Factors That Influence Epidemics Transmission and The Role of Nurses in the Identification of an Epidemic.

1. Host susceptibility – How susceptible is individual to coming down with infectious disease?  Immunization  Genetic background  Health of individual ◦ Young and old are especially susceptible.  Culture ◦ Hispanics might be more affected by flu because they are big huggers.  Religion ◦ What you believe can help/hinder your chances of surviving an infectious disease. Some religions do not permit invasive procedures (vaccinations included), seeking medical attention etc...

2. Time of year summer is usually the worst time because people are out socializing a lot.

3. Parasite/infectious entity and its pathogenicity  Its ability to adhere to host (attach and stay with)  Its invasiveness (how easily does it get into the body)

3. Parasite/infectious entity and its pathogenicity  Its antigenic variation (mutation) ◦ Plagues mutate really quickly. You might treat it one way and then it mutates and you have to figure out how to treat the new mutation.  Ability of the pathogen to exist as an intracellular pathogen ◦ Can it get inside the cell and propagate  HIV, AIDS, Malaria, Chlamydia

3. Parasite/infectious entity and its pathogenicity  Ability of the pathogen to produce toxins ◦ Botulism  Dose of an agent – how much of organism has to enter the body or come in contact with it. ◦ Salmonella – need 100,000 cells ◦ Shigella – need only 10 cells (more virulent than salmonella)

3. Parasite/infectious entity and its pathogenicity  Incubation period – you can communicate a disease before you even know you have it. ◦ HIV, Chlamydia

Formation of cyst – dormant (protozoan) Endospores Mutation (antigenic variation) Intracellular pathogen Development of a complex life cycle Capsules (bacteria/yeast)

Reduction of source of infection  Quarantine  Destroy infected host

Disruption of chain of Transmission  Destroy vectors  Pasteurization – 60°C for 30 minutes  Flash pasteurization – 72°C for 15 seconds  Water treatment

Immunization Best way to protect the entire population is to have as many citizens immunized.

Control of hospital acquired and community acquired infection  Nosocomial – an infection acquired in a health related facility.

Surveillance  The job of CDC and state health departments. There is a certain set of infectious diseases that doctors/schools/hospitals must report immediately. ◦ Salmonella ◦ Rabies ◦ Botulism ◦ Shigella ◦ Anthrax

NURSES!! (Healthcare Workers) They see things before anyone else. People who are really sick are going to the ER not to their family doctor.

◦ Symptoms – subjective characteristics of disease felt only by the patient ◦ Signs – objective manifestations of disease that can be observed or measured by others ◦ Syndrome – group of symptoms and signs that characterize a disease or abnormal condition ◦ Asymptomatic, or subclinical, infections lack symptoms but may still have signs of infection

 Sign: any objective evidence of disease as noted by an observer  Symptom: the subjective evidence of disease as sensed by the patient  Syndrome: when a disease can be identified or defined by a certain complex of signs and symptoms

 Fever, pain, soreness, swelling  Edema  Granulomas and abscesses  Lymphadenitis  Lesion: the site of infection or disease

Changes in the number of circulating white blood cells Leukocytosis Leukopenia Septicemia: general state in which microorganisms are multiplying in the blood and are present in large numbers Bacteremia or viremia: microbes are present in the blood but are not necessarily multiplying

 Asymptomatic, subclinical, or inapparent infections  Most infections do have some sort of sign

 Nosocomial infections: infectious diseases that are acquired or develop during a hospital stay  2-4 million cases a year  The importance of medical asepsis

◦ Types of nosocomial infections  Exogenous – pathogen acquired from the health care environment  Endogenous – pathogen arises from normal microbiota due to factors within the health care setting  Iatrogenic – results from modern medical procedures

◦ Control of nosocomial infections  Involves precautions designed to reduce the factors that result in disease  Hand washing is the most effective way to reduce nosocomial infections

 Universal precautions (UPs): guidelines from the Centers for Disease Control and Prevention ◦ Assume that all patient specimens could harbor infectious agents ◦ Include body substance isolation (BSI)techniques to be used in known cases of infection

◦ Agencies at the local, state, national, and global level share information concerning disease  The United States Public Health Service is the national public health agency  World Health Organization (WHO) coordinates public health services internationally ◦ Public health agencies work to limit disease transmission  Monitor water and food safety ◦ Public health agencies campaign to educate the public on healthful choices to limit disease