Chain of Infection

Chain of
Infection .
Al-Ghad international college for applied
medical sciences
2020-2021 2th semester
(NURS 425)
Prepared by:
Nouf Othman Anbar Seri
Supervisor by:
Dr. Thoraya
Contents of Chain of Infection :
● Introduction .
● Understanding the Chain of Infection.
● Infectious agent (pathogen).
● Reservoir (the normal location of the pathogen).
● Portal of exit from the reservoir.
● Mode of transmission.
● Portal of entry into a host.
● Susceptible host.
● Reference .
whoa!
My name is Nouf and I’m student nurse in my last
year. I’m going to interduce for you chain of
infection presentation , so grab your coffee and
join me ...
“How very little can be done under the spirit of
fear.”
—Florence Nightingale
Introduction .
The spread of an infection within a community is described as a “chain,”
several interconnected steps that describe how a pathogen moves
about. Infection control and contact tracing are meant to break the
chain, preventing a pathogen from spreading.
Emerging infectious diseases are those whose incidence in humans has

increased in the past two decades or are a threat to increase in the near future.
These diseases, which can rapidly spread across national boundaries and
communities, may challenge the ability of public health systems to prevent and
control the spread of the disease, especially in resource-limited countries and
regions.
1-Infectious agent 2-Reservoir (the normal location of the
(pathogen) pathogen)
3-Portal of exit from the 4-Mode of transmission

reservoir
5-Portal of entry into

a host 6-Susceptible host
01
Infectiou
s Agents
Infectious agents (pathogens) include not only bacteria
but also viruses, fungi, and parasites. The virulence of these
pathogens depends on their number, their potency, their
ability to enter and survive in the body, and the susceptibility
of the host. For example, the smallpox virus is particularly
virulent, infecting almost all people exposed. In contrast, the
tuberculosis bacillus infects only a small number of people,
usually people with weakened immune function, or those
who are undernourished and living in crowded conditions.
Viruses are intracellular parasites; that is, they can only

reproduce inside a living cell. Some viruses, such as HIV
and hepatitis B and C, have the ability to enter and survive
in the body for years before symptoms of disease occur.
Other viruses, such as influenza and COVID-19, quickly
announce their presence through characteristic
symptoms.
02
Reservoi
r
A reservoir is any person, animal, arthropod, plant, soil or
substance (or combination of these) in which an infectious
agent normally lives and multiplies. The infectious agent
depends on the reservoir for survival, where it can reproduce
itself in such manner that it can be transmitted to a
susceptible host.
Animate reservoirs include people, insects, birds, and other

animals. Inanimate reservoirs include soil, water, food, feces,
intravenous fluid, and equipment.
03
Portal of
Exit
Portals of exit is the means by which a pathogen exits from a
reservoir. For a human reservoir, the portal of exit can include
blood, respiratory secretions, and anything exiting from the
gastrointestinal or urinary tracts.
Once a pathogen has exited the reservoir, it needs a mode of

transmission to transfer itself into a host. This is accomplished
by entering the host through a receptive portal of entry.
Transmission can be by direct contact, indirect contact, or
through the air.
Transmission of respiratory infections such as COVID-19 is
primarily via virus-laden fluid particles (i.e., droplets and aerosols)
that are formed in the respiratory tract of an infected person and
expelled from the mouth and nose during breathing, talking,
singing, coughing, and sneezing. The competing effects of inertia,
gravity, and evaporation determine the fate of these droplets. Large
droplets settle faster than they evaporate and contaminate
surrounding surfaces. Smaller droplets evaporate faster than they
settle, forming droplet nuclei that can stay airborne for hours
(becoming aerosolized) and may be transported over long
distances (Mittal et al., 2020, July 10).
Human-to-human transmission of COVID-19 occurs
primarily via three routes:
(1) (2) (3)

Large particles that are Physical contact with Inhalation of aerosolized
expelled with sufficient droplets deposited on a droplet nuclei delivered by
momentum so as to directly surface and subsequent ambient air currents
impact the recipients’ transfer to the recipient’s
mouth, nose, or conjunctiva respiratory mucosa
The first two routes associated with large droplets are referred to as the “droplet” and
“contact” routes of transmission, whereas the third is referred to as “airborne”
transmission (Mittal et al., 2020, July 10).
This photograph captures a sneeze in
progress, revealing the plume of
salivary droplets as they are expelled
in a large cone-shaped array from this
man’s open mouth, thereby
dramatically illustrating the reason for
covering your mouth when coughing or
sneezing, in order to protect others
from germ exposure. Source: James
Gathany, CDC PHIL, 2009.
04
Mode of
transmissio
n
Mode of transmission :
direct Contact Indirect Contact

direct Contact:
Direct contact
transmission requires
physical contact between an
infected person and a susceptible
person, and the physical transfer of
microorganisms. Direct
contact includes touching an
infected individual, kissing,
sexual contact, contact with oral
secretions, or contact with body
lesions.
Indirect Contact:
Indirect contact includes both vehicle-borne and vector borne contact. A vehicle
is an inanimate go-between, an intermediary between the portal of exit from the
reservoir and the portal of entry to the host. Inanimate objects such as cooking or
eating utensils, handkerchiefs and tissues, soiled laundry, doorknobs and handles,
and surgical instruments and dressings are common vehicles that can transmit
infection. Blood, serum, plasma, water, food, and milk also serve as vehicles. For
example, food can be contaminated by E.coli if food handlers do not practice
appropriate handwashing techniques after using the bathroom. If the food is
eaten by a susceptible host, such as a young child or a person with HIV/AIDS, the
resulting infection can be life-threatening.
Vector-borne contact is transmission by an animate intermediary, an animal,

insect, or parasite that transports the pathogen from reservoir to host.
Transmission takes place when the vector injects salivary fluid by biting the host,
or deposits feces or eggs in a break in the skin. Mosquitoes are vectors for malaria
and West Nile virus. Rodents can be vectors for hantavirus.
05
Portal of
Entry
Infectious agents get into the body through
various portals of entry, including the mucous
membranes, non-intact skin, and the
respiratory, gastrointestinal, and genitourinary
tracts. Pathogens often enter the body of the
host through the same route they exited the
reservoir, e.g., airborne pathogens from one
person’s sneeze can enter through the nose of
another person.
06
Suscepti
ble Host
The final link in the chain of infection is a susceptible host,
someone at risk of infection. Infection does not occur
automatically when the pathogen enters the body of a person
whose immune system is functioning normally. When a
virulent pathogen enters an immune-compromised person,
however, infection generally follows.
Whether exposure to a pathogen results in infection depends

on several factors related to the person exposed (the host),
the pathogen (the agent), and the environment. Host factors
that influence the outcome of an exposure include the
presence or absence of natural barriers, the functional state of
the immune system, and the presence or absence of an
invasive device.
How COVID-
19 Spreads ?
From the start of the COVID-19 epidemic, it was known that the virus spreads
via respiratory droplets (infectious agent). In a CDC telebriefing on February
14, CDC’s Messonnier said, “Based on what is now known about COVID-19,
we believe this virus spreads mainly from person (reservoir) to person among
close contacts (defined as about six feet) through respiratory droplets
produced when an infected person coughs or sneezes.” This is similar to the
way influenza and other respiratory pathogens spread. These droplets can
land in the mouths or noses of people (susceptible host) who are nearby or
possibly be inhaled into the lungs (portal of entry).
What was not initially known was that asymptomatic people can act as a
reservoir for the virus, thus infecting others. Those who do develop symptoms
appear to be “shedding significant virus in their oropharyngeal compartment”
up to 48 hours before developing symptoms. “This helps explain how rapidly
this virus continues to spread across the country, because we have
asymptomatic transmitters and we have individuals who are transmitting 48
hours before they become symptomatic,” said CDC Director Robert Redfield.
A July 9, 2020 scientific brief from the World Health Organization
titled Transmission of SARS-CoV-2: Implications for Infection Prevention
Precautions, indicates that infectious particles much smaller than droplets can
become airborne and remain suspended in the air for long periods of time.
These so-called aerosol particles appear to be capable of infecting people who
inhale them. WHO reports that outbreaks related to activities in crowded,
enclosed spaces “suggest the possibility of aerosol transmission combined
with droplet transmission” during activities such as choir practice, eating in
restaurants, and exercising in gyms.
Resource
s
Barreto ML, Teixeira MG, Carmo EH (2006).
"Infectious diseases epidemiology". Journal of
Epidemiology and Community Health. 60 (3): 192–95
"The World Health Report (Annex Table 2)"

(PDF). 2004.

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Chain of

Emerging infectious diseases are those whose incidence in humans has

3-Portal of exit from the 4-Mode of transmission

5-Portal of entry into

Viruses are intracellular parasites; that is, they can only

Animate reservoirs include people, insects, birds, and other

Once a pathogen has exited the reservoir, it needs a mode of

(1) (2) (3)

direct Contact Indirect Contact

Vector-borne contact is transmission by an animate intermediary, an animal,

Whether exposure to a pathogen results in infection depends

"The World Health Report (Annex Table 2)"

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