied by the
employment of gaseous
agent.
 Practice of medical asepsis-
gloving, gowning and
handwashing, placarding,
eye shields, eye goggles.
 FUNDAMENTALS OF
STANDARD PRECAUTION
 Handwashing
 Gloves
 Masks, goggles, face shields
 Air filters
 Gowns
 Isolation
 Strict isolation
 Contact isolation.
 Respiratory isolation
 Tuberculosis isolation
 Enteric precaution
 Enteric precaution
 Drainage/secretion
precaution
 Blood/body fluids
precautions
ISOLATION
 it is necessary when a
person is known or
suspected to be
infected with pathogens
that can be transmitted
by direct or indirect
contact
 the principle behind
isolation technique is to
create a physical barrier
that prevents the
transfer of infectious
agents. To do this you
have to know how the
organisms are
transmitted.
TRANSMISSION-BASED PRECAUTIONS
 Contact transmission- most common;
direct, indirect and droplet spread (3
feet/ 1 meter)
 Air-borne transmission < 5 microns
vehicle transmission articles or
substances that harbor the organism
until it is ingested or inoculated
 Vector-borne transmission intermediate
carrier.
BARRIER PROTECTION
 Airborne private room- airflow or at
least 6 air exchanges per hour
 Droplet-private room, mask with 3 feet
 Contact private room, mask, gown
 A. HEPA air filter can reduce the amount
of airbone allergens
OTHER TYPE OF ISOLATION
 AFB ISOLATION
VISITORS
Report to nurses station before entering
room
- Mask are to be worn in the patient’s
room
- Gowns are indicated to prevent
clothing contamination.
- Gloves are indicated for body fluids
and non-intact skin.
- Handwashing: after touching the
patient or potentially contaminated
articles and after removing gloves
- Articles should be discarded,
cleaned or sent for
decontamination and reprocessing.
- Room is to maintain closed.
- Patient is to wear mask during
transport.
 STRICT ISOLATION
 RESPIRATORY ISOLATION
 WOUND AND SKIN ISOLATON
 ENTERIC ISOLATION
 PROTECTIVE OR REVERSE ISOLATION
STRICT ISOLATION
 Visitors-report to nurses station before
entering room
 Private room-necessary, door must be
kept closed.
  Gowns, masks, gloves= must be worn by  Gowns- must be worn by all persons
 all persons entering the room having direct contact with the patient
 HANDWASHING  MASKS
 Article- must be discarded, or wrapped  HANDWASHING
before being sent to central supply for  GLOVES- must be worn by all persons
disinfection or sterilization having direct contact with patient or
articles contaminated with fecal
RESPIRAOTRY ISOLATION material.
 Visitors-report to nurses station before  ARTICLES- special precautions necessary
entering room for articles contaminated with urine and
 Private room- necessary, door must be feces, must be disinfected or discarded.
kept closed
PROTECTIVE ISOLATION
 GOWNS
 Masks- must be worn by all persons  Visitors- report to nurses station
entering the room if susceptible disease before entering room
 Handwashing  Private room- door must be
 Gloves kept closed
 Articles- those contaminated with  GOWNS & MASK- must be worn
secretions must be disinfected by all persons entering room
 CAUTION- all persons susceptible to the  HANDWASHING
specific disease should be excluded  GLOVES- must be worn by all
from the area, susceptible to the persons having direct contact
specific disease should be excluded with patient
from the area susceptible must wear
DIAGNOSTIC TOOLS
masks.
 Collection of specimen
WOUND AND SKIN PRECAUTIONS
 Principles
 Visitors-report to nurses station before  Types of specimen collection
entering room - Blood
 PRIVATE ROOM - Urine
 GOWNS & GLOVES- must be worn by all - Stool
persons having direct contact with - Sputum
patient. - Wounds
 MASKS- during dressing changes - Throat
 HANDWASHING
LABORATORY TEST
 GLOVES- must be worn by all persons
having direct contact with infected area  Microscopy
 ARTICLES- instruments, dressing, linens.  Culture
 Antibiotic susceptibility testing white
ENTERIC PRECAUTIONS
blood cell count
 Visitors- report to nurses station before  Immunologic test
entering room
 Private room- -necessary FOR children
only
 CENTRAL NERVOUS SYSTEM (CNS)
TETANUS (LOCKJAW)
 Clostridium tetani- direct inoculation
resulting to tonic muscular spasms;
anaerobic bacteria gm +
 Toxins = tetanospasmin, tetanolysin
 MOT = OM, Tooth decay, tet neonat
 IP = 3-21 days adult, 30 days NB
 IMMUNITY
 Active = TT
 Passive = TAT and TIG
 Natural = active non, passive (+)
CLINICAL MANEFESTATIONS
 Trismus- lock jaw, neck and facial
muscle last to disappear
 Risus sardonicus- maskface; sardonic
grin
 Opisthotonos- arching of the back
 Rigidity of abdominal muscles and
extremities
 Difficulty in swallowing and breathing
 Urinary and bowel incontinence
 Pain- redness and swelling
 Dx exam: wound history and wound
culture.
TETANUS NEONATORUM:
A. Feeding and sucking abn.
B. Voiceless crying
C. Sucking- cyanosis
D. Dehydration
E. Tonic or rigid muscular contraction
F. Flaccidity-exhaustion- death
IMMUNIZATION:
 DPT (0.5 ml IM)
 1-1 ½ months old
 2- after 4 weeks
 3 – after 4 weeks
 1st booster – 18 months
 2nd booster – 4-6 years old subsequent
booster
 Every 10 years thereafter
 TT (0.5 ml IM)
 TT1 – 6 months preg
 TT2-4 weeks after
 TT3-6 months after
 TT4 at least 1 year after TT3
 TT5 – atleast 1 year after TT4
 TAT (horse) and TIG (human)
3 types of patients w/skin wounds post
exposure prophylaxis
1. (+) immunization as a child w/ booster
but last shot > 1o years – give TT
2. (-) immunization – TT + TIG/TAT
3. (+) tetanus – TIG/TAT + TT + ATBC +
wound cleansing + supportive therapy
Planning and implementation
Preventive measure
1. Immunization
2. Proper wound care
3. Avoidance of wound
3 objectives of medical management
1. Neutralize toxins- antititetanus
toxins; epinephrine and
corticosteroids present
2. Kill the bacteria – penicillin, daily
cleansing of wound
3. Prevent muscle spasm- sedatives,
muscle relaxant to increase effect of
sedatives.
NURSING CARE
 Avoid stimulation to avoid
muscle spasm
 Proper oral hygiene
 Record intake and output
 Provide a quiet and well
ventilated room
  Always have padded tongue
depressor to maintain
patient airway
 Never leave the patient
alone
COMPLICATIONS
 Pneumonia
 Serum sickness in the form of rashes or
hives due to administration of antitoxin
RABIES/LYSSA (Hydrophobia)
 Rhabdovirus/filterable virus
 MOT = saliva of infected animal
 Canine (human) and sylvatic (animals)
 IP = 10 Days to 15 years man;
 7 days – 7 ½ months for dogs
 Immunity
 Active = rabies vaccine
 Passive = HRIG, ERIG
 Natural = active none, passive none
RABIES/ LYSSA (zoonotic)
 Hydrophobia (fear of choking)
 Aerophobia (laryngospasm)
 Bite from warm blooded animals
 Encephalitis/meningitis/respiratory
paralysis
CATEGORIES OF BITES
 I – intact skin (lick)
 II- mucosal, non-bleeding wounds,
abrasions
 III – bleeding bites and above neck,
stray dogs, laceration, multiple bites
CLINICAL MANIFESTATION
Rabid animals
1. Dumb form – complete change in
disposition; very affectionate and
walking to and from; paralysis and
coping flow of saliva
2. Furious form – vicious, agitated, then
become paralyzed, emits excessive
saliva and dies.
FOR MAN
A. Invasive stage – numbness on site of
bite, headache, malaise,
restlessness, fever, photosensitivity,
apprehension.
B. Excitement stage – hydrophobia,
spasms of laryngeal and pharyngeal
mescle maniacal (climbing the wall
and excessive salivation)
C. Paralytic stage – laryngospasm
stopped, last for how many seconds
or hours.
DIAGNOSTIC EXAM
 10 Days observation for
maniacal s/sx
 Brain biopsy of the animal
 Fluorescent rabies
antibody- specimen blood
of individual
PREVENTIVE MEASURES
 Immunization of
animals
 Keep away from stray
animals.
AFTER THE BITE
- wash with soap and water
- give an antibiotic and antitetanus
- observe dog for 14 days, if it dies
consult doctor
- if dog shows suggestive of rabies,
kill the dog immediately and bring
head for lab exam (+) negri bodies
 submit for immunization while
waiting for results
- if dog is not available for
observation submit for
immunization.
IMMUNIZATION
 rabies vaccines (5 shots) IM
(2ml deltoid) 0,3,7,14,28 days
ID (0.1 ml deltoid)
0,3,7 days (0.1 deltoid 2 shots)
30,90 days (0.1 ml deltoid single
shot)
 rabies Ig
 single shot
 wound 40%
 deltoid 60%
RESPONSIBLE PET OWNERSHIP
 Have pet immunized at 3
months and every year after
 Never allow pets to roam in
the street
 Leashed your dog
 You pet action is your
responsibility.
CENTRAL NERVOUS SYSTEM
 TETANUS
 An acute disease induced by an exotoxin of
the tetanus bacillus, which grows in
anaerobically at the site of an injury.
 The disease is characterized by painful
muscular contractions, primarily of the
masseter and neck, secondarily of trunk
muscle.
 CAUSATIVE AGENT:
 CLOSTRIDUM TETANI - ANAEROBIC
BACTERIA
 Is a gram (+), ANAEROBIC, SPORE-FORMING
BACTERIA
 Secretes tetanospasmin
 (destroys the inhibitory reflexes in the NMJ
resulting to uncontrolled muscle
contractions)
 Tetanolysin- dissolves RBC in the circulation
 Is a gram (+), ANAEROBIC, SPORE-FORMING
BACTERIA
 Secretes tetanospasmin
 (destroys the inhibitory reflexes in the NMJ
resulting to uncontrolled muscle
contractions)
Tetanolysin- dissolves RBC in the circulation
 TETANUS
 TOXIN PRODUCED
 TETANOLYSIN- DISSOLVES THE
RED BLOOD CELLS
 TETANOSPASMIN- PRODUCES
THE SPASM OF VOLUNTARY
MUSCLES AND CONVULSION OF
TETANUS.
MODE OF TRANSMISSION
 Usually through a puncture wound
contaminated with soil, street dust, or
animal or human feces.
 Through lacerations, burns and trivial or
unnoticed wounds.
 Tetanus usually follows surgical
procedures, which include circumcision
 INCUBATION PERIOD: USUALLY 3-21
DAYS
 Although it may range from 1 day to
several months, depending on the
characters, extent and locations of the
wounds.
 Average 10 days
ASSESSMENT
Clinical manifestation
 Trismus
 Stiffness that gradually
increases until the jaws are
locked and cannot be opened
  Risus sardonicus (sardonic grin)
 The lips protrude and corners of
the mouth are drawn out of
shape
 Opisthotonus position
 The arching of the back
CLINICAL MANIFESTASTION
 Rigidity of abdominal
muscles and extremities
 Difficulty in swallowing and
breathing
 Urinary and bowel
incontinence
 Pain, redness and swelling.
DIAGNOSTIC EXAMINATION:
 Attempts of laboratory confirmation are
of little help.
 The organism is rarely recovered from
the site of infection.
 Usually there is no detectable antibody
response.
PLANNING AND IMPLEMENTATION/
MEDICAL MANAGEMENT:
 3 objectives
 Neutralize toxins
 Kill the bacteria prevent muscle spasm
1. NEUTRALIZE TOXINS
 Administer anti-tetanus toxins
 Epinephrine and corticosteroid must be
present.
 Tetanus immunoglobulin
2 . KILL THE BACTERIA
 ANTIBIOTIC (PENICILLIN)
 DAILY CLEANSING OF WOUND
 THIN DRESSING TO ALLOW AIR TO
CIRCULATE.
3. PREVENT MUSCLE SPASM
 sedative to relax patient and
decrease response to stimuli.
 Muscle relaxant to increase the
effect of sedatives.
NURSING CARE
 A. avoid stimulation to avoid
muscle spasm
 B. proper oral hygiene
 C. provide a quiet and well –
ventilated room
 D. always have padded tongue
depressor to maintain patient
airway
 E. never leave the patient alone.
PREVENTIVE MEASURES
 Immunization
 (DPT, TETANUS TOXOID, TETANUS IG
OR ATS)
 Avoidance of wound > hazards of
puncture wounds and closed
injuries that are particularly liable to
be complicated by tetanus
 Prophylaxis in wound management
COMPLICATIONS:
 Pneumonia- usually will not result
to mortality
 2. Serum sickness in the form of
rashes or hives – due to
administration of anti-toxin
MENINGITIS
 An acute contagious disease as a
result of inflammation of meninges
of the spinal cord.
  Caused by several microorganism
(viral, bacterial, fungal, parasitic)
 Causative agents:
 Viral etiology (heroesviruses,
adenovirus, arbovirus)
 Bacterial (meningococcus, N.
meningitidis, streptococcus,
staphylococcus, haemophilus, etc)
 Fungal (cryptococcus)
 Parasitic (naegleria)
MODE OF TRANSMISSION:
Meningococcal meningitis
 By direct contact, including respiratory
droplets from nose and throat of
infected people.
 INCUBATION PERIOD:
 Varies from 2 -10 days
 Commonly 3-4 days
PERIOD OF COMMUNICABILITY
 Until meningococci are no longer
present in discharges from nose and
mouth
 Meningococci usually disappear from
the nasopharynx within 24 hours after
institution of treatment with
antimicrobial agents.
ASSESSMENT FINDINGS:
CLINICAL MANIFESTATIONS
 Headache, photophobia, malaise,
irritability
 Chills and fever
 Vomiting
 Seizures and decreasing level of
consciousness.
 Signs of meningeal irritation
SIGNS OF MENINGEAL IRRITATION
 Kernig’s signs- pain in the hamstring
muscle when attempting to extend the
leg when the hip is flexed. (knee)
 Brudzinki sign- flexion at the hip and
knee in response to forward flexion of
the neck (batok)
 Nuchal rigidity
 Opisthotonus (backward arching of the
spine)
SIGNS OF INCREASED ICP
 Altered level of consciousness
 Projectile vomiting
 Papilledema
 Dilated pupils
 Increased BP and widened pulse
pressure.
 Bradycardia
 Irregular breathing pattern
 Headache
IN INFANTS:
 Bulging fontanels
 High-pitched cry
 Increased head circumference
 Widened cranial sutures
DIAGNOSTIC EXAM:
 Confirmed by the recovery of
meningococci from the CSF or blood
 Microscopic examination of gram-
stained smears from petechiae may
reveal organisms.
MEDICAL MANAGEMENT:
 Mannitol-check BP
 Antibiotics (penicillin, third and 4th
generation cephalosporins, etc.)
 Corticosteroids (diazepam,
phenobarbital, etc.)
PLANNING AND IMPLEMENTATION
 1. Drugs-antibiotics, IV
 2. Provide nursing care of increased ICP
and seizures
 3. Provide bed rest; keep room quiet  Ecchymosis-a bruise an initially bluish
and dark if client has headache or black mark on the skin.
photophobia
 4. Maintain fluid and electrolyte balance
 5. Monitor vital signs and neuro-vital
signs frequently
 6. Health teaching concerning
importance of good diet: high protein,
high calorie with small, frequent
feedings.

PREVENTIVE MEASURE

 Proper disposal of nasopharyngeal DIAGNOSTIC EXAMINATIONS:

secretions.
COMPLICATIONS:
 1. Pneumonia
 2. Endocarditis or pericarditis
 3. Otitis media and mastoiditis
 4. Hydrocephalus
 5. Ocular conditions
MENINGCOCCEMIA
 A contagious, acute, fetal bacterial
infection of the blood and meninges
 Characterized by rapid deterioration of
clinical condition within 24 hours
 More commonly affects children than
adults
 Common in cold and congested areas.
CAUSATIVE AGENT:
 Neisseria meningitidis
 Gram (-) kidney-shaped diplococci:
CLINICAL MANIFESTATION:
 High-grade fever
 Signs of meningeal irritation
 Appearance of rashes-petechiae and
ecchymosis on wrist and ankles
 Petechiae-small round flat dark-red
spots caused by bleeding into the skin
or beneath the mucous membrane.
 Blood culture
 To confirm the presence of N.
meningitidis
 Wound or skin lesion culture.
 CSF culture.
MEDICAL MANAGEMENT
 early administration of penicillin G or
ceftriaxone (meningeal dose)
NURSING INTERVENTION
 ISOLATE the px immediately
 Monitor NVS
 Observe droplet and contact
precautions
 Maintenance of fluid and electrolyte
balance
 Monitor bleeding tendencies
(waterhouse-freidrichsen syndrome)
 Advise prophylaxis of all family
members that had close contact with
the patient (rifampicin, ciprofloxacin,
meningococcal vaccine)
WATERHOUSE-FRIEDRICHSEN SYNDROME
 Acute hemorrhage in the adrenal glands
with hemorrhage into the skin
associated with sudden onset of acute
bacteremic shock.
 It is usually caused by meningococcal
septicemia.
 ENCEPHALITIS:
 an acute inflammatory condition of the
brain as a complication of nervous
infectious disease causing
manifestations of cerebral dysfunction.
CLASSIFICATION
A. Primary
 Virus attacks the brain directly thru bite
of infected vectors
 E.g. st. louis encephalitis, Japanese B,
Australian X, Equine encephalomyelitis.
 B. secondary
 Occurs as a complication of
communicable diseases of viral origin
such as measles, mumps, chicken pox,
and following vaccination for small pox
(post-infection encephalitis)
 C. toxic
 A result of the action of metal poisoning
such as lead and mercury.
MODE OF TRANSMISSION
 Vector-borne transmission
 Direct complication or extension
 Accidental ingestion or inhalation of
chemical
CLINICAL MANIFESTATIONS
 Lethargy and alterations on the level of
consciousness
 Headache, convulsions
 Fever, chills and vomiting
 Decorticate rigidity: extension of legs,
internal rotation and adduction or arms
with flexion of elbows, wrists, and
fingers.
 Decerebrate rigidity: back arched, rigid
extension of all four extremities with
hyperpronation of arms and plantar
flexion of feet.
 Signs of meningeal irritation-stiff neck
and back.
DIAGNOSTIC EXAM:
 A. lumbar puncture
 B. electroencephalogram (EEG)
 C. blood culture
MEDICAL MANAGEMENT:
 Supportive and symptomatic
 Anti-viral medications (acyclovir)
 Anti-convulsant (diazepam)
 Corticosteroids
 Mannitol
PLANNING AND IMPLEMENTATION
 1. Monitor vital signs and neuro checks
frequently
 2. Provide nursing measures for
increased ICP, seizures and
hyperthermia if they occur.
 3. Provide nursing care for confused or
unconscious client as needed
 4. Increase body resistance through
adequate rest and food
RABIES
 An acute infectious disease transmitted
by direct inoculation from an infected
animal to man.
 Always fatal after it has once developed
CAUSATIVE AGENT:
 Rhabdovirus (filterable, bullet shape)
MODE OF TRANSMISSION
  Bite of an infected animal
 Licking of open wounds by a rabid
animal
 Scratch of rabid animal
 Man-to-man transmission: (10%)
INCUBATION PERIOD
 Ranges from 7 days to over 1 year
(mean, 1 to 2 months)
 Cases of human rabies with extended
incubation period (2-7 years) have been
reported, but they are rare.
CLINICAL ASSESSMENT
A. PRODROMAL/NONSPECIFIC
PRODROME
 From the time of incubation
and usually last 1 to 4 days
 Numbness on site of bite
 Fever
 Malaise
 Myalgias
 Anorexia
 Nausea and vomiting
 Sore throat
B. ENCEPHALITIC PHASE
 Excessive motor activity
 Excitation
 Agitation
 Confusion, hallucinations
 Combativeness
 Muscle spasm
 Opisthotonic posturing.
 Focal paralysis.
 Excessive sensitivity to bright
light, loud noise, touch, and
even gentle breeze.
 Paralysis of vocal cords is
common.
C. BRAISNTEM DYSFUNCTION
 Produces the classic features of
rabies encephalitis.
 Cranial nerve involvement –
diplopia, facial palsies,
characterisitic difficulty in
deglutition.
 Foaming at the mouth –
combination of excessive
salivation and difficulty in
swallowing.
 Hydrophobia – involving all
senses.
D. DEATH OR IN RARE CASES RECOVERY
 Patient lapses into coma
 Involvement of the respiratory
centers produces an apneic
death. Median period of
survival after the onset of
symptoms is 4 days with a
maximum of 20 days, unless
artificial supportive measures
are instituted.
 Recovery is very rare and, when
it occurs, gradual.
DIAGNOSTIC EXAM:
A. Fluorescent rabies
antibody- specimen: blood
of an individual
B. Brain biopsy of the animal
(NEGRIES BODIES)
C. 10 days observation of the
animal.
MEDICAL MANAGEMENT:
 “No specific treatment”
  PREVENTION is the best treatment.
 Anti-rabies vaccination of animal and
exposed individual.
PLANNING AND IMPLEMENTATION
 1. Provide a dim, quiet and non-
stimulating room for patient
 2. Wear gown, mask and goggles
 3. All noises no matter how minor
should be avoided
PREVENTIVE MEASURES
 1. Immunization of animals
 2. Keep away from stray animals.
CATEGORIES OF BITES
I- Intact skin (lick)
II- Mucosal, non bleeding wounds,
abraisons
III- Bleeding bites and above neck, stray
dogs, laceration, multiple bites.
 Other names: weil’s
disease, canicola fever,
hemorrhagic jaundice, mud
fever, swine herd disease
 Main problem: a zoonotic
infectious disease
 Etiologic agent: leptospira
interrogans
 Incubation period: 6 to 15
days
 Period of communicability:
in urine between 10 to 20
days after the disease onset
 Mode of transmission:
 Ingestion, skin penetration,
contact with the skin.
SIGNS AND SYMPTOMS:
 Septic or leptospiremic stage
 F-ever (remittent) – lasting 4 to 7 days
 H- eadache
 M-yalgia
 N- ausea
 V- omitting
 C-cough
 C-hest pain
 IMMUNE OR TOXIC STAGE
- With or without jaundice
- Lasts for 4 to 30 days
- Iritis, headache, meningeal
manifestations
- Oliguria, anuria with renal failure
- Shock, coma and congestive heart
failure
- Death may occur between 9th and
16th days
- Convalescence-relapse 4th to 5th
weeks.

TREATMENT MODALITIES
 1st line drugs
 1. Penicillin G – drug of
choice
LEPTOSPIROSIS  2. Doxycycline
  2nd line drugs 1. Dengue virus type 1,2,3,4
 3. Ampicillin 2. Chikungunya
 4. Amoxicillin 3. Onyong yong virus
4. West nile
COMPLICATIONS
5. Flavivirus
 Meningitis  MOT:
 Respiratory distress - Mosquito bites of the following:
 Renal interstitial tubular necrosis that 1. Aedes aegypti
result in renal failure-weil’s disease 2. Aedes albopticus
 Cardiovascular problems 3. Culex fatigans

SIGNS AND SYMPTOMS CLINICAL MANIFESTATION:

 Immune or toxic stage
- With or without jaundice
- Lasts for 4 to 30 days.
- Iritis headache, meningeal
manifestations
- Oliguria, anuria with renal failure
- Shock, coma and congestive heart
failure
- Death may occur between 9th and
16 days convalescence-relapse 4th to
5th weeks.
DANGUE HEMORRAGHIC FEVER (BREAKBONE
FEVER/HEMORRHAGIC FEVER/ DANDY
FEVER/INFECTIOUS THROMOCYTOPENIC
FEVER)
-an acute febrile disease characterized by severe
pain behind the eyes, joints and bones,
accompanied by initial erythema and terminal
rash or varying morphology.
- incubation period: 3 to 14 days: 3-7 days.
PERIOD OF COMMUNICABILITY
 Patient are infective to the mosquito
from a day before the febrile to the end
of it.
 The mosquito become infective from 8
to days after the blood meal and
remains infective throughout its life.
ETIOLOGY:
Grade I (last for 3 to 5 days)
- Herman’s sogn (generalized flushing
of the skin)
- Fever accompanied with non-
specific constitutional symptoms
and the only hemorrhagic
manifestation is positive tourniquet
test.
- Grade II
- All signs of grade 1 plus
spontaneous bleeding from the
nose, gums, and GIT are present
- Grade III
- There is the presence of circulatory
failure
- Grade IV
- There is profound shock and
undetectable blood pressure and
pulse.
DIAGNOSIS:
1. Tourniquet test
(rumple leede
test)
- Crude test of vascular resistance
and platelet number and function
- Done by placing blood pressure cuff
on arm for 5 minutes and then
counting the petechiae.
2. Hematocrit
level
- Increased
 3 . platelet count
determination
- Decreased
MALARIA, KING OF TROPICAL DISEASE (AGUE)
MANAGEMENT:
1 . provide a comfortable and quiet room
2 . provide adequate rest
3 . ice pack to relieve constant headache
4 . protect the eyes from the bright light
5 . boric acid or saline compresses to the eyes
relives soreness of the eyeball.
6 . good oral hygiene
7 . monitor intake and output
8 . prevent and control bleeding
- Preventive measures:
- Screening
- Good environmental sanitation
- Eradicate source of infection
MALARIA, KING OF TROPICAL DISEASE
 MOT
 Bite from the infected
anopheles mosquito or minimus
flavire (night biting)
 Blood transfusion
 Mosquito or sexual cycle
 Sporogony
 Gametes is the infective stage
 Human or asexual cycle
 Schizogony
 FEMALE ANOPHELES
MOSQUITO
 Breeds in clear, flowing, and
shaded stream usually in the
mountains
 Bigger in size
 Brown
 Night biting
 Not bite a person in motion
 Protozoan plasmodium
 Plasmodium ovale- dormant (liver)
 Plasmodium vivax – benign tertian
 Plasmodium malariae- mild but
resistant, quartant malaria
 Plasmodium falciparum-malignant
tertian (cerebral malaria)
CLINICAL MANIFESTATION
 Cold stage-last for 10 to 15 minutes,
presence of chills
 Hot stage-last for 4 to 6 hours, nauseas
and vomiting, fever, diarrhea, nose,
bleeding, headache
 Diaphoretic stage-generalized
weakness, sweating, decreased pulse
rate, temperature and respiratory rate
NURSING CONSIDERATIONS:
Dx:
 blood extraction (extract blood at the
height of fever)
 fever, chills, profuse sweating-
convulsion
 anemia and fluid and electrolytes
imbalance, hepatomegaly,
splenomegaly, rigor, headache and
diarrhea.
 Chloroquine and primaquine drug of
choice
  Chloroquine for pregnant women
 For resistant plasmodium-use chemo
drug.
 Sulfadoxine-resistant P. falciparum
 Primaquine-for relapse of P. vivax &
ovale.
NURSING CONSIDERATIONS:
 IV fluids and electrolytes
 Black water fever – hemolysis and
hemoglobinuria
 Sickle cell trait- provides natural
resistance
 Decrease fluids in cerebral edema
 Assisted ventilation in pulmonary
edema
 Dialysis in renal failure
 BT in anemia
 TRAVELERS TO MALARIA ENDEMIC area
SHOULD follow preventive measures-
 (CHEHMOPROPHYLAXIS CHLOROQUINE
1 WEEKS BEFORE ENTERING ENDEMIC
AREA) 6 WEEKS AFTER DEPARTURE
 Soaking of mosquito net in an
insecticide solution
 BIO PONDS FOR FISH
 ON STREAM CLEARING (TO EXPOSE THE
BREEDING STREAM TO SUNLIGHT)
 VECTORS PEAK BITING AT NIGHT 9PM
TO-3AM
 PLANTING OF NEEM TREE (REPELLANT
EFFECT)
 ZOOPROPHYLAXIS (DEVIATE MOSQUITO
BITES FROM MAN TO ANIMALS)
 INFECTED MOTHER CAN STILL
CONTINUE BREAST FEEDING
PLANNING AND IMPLEMENTATION
 Tepis to cool sponges for fever
 Provide adequate fluids
 Monitor EVS especially temperature
 Provide diet high in calories, vitamins
and minerals.
 Maintain fluid and electrolyte balance
 Oral hygiene should be maintained
 Iron rich food for anemia
 Drugs
DISEASES REQUIRED THROUGH INOCULATION
OF THE MUCOUS MEMBRANE
 Gonorrhea
 Syphilis
 Chlamydia
 AIDS
 Hepatitis B,C,D
ACQUIRED IMMUNE DEFICCIENCY SYDNROME
 RETROVIRUS THAT LEADS TO AIDS
 Human conditions start to fail leading to
life-threatening-opportunistic infections
 As of January 2006, AIDS has killed
more than 25M since December 2001
TRANSMISSION
 Sexual route-unprotected relations,
sexual practices that permit contact
with mucous membranes.
 Parenteral- blood or blood product
route, needles, syringes or drug
paraphernalia
 Perinatal (mother to child)
transmission- in utero during last
weeks of pregnancy and childbirth.
CLINICAL MENIFESTATION:
 PRIMARY INFECTION
 Acute mononucleosis like syndrome
(fever, fatigue, sore throat night sweats,
GI problemslypmphadenopathy,
maculopapular rash and headache.)
 Anorexia
 Dyspnea
 Fever
 Enlarged lymph nodes- chronically
swollen for 3 months
 LATENT STAGE
  No signs and symptoms
 Drop in CD4 count
 lympadenopathy (for 3 months)
 OVERT
 CD4 count is less than 200
 HIV encephalopathy: memory loss, lack
of coordination, partial paralysis, mental
deterioration
 HIV wasting syndrome, emaciation
 Opportunistic infections:
 Pneumocystiis carinii
 Cytomegalovirus
 Kaposi’s sarcoma
 Tuberculosis
 Candidiasis

DIAGNOSIS:

 ELISA test (enzyme linked

DIAGNOSIS
immunosorbent assay) screening test,
 Lymphocyte counts
inexpensive.
 CD4+/CD8+ counts
 Western blot – confirmatory test, more
 Viral culture
sensitive
 Viral load testing (RNA)
 Blood exam – CD4 and T cell are
 Antibody tests
decrease
 ELISA (enzyme-linked immunosorbent
 Skin biopsy
assay) – inexpensive and accurate
OPPORTUNISTIC INFECTIONS:  Immunofluorescence assay (IFA)
 Western blot test- conforms a positive
 PROTOZOAL INFECTIONS:
ELISA test.
 Pneumocystis carninii pneumonia
 Toxoplasma gandii encephalitis TREATMENT AND PREVENTION
 FUNGAL INFECTIONS:
 Only known prevention is to AVOID
 Candida albicans
exposure to the virus.
 Cryptococcus meningitis
 Current treatment consists of highly-
 Histoplasmosis
active antiretroviral therapy (HAART)
 BACTERIAL INFECTIONS:
 HAART options includes combination of
 Myobacterium avium complex
nucleoside analogue reverse
 VIRAL INFECTIONS
transcriptase inhibitor plus protease
 Cytomegalovirus
inhibitor.
 Herpes infections, varicella zoster
 Complementary and alternative
 MALIGNANCIES
therapies which includes vitamins,
 Kaposi’s sarcoma botanical products, aloe vera, and
 Malignant lymphoma immune enhancing agents like
echinacea and astralagus.
NURSING INTERVENTIONS (NEUTROPENIC
PRECAUTIONS)
 Place patients in private room
 Good handwashing technique
 Limit health care personnel
caring for patient.
 Inspect IV sites q 4h
 Inspect skin and mucous
membranes q 8h
 Limit visitors
 Use strict aseptic technique for
ALL invasive procedures.
 Avoid, if possible indwelling
catheters
 Monitor blood examinations.
GONORRHEA (BACTERIA)
 Neisseria gonorrheae (gram positive)
 IP 3-7 days
 Asymptomatic in women
 Mucopurulent discharge
 Painful urination
DX:
 Gram stain of cervical secretions
 Drugs: single dose only
 Ceftriaxone (Rocephin) 125 mg IM
 Ofloxacin (floxin) 400mg orally
CX:
 PID, ectopic pregnancy and infertility
 Ophthalmia neonatorum and sepsis
(infant) vaginal birth
MANAGEMENT: single dose only
 Ceftriaxone (Rocephin) 125 mg IM
 Ofloxacin (floxin) 400 mg orally
 Treat concurrently with doxycycline or
azithromycin for 50% infected w/
chlamydia
SEXUALLY TRANSMITTED DISEASES
SYPHILIS
 A contagious disease that leads to many
structural and cutaneous lesions.
CAUSATIVE AGENT:
 Treponema pallidum
MODE OF TRANSMISSION:
 Sexual contact
INCUBATION PERIOD:
 3 TO 6 weeks
CLINICAL MANIFESTATIONS:
 1. Primary syphilis
 chancre or genitalia, mouth or anus
 serous drainage from chancre
 enlarged lymph nodes
 painless ulcer
 highly infectious
2 . Secondary syphilis
 skin rash on palms and soles of feet
 reddish copper-colored lesions on palms
of hands and soles of feet
 condylomas: lesions/sores that fused
together
 erosions of oral mucus membranes
 alopecia
 enlarged lymph nodes
 fever, headache, sore throat, and
general malaise.
  Persistent vesicular eruptions and nasal
discharges
 Old man feature
 Mucus patches on mouth and anus.
 CHILD BORN WITH LATE SYPHILIS (SIGNS
AND SYMPTOMS AFTER 2 YEARS)
 Hutchinson’s teeth
 Deafness
 Saddle nose
 High palate
3 . tertiary syphilis:

 gumma: the characteristic lesion

 cardiovascular changes
 ataxia
 stroke, blindness.

DIAGNOSTIC EXAM:

 serology
 venereal disease research laboratory
(VDRL)
 Rapid plasma reagin circle card test
(RPR-CT)
 Fluorescent treponemal antibody
absorption test (FTA-ABS)
 Darkfield microscopy
 Culture and sensitivity test.

PLANNING AND IMPLEMENTATION

 Strict personal hygiene is an absolute

requirement
 Assist in case finding
 Instruct client to avoid sexual contact
until clearance is given by physician
 Encourage monogamous relationship
 Explain need to complete course of
antibiotic therapy
 Drugs-penicillin, tetracycline.

COMPLICATIONS:

 Still birth
 Child born with syphilis
 Placenta is bigger than the baby
  November 2019 – patient zero
retrospectively identified in wuhan,
china
 January 30, 2020 – WHO declared the
outbreak a “ public health emergency of
international concern”
 March 11, 2020 – WHO determined that
the outbreak reached pandemic
classification due to widespread
community transmission across the
world
 December 14 & 18, 2020 – the UK and
south Africa detected two new variants
of SARS-CoV-2, commonly referred to as
l a alpha and beta, respectively.
 May 10, 2021 – it was announced
during WHO’s briefing that a new SARS-
CoV-2 variant, first detected in india, is
now a variant of concern.
 May 28, 2021 – the global death toll
from COVID-19 surpassed 3.5 million.
 July 19, 2021 – Indonesia surpassed
india and brazil with the highest
number of COVID-19 confirmed cases
and death, making south east asia as
the new epicenter of the COVID-19
pandemic.

CORONAVIRUSES

 Coronaviruses (CoV) are a large family

of viruses that cause illness ranging
from the common cold to severe and
critical illness.
 Coronaviruses are zoonotic, which
means they are passed
 Between animals and people.
 Incubation period is the time from
when a person has an infectious agent
in their body (like virus) to the time
when a person begins having
symptoms from the infection
 For COVID-19, the incubation period is
likely 2-14 days.
COVID-19 TIMELINE
  The incubation period is the same for
children and adults.
 Most commonly, people who become
infected with SARS=CoV-2 begin feeling
ill and having symptoms after 5-6 days.
VIRUS MUTATIONS:
 Viruses naturally mutate over time
 The severity of the mutations depends
on the change that occurs in the virus
genetic material, some may have no
observable effect, while others during
replication
 Notable variants reported (as of august
2021):
 Alpha (> transmission: discovered in the
UK)
 Beta (> viral load: discovered in the
south Africa)
 Delta (> transmission: detected In india)
 Gamma (< effectiveness of covid-19
treatment, first detected in travelers
from brazil who travelled to Japan)
 Lambda (> transmission: detected in
peru)
 Mu (< effectiveness of COVID-19
vaccines, detected in Colombia)
EPIDEMIOLOGIC PROFILE OF COVID-19
 Up to 40% of patients infected with
COVID-19 may never develop any
symptoms. However, they can transmit
the disease.
 Among patients who are symptomatic:
 80% will have only mild to moderate
symptoms and can be managed as
outpatients.
 15% will develop lower respiratory tract
infections and may require
hospitalization.
 3-5% will require intensive care and may
need ventilator support.
 0.5-1% of patients will die (but case
mortality rates are variable across
settings and populations)
SYMPTOMS:
Most common symptoms
 Fever (83% - 99% of cases)
 Cough (59%-92% of cases)
 Shortness of breath (31%-40% of cases)
OTHER SYMPTOMS:
 Loss of smell and taste
 Feeling tired
 Headache
 Myalgias
 Sore throat
 Nasal congestion
 Diarrhea
 Muscle or body aches
TRANSMISSION of COVID-19
 Person-to-person transmission occurs
mainly trough the transfer of respiratory
droplets can travel about 1-2 meters,
landing on that person’s hands, other
people’s bodies or the surface of nearby
objects.
 When other people touch those
droplets and then touch themselves,
the virus can enter their body through
the mucous membrane of their eyes,
nose or mouth.
 WHO emphasized the importance of
social distancing (staying 1 meter away
from others), clean hands frequently,
and cover the mouth with a tissue or
bent elbow when sneezing or coughing.
 Ventilation can also help reduce the risk
of infection. The US CDC recommends
the following:
 Open windows and doors to increase
outdoor airflow.
  Use a window fan (placed securely in a
window) to exhaust air to the outdoors.
 Use exhaust fan in the kitchen
restrooms, etc. if available.
BREASTFEEDING WOMEN
RISK FACTORS FOR SEVERE/CRITICAL
DISEASE AND MORTALITY
 Age more than 60 years (increasing with
age)
 People of any age with the following
conditions:
 Pregnant women
 Hypertension
 Chronic kidney disease
 COPD (chronic obstructive pulmonary
disease)
 Immunocompromised state (weakened
NEWBORN BABIES
immune system) from solid organ
transplant or cancer.
 Obesity (body mass index (BMI) of 30 or
higher)
 Serious heart condition, such as heart
failure, coronary artery disease, or
cardiomyopathies
 Sickle cell disease
 Type 2 diabetes mellitus
 Active tobacco smokers.
SPECIAL POPULATIONS
PREGNANT WOMEN
 Update form US CDC (As of august 11.
2021)
 Although people and recently pregnant
people are at an increased risk for
severe illness from COVID-19 when
compared to non-pregnant people.
 Pregnant women with COVID-19 are at
risk for preterm birth.
 Other factors pose increased risk for
pregnant women in developing severe
COVID-19 infection:
 Underlying medical conditions
 Age (older than 25)
 Environment.
 According to the US CDC, breastmilk
provides protection against many illness
and it’s the best source of nutrition for
most babies even if the mother tested
positive for COVID-19.
 Precautions for women who are
suspected or confirmed to have COVID-
19 and choose to breastfeed:
 Wash your hands before breastfeeding
 Coughing and sneezing in a tissue.
 Wear a mask while breastfeeding and
within 1 meter of the baby.
 Disinfecting high touch surfaces.
 The risk of new born getting infected
with COVID-19 from their mother is low,
especially when the mother is practiced
minimum health precautions.
 The following precautions are
recommended to reduce the risk of
transmission of COVID-19:
 Do not put the mask or a face shield on
a baby. Their movements can block
their nose and mouth
 Limit face to face gatherings. Of
gatherings are unavoidable, keep 1
meter distance from visitors.
  Stay alert of signs and symptoms of
COVID-19 infection among babies.
 Symptoms include:
 Fever
 Lethargy
 Runny nose
 Cough
 Vomiting
 Diarrhea
 Poor feeding
 Shallow breathing.
CHILDREN
 According to the “WHO” data suggests
that children under the age of 18 years
represents about 8.5& of population
reported cases, with relatively few
deaths compared to other age groups
and usually mild disease. However,
cases of critical illness have been
reported. As with adults, pre-existing
medical conditions have been suggested
as a risk factor for severe disease and
intensive care admission in children.
 Children with medical complexity, with
genetic, neurologic metabolic
conditions, or with congenital heart
disease obesity, diabetes, asthma and
chronic lung. Disease, sickle cell disease,
or immunosuppression might be at
increased risk for severe illness from
COVID-19.
 Currently, the surveillance and analysis
of COVID-19 in children nationwide
(salvacion) is ongoing to assess the
impact of COVID-19 on children.
 Preliminary results released last June 30
indicate that majority of the symptoms
observed in children are:
 Fever
 Cough
 Difficulty breathing
 Colds
 Decrease in appetite.
 Vomiting
 On the increase of infection among
children, DOH clarified last august 9,
2021 that: increase in COVID-19 cases is
being experienced across all age groups
and not just among children. There was
an overall 59% increase in cases among
all age groups during the period of July
13 to 25 compared with July 26 to
august 8.
IMPORTANCE OF IPC COMMUNITY
SETTING
 Community spread of COVID-19
involves rapid person-to-person local
transmission.
 Slowing the outbreak at the community
level is challenging and requires local,
national and international actions.
 Infection prevention and control
procedures should be initiated in the
community just as they are initiated in
health facilities.
 There should be clear illness of
communication between healthcare
facility leadership, HCWs and public
health officials to manage community
spread.
IPC EARLY RECOGNITION AND SCREENING:
  Ensure staff maintain a high level of
clinical suspicion for COVID-19 through
education on symptoms and risk factors.
 Set up a screening station at all
entrances to assess patients for
symptoms and/or potential exposure.
 Requires face mask use for all patients,
regardless of symptoms.
 Screen using questionnaires for
currently risk factors for COVID-19:
 Exposure to suspected or confirmed
cases for the past 30 days
 Presence of symptoms- fever, cough,
shortness of breath, sore throat,
fatigue, muscle aches, loss of smell or
taste, congestion, diarrhea, eye
redness/ discharge.
 Travel to areas with high levels of cases
(both nationally and internationally)
RESPIRATORY PRECAUTIONS FOR PATIENTS
within the past 14 days
 Travel history is less relevant once there
is community spread.
IMPORTANT REMINDERS FOR THE
COMMUNITY
 While vaccines are being rolled out and
medicines are tested, it is the
combination of prevention measures,
effective medicines, and widespread
vaccination in the long-term will help us
overcome COVID-19
 We want to focus on risk reduction
rather than absolute prevention.
 Mask
 The best mask is one that be worn
comfortably and consistently, usually
preferred are surgical mask or cloth
masks.
 Use of N95 masks in the community are
not necessary.
 Double masking is an effective
alternative to receive a similar level of
protection.
 Practice minimum public health
standards.
STANDARD PRECAUTIONS FOR
PATIENTS
 Handwashing: use at least one of the
following, for at least 20 seconds
 Soap and water- sing happy birthday 2
times = 20 seconds
 Alcohol based hand rub (at least 60% of
alcohol) for at least 30 seconds.
 If these are not readily available. 0.05%
chlorine solutions from diluted bleach
can be used.
 Always wash hands with soap and water
and do not use alcohol-based hand rub
when hands are clearly soiled.
 Respiratory hygiene
 Everyone should cover their nose and
mouth with a tissue or upper sleeve
when coughing or sneezing.
 Wash hands after coughing and
sneezing.
 If upper respiratory symptoms are
present, face masks should be provided
to patients while they are in waiting or
public areas
 Perform hand hygiene after any contact
with respiratory secretions.
 Avoid touching eyes, nose, or mouth.
  After removal, masks can be stored in a
labeled bag for re-use.
 Eye protection
 Eye protection such as goggles for face
shields can be re-used. Clean after each
use by using disinfectant wipes and
store in a labelled bag.

ENVIRONMENTAL CONSIDERATIONS

 Use disposable equipment for

patient room wherever possible.
 For any possible that needs to be
washed to reuse, use the hottest
temperature.
 Daily cleaning of high touch
surfaces in the room
 If done by environment staff, they
should wear the same PPE as
clinical staff.
 After discharge, do not allow
another patient into the room until
cleaning is done and waiting at least
1-2 hours (to allow air exchange)
 All cleaning personnel should wear
PPE. (gown, gloves, face mask, and
eye protection)

DILUTE CHLORINE SOLUTIONS AS

DISINFECTANTS:
REUSING PPE IN CASE OF LOW SUPPLY
 In many places, alcohol based
 Gowns
disinfectants are very expensive or not
 Can be washed with hot water and
available.
detergent for re-use
 Dilute chlorine solutions have been
 Store used gowns in a closed container
shown to be effective in eliminating a
In patients rooms.
broad of viruses.
 Staff handling dirty gowns should wear
 The chlorine concentration needed to
PPE.
be effective differs concentrations
 Gloves
needed to be effective differs by it’s
 Disposable gloves preferred.
anticipated use:
 Masks
 For environmental surface disinfection,
 Masks can be reused up to 2=3 days
0.5% (5000 ppm) of available chlorine is
avoid touching the mask when you
needed.
apply and remove by touching only.
 For hand hygiene, 0.05& (500 ppm) of
available chlorine is needed.
 Bleach (Sodium hypochlorite, NaOCI)  It should be made clear who they need
product made in different to contact if they have fever or
concentrations in different of the world respiratory symptoms.
(2%-12%).  Active monitoring- other health care
 How much dilution is needed depends personnel or public health officials
on the product that is available. communicate by phone, text message
or electronic format to assess the
exposed worker for fever or respiratory
symptoms.
 Self-monitoring- with supervision (for
situations where there is a shortage of
healthcare workers at the facility) on
days the exposed healthcare provider is
scheduled to work, other healthcare
personnel may measure the exposed
worker’s temperature and assess
symptoms before starting to work.
 Or, the exposed healthcare worker may
report their own temperature and
symptoms before starting work by
KEY DEFINITIONS:
direct contact, telephone calls, or any
 Health care workers – all paid and
electronic or internet-based methods.
unpaid persons working in the
healthcare facility who may have direct
HCWs who have had potential
or indirect exposure to patients of
exposure to COVID-19
infectious materials and surface
(medical supplies, devices and The WHO has provided guidance and
equipment, surrounding surfaces or recommendations on categorizing and
contaminated air) managing the RISK to HCWs during COVID-19
 Close contact- being within 2 meters of outbreak
a persons with COVID-19 for 15 minutes
or longer- without proper PPE (whether
caring for a patient or being in a waiting
area)
 Having direct contact with infectious
secretions or excretions of the patient
(for example, being coughed on or
touching used tissue with hand) without
proper PPE.
 Self-monitoring- health care personnel
monitor themselves for fever and
respiratory symptoms and shortness of
breath, sore throat)
 HCW exposure to COVID-19 in the
community
 Community/travel-related experience:
 Healthcare personnel should inform
their facility’s assigned individual/team
if any community or travel related
exposure.
 They should undergo monitoring as
outlined on the previous slide.
 Those in the high-risk category should
be removed from working for 14 days
after their exposure.
 Health care personnel who develop
signs or symptoms of COVID-19 should
contact the assigned person at their
workplace for medical check-up before
returning to work.