INFECTION CONTROL MIDTERM
PROF: DR. DE OCAMPO
HISTORY
MODULE
1 LESSON
1: BRIEF
HISTORY
OF
INFECTION CONTROL
World health was recently stunned by an infection which has
caused colossal devastation to health, healthcare personnel and
world economy. It was clear that the disease was severe and
that it was spreading quickly over a wide area.
 A DISEASE is a disorder or an abnormal condition
which negatively affects the structure or function of
body parts and thus produces specific signs and
symptoms.
 WORLD HEALTH ORGANIZATION (WHO) declared
this infectious disease as a pandemic.
 A PANDEMIC is a disease outbreak that spreads
across countries or continents.
WHO defines INFECTION as the invasion of an organism's body
tissues by disease-causing agents, their multiplication, and the
reaction of host tissues to the infectious agents and the toxins
they produce.  An infection may enter a patient's body through
the environment or the infection may come from the host's own
microflora.
If the infection involves a pathogen entering a patient's body from
the environment it is called EXOGENOUS INFECTION. The
pathogens can be introduced through a contaminated device,
healthcare worker, surface, or other vector. Persons with open
incisions, in-dwelling devices, and compromised immune
systems are especially at risk for exogenous infections.
When a patient with a compromised immune system, such as
after chemotherapy, may become sick from bacteria already
present in their own body and it grows unchecked, an
ENDOGENOUS INFECTION will set in. Endogenous infection is
caused by our own bacteria, our own microflora.
The Center for Disease Control (CDC) indicates that in a
healthcare setting, patients, health workers and visitors can be a
source of infection.  Infection control is mandatory to prevent or
stop the infection in healthcare setting.  Infection Control is the
prevention of the spread of pathogenic microorganisms that have
the potential to cause infectious disease.  It encompasses
policies and procedures exercised to reduce the risk of spreading
infections, to humans, animals and health care facilities.
There have been significant changes in the field of infection
control over the years as early as 1827 when chlorine was used
widely for disinfection. 
MODULE 1 LESSON 2: UNIVERSAL PRECAUTION
Infection Prevention and Control is not a new concept. It has
been an essential part of ‘healthcare’ since the Nightingale era,
and Standard Precautions, though not formalized with that term,
were being practiced even back then.
As scientists learn more and more about what causes disease,
they try harder to control the spread of infection. For example, a
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recent event that triggered new infection control guidelines was
the outbreak of HIV/AIDS. Because of this disease, the US
Centers for Disease Control (the CDC) developed Universal
Precautions in 1985. UNIVERSAL PRECAUTIONS are a
standard set of guidelines that aim to prevent BLOODBORNE
PATHOGEN TRANSMISSION through exposure to blood and
other potentially infectious materials. 
In 1987, the CDC introduced another set of guidelines
termed ‘BODY SUBSTANCE ISOLATION’. These advocated
the avoidance of direct physical contact with “all moist and
potentially infectious body substances”, even if blood was not
visible.
UNIVERSAL PRECAUTIONS
In order to avoid discrimination, treat all bodily fluids and fecal
matter as though they may be infected and observe the
following precautions:
1. Use Barrier Protection: cover up any open wounds or
sores before proceeding.
2. Wear Gloves when handling bodily fluids or contaminated
materials or other wastes.
3. Wear a Face Mask/Gown.
4. Use Caution when handling sharp objects, needles and
wastes.
5. Discard Contaminated Materials: follow biohazard
procedures for disposal.
6. Clean Area Thoroughly with a disinfectant.
7. Wash Hands Thoroughly with soap and water for at least
20 seconds.
8. Wash Clothing in hot water.
MODULE 1 LESSON 3: STANDARD PRECAUTIONS: BLOOD
AND FLUID TRANSMISSION
Blood and body fluid refers to blood and other body fluids that
contain visible traces of blood, semen, and vaginal fluids. They
also apply to tissues and other body fluids, such as from around
the brain or spinal cord (cerebrospinal fluid), around a joint space
(synovial fluid), in the lungs (pleural fluid), in the lining of the belly
and pelvis (peritoneal fluid), around the heart (pericardial fluid),
and amniotic fluid that surrounds a fetus.
BLOODBORNE TRANSMISSION means that a disease is
spread when the blood of an infected person reaches the
bloodstream of another person.
Blood and body fluid precautions are recommendations designed
to prevent the transmission of HIV, HEPATITIS B VIRUS
(HBV), HEPATITIS C VIRUS (HCV), and other diseases while
giving first aid or other health care that includes contact with
body fluids or blood. These precautions treat all blood and body
fluids as potentially infectious for diseases that are transmitted in
the blood. The organisms spreading these diseases are
called BLOOD-BORNE PATHOGENS. 
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 INFECTION CONTROL
HISTORY
In 1996,
the CDC
Guideline
for
Isolation
Precautions in Hospitals, prepared by the Healthcare Infection
Control Practices Advisory Committee (HICPAC), combined the
major features for Universal Precaution and Body Substance
Isolation into what is now referred to as STANDARD
PRECAUTIONS.  touching an infected individual, kissing, sexual
STANDARD PRECAUTIONS are the basic, minimum infection
prevention practices that apply to all patient care, regardless of
suspected or confirmed infection status of the patient, in any
setting where health care is delivered. It also includes infection
control guidelines for health care workers
“STANDARD PRECAUTIONS APPLY TO ALL YOUR
PATIENTS, NO MATTER WHAT DIAGNOSIS—EVEN IF THEY
DON’T SEEM SICK!”
PRACTICER UNDER STANDARD PRECAUTIONS
INCLUDE:
1. Hand Hygiene.
2. Use of Personal Protective Equipment (e.g., gloves,
masks, eyewear, head covering).
3. Respiratory Hygiene/cough etiquette.
4. Sharps Safety (Engineering and Work Practice
Controls).
5. Safe Injection Practices (i.e., aseptic technique for
parenteral medications).
6. Sterile Instruments and Devices.
7. Clean and Disinfect Environmental Surfaces.
MODULE 1 LESSON 4: TRANSMISSION – BASED
PRECAUTIONS: CONTACT, DROPLET AND AIRBORNE
TRANSMISSION
According to the Center for Disease Control, Transmission-
Based Precautions are for patients who are known or suspected
to be infected or colonized with infectious agents, including
certain epidemiologically important pathogens, which require
additional control measures to effectively prevent transmission.
Since the infecting agent often is not known at the time of
admission to a healthcare facility, Transmission-Based
Precautions are used.
Transmission-Based Precautions are the second tier of basic
infection control and are to be used in addition to standard
precaution for patients who may be infected or colonized with
certain infectious agents for which additional precautions are
needed to prevent infection transmission.
THERE ARE 3 CATEGORIES OF TRANSMISSION-BASED
PRECAUTIONS:
Contact Transmission, Droplet Transmission and
Airborne Transmission
CONTACT TRANSMISSION
MIDTERM 4TH YEAR – 1ST SEMESTER (SY: 2023-2024)
PROF: DR. DE OCAMPO
DATE:
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There are two types of contact transmission of pathogens:
DIRECT AND INDIRECT CONTACT TRANSMISSION
A. DIRECT CONTACT TRANSMISSION
 requires physical contact between an infected
person and a susceptible person and the physical
transfer of microorganisms. Direct contact includes
contact, contact with oral secretions, or contact with
body lesions. This type of transmission requires
close contact with an infected individual, and will
usually occur between members of the same
household or close friends and family.
 Diseases spread exclusively by direct contact are
unable to survive for significant periods of time
away from a host. Sexually transmitted diseases
are almost always spread through direct contact, as
they are extremely sensitive to drying.
B. INDIRECT CONTRACT TRANSMISSION
 refers to situations where a susceptible person is
infected from contact with a contaminated surface.
Some organisms (such as Norwalk Virus) are
capable of surviving on surfaces for an extended
period of time. To reduce transmission by indirect
contact, frequently touched surfaces should be
properly disinfected.
Frequently touched surfaces (fomites) include:
 Door knobs, door handles, handrails
 Tables, beds, chairs
 Washroom surfaces
 Cups, dishes, cutlery, trays
 Medical instruments
 Computer keyboards, mice, electronic devices
with buttons
 Pens, pencils, phones, office supplies
 Children's toys
Diseases associated with contact transmission include
norovirus, rotavirus, draining abscesses, head lice, skin
lesions/infection, and activities like: taking the vital signs and
dressing a wound and handshaking and kissing.
DROPLET TRANSMISSION
Droplet carrying infectious pathogens transmit infection when
they travel directly from the respiratory tract of an infectious
individual to susceptible mucosal surfaces of the recipient.
Droplets are produced when a person, coughs, sneezes, or
speaks and during procedures like suctioning, intubation,
cardiopulmonary resuscitation and other medical procedures
done in the hospital.
In Dentistry, droplet transmission can be translated to the release
of saliva where virus and other pathogens are isolated.
Droplets are considered to be > 5 um in size, droplet nuclei
(particles from desiccation of suspended droplets) are defined
as < 5 um and have been associated with airborne transmission.
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HISTORY DATE:
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particulate (“droplet nuclei”) free to float on very long

distances, causing what we often refer to as “airborne”
transmission. (Nicas 2005; Judson 2019).

In Dentistry, aerosols are generated during irrigation of operating

field in the mouth using syringes, drilling of the tooth using rotary
instruments, the use of electronic scalers and polishing after
scaling.

RECOMMENDED TRANSMISSION BASED PRECAUTIONS

AIRBORNE TRANSMISSION
Some diseases are known to be spread by airborne
transmission. This means that the germs that cause these
diseases are so tiny that they can float in the air for long
periods of time. These germs can also "catch a ride" on
dust particles, travelling wherever the dust particles go. 
Germs that are spread by airborne transmission can travel
across a room or even farther, and can even be helped to
spread by things like an electric fan. 
The figure above shows how the spread of the 3 categories of
Diseases spread by Airborne Transmission Include: the 3 transmission-based pathogens occurs in the dental office.
Influenza, Tuberculosis, Measles, Chickenpox, Shingles,
SARS, MERS and COVID-19 - (droplet & aerosol). CONTACT  Standard Precautions
PRECAUTIONS  Observe 6 feet distancing
AEROSOLS VS DROPLETS  All re-usable items taken into
In general, aerosols are liquid or solid particles suspended an exam room or home should
in the air. (Tellier 2009; Judson 2019) They can be visible, be cleaned and disinfected
before removed.
like fog, but are most often invisible, like dust or pollen.
 Disposable items should be
They are often divided into small droplets termed “aerosol” discarded at point of use.
and large droplets.  Frequent disinfection of
surfaces commonly touched.
DROPLET  Standard Precautions with
PRECAUTIONS physical distancing
 Patient placed in a single room.
 Patient wears a mask when
outside of the room
 Providers follow the standard
precautions
 Special air handling ventilation
is not required
 Respirators are not required –
Large droplets drop to the ground before they evaporate, causing for the reason that if a patient
local contamination. Disease transmission through these large is infected no treatment
droplets is what we often refer to as “droplet/contact procedures will be done,
spread”, where disease transmission occurs because you touch instead advice patient to go on
a surface contaminated by these droplets, or get caught within self-quarantine
the spray zone when the patient is coughing or during
procedures where aerosol is generated.

Aerosols are the dissemination of airborne droplet nuclei or small AIRBORNE  Standard precautions with
particles in the respirable size range < 5 um. It contains PRECAUTIONS physical distancing
infectious agents that remain infective over time and distance.  Use Respirators
Aerosols are so small that buoyant forces overcome gravity,  AIIR – Airborne infection
allowing them to stay suspended in the air for long periods, or isolation room consisting of the
they evaporate before they hit the floor, leaving the solid following requirements:

a. 6 air exchanges/hour in the

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PROF: DR. DE OCAMPO

HISTORY DATE:
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Airborne, droplet, contact

(e.g., skin), bite, needlestick
or other sharps injury
o Indirect Transmission:
room Fomites – contaminated
b. the room must have negative equipment or medication
air pressure (multidose vials, single dose
c. exhaust via HEPA filter vials), vectors, food, water
d. materials for walls and floors
must be cleaned 2x daily PORTAL OF ENTRY Opening where the pathogen may
enter
e. proper signage to the door o Body openings (e.g., mouth,
eyes, urinary tract,
 Administrative, engineering and respiratory tract), incisions,
work practice controls wounds
 Patient should be referred to an
appropriate facility. SUSCEPTIBLE HOST The person at-risk: patient or
healthcare worker

o Factors affecting
MODULE 1 LESSON 5: CHAIN OF INFECTION susceptibility (e.g., age,
health, co-morbidities,
According to CDC, the epidemiologic triad model of infection
immune system, nutrition,
results from the interaction of agent, host and environment.
infective dose, medications)
Transmission occurs when the pathogenic agent leaves the
reservoir or host through a portal of exit and is conveyed by
some mode of transmission and enters through an appropriate
portal of entry to infect a susceptible host. This sequence is
sometimes called the chain of infection.

CHAIN OF INFECTION COMPONENTS

MICROORGANISMS Disease producing, also called
pathogens
o Virus, parasite, fungus,
bacterium
o Risk factors: Virulence,
pathogenicity, ability to enter
host
RESERVOIR/SOURCE Environment/habitat where a
pathogen can live and multiply
o Environmental
surfaces/equipment, body
fluids (blood, saliva),
urine/fecal material,
food/water, soil, skin,
respiratory tract

PORTAL OF EXIT How the pathogen exits or leaves

MODES OF TRANSPORT
reservoir
o Skin to skin, skin to surface,
blood, mucous membranes,
oral cavity, fecal
o Other potentially infectious
material (OPIM): Seminal
fluid, joint fluid, saliva,
urine/fecal material, anybody
fluid contaminated with blood
How a pathogen moves from
reservoir to susceptible host

o Direct Transmission:

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