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The concept of the chain of infection, which refers to the conditions necessary for a microbe or infectious disease to spread from person to person. By understanding the six links in the chain - disease microorganisms, reservoir, mode of escape, susceptible host, mode of entry, and portal of exit - we can learn how to break the chain and prevent the spread of infections. examples of modes of escape and modes of entry, as well as ways to control the spread of diseases in various settings.
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Certain conditions must be met in order for a microbe or infectious disease to be spread from person to person. This process, called the chain of infection, can only occur when all six links in the chain are intact. By breaking this chain at any of the links, the spread of infection is stopped.
communicable diseases. Most commonly these are bacteria, virus, fungi or parasites.
and possibly grow, and multiply. Humans, animals and the environment can all be reservoirs for microorganisms. Sometimes a person may have a disease but is not symptomatic or ill. This type of person is a carrier and she/he may be referred to as ‘colonized’. Examples of reservoirs are standing water, a person with a common cold or syphilis, or a dog with rabies.
microorganisms escape or leave the reservoir. For example, pathogens that cause respiratory diseases usually escape through the respiratory tract (coughing and sneezing).
Diagram: The chain of infection
the body of the infected person by means of droplets exhaled as a spray when coughing, sneezing, talking, singing or just breathing. Microorganisms also escape through nose and throat secretions.
that leave the body of the infected person by means of body secretions (e.g. stool and vomit). For example hepatitis A virus is shed in the stool of the infected person.
the infected person by wound drainage or through skin lesions.
blood gets into another person’s system.
Susceptible hosts abound in health care settings, as those accessing the health care system often have compromised immune systems. This may be due to other illnesses processes, treatments or medications. This ineffective immune system leaves them vulnerable to infectious agents that may be in the health care environment.
Transmission may be interrupted when:
Diagram: Breaking the Chain of Infection
INFECTIOUS AGENT
SUSCEPTIBLE HOST RESERVOIRS
MEANS OF TRANSMISSION
PORTAL OF ENTRY
PORTAL OF EXIT
Bacteria Fungi Viruses Rickettsiae Protozoa
Rapid, accurate identification of organisms
Immunosuppression Diabetes Surgery Burns Cardio-pulmonary disease
Treatment of underlying diseases
Recognition of high-risk patients
Mucous membrane GI tract Respiratory tract Broken skin
Aseptic Technique
Catheter care
Wound care Direct contact Fomites Ingestion Airborne
Handwashing Sterilization Air flow control
Food handling
Isolation
People Equipment Water
Excretions Secretions Skin Droplets
Employee health
Environmental sanitation
Disinfection/ Sterilization
Proper attire
Handwashing
Control of excretions & secretions Trash & waste disposal