The mission of the DOH is to provide and strengthen an integrated, responsive, and collaborative

health system on emerging and re-emerging infectious diseases towards a healthy and bio-secure
country. Its goal is to prevent and control of emerging and re-emerging infectious disease from becoming
public health problems.

To achieve this, with a benchmark of less than 1% emerging and re-emerging infectious disease (EREID)
case fatality rate, the EREID Program Strategic Investment Plan highlights the seven Strategic Priorities.
1. Establish updated, relevant, and implementable policies on EREID, providing the overall direction
in implementing the different program components for all the networks of health providers and
facilities.
2. Effectively manage and mobilize available resources from the DOH and partners, both local and
international, for EREID detection, preparedness, and response.
3. Organize adequate and efficient systems of coordination among the network of facilities, both
public and private, needed in EREID detection, preparedness, and response within the context of
integrated health service delivery system at national and sub- national levels.
4. Health care professionals must be skilled, competent, and motivated in detecting, preventing,
and managing of EREID cases, with provision of supervised psychosocial support and risk
communication at the national and sub-national levels.
5. Manage the systems of procurement and distribution of logistics for EREID detection,
preparedness, and response under each mode of disease transmission.
6. Improve case detection and surveillance of EREID to prevent and/or minimize its entry and
spread, and to mitigate the possible impact of widespread community and
national transmission.
7. Institute a risk communication and advocacy system that is factual, timely, and context- relevant
implemented at the national and sub-national levels.

Other Factors Affecting the Emergence or Re-emergence of Infectious Diseases

1. The increasing number of different organisms that are developing resistance to available
antimicrobials outpace the production of new antibodies.
2. The increasing number of persons in the state of immunosuppression (those who would have
formally died of cancer, leukemia, and others) are susceptible to invasion by virtually any type of
organism, including non-pathogenic ones.
3. Persons with chronic diseases are living longer and are expected to undergo more extensive
surgical procedures.
4. The use of indwelling lines and implanted foreign bodies have increased; those rendering care to
these patients are more susceptible to infection.
5. Some drastic changes are caused by natural processes such as the evolution of pathogens over
time, while some are the result of human behavior and practices.
6. Population growth, migration from rural areas to cities, international air travel, poverty. wars,
and destructive ecological changes due to economic development and land use all contribute to
the presence and transfer of microorganisms among various populations.
 7. Ecological transformation like deforestration/reforestation, dam construction, and climate
change combined with growing population increases the contact between humans and animals
harboring potentially infectious organisms (Kwan-Gett, 2009).

INFECTION PREVENTION AND CONTROL MEASURES

Infection prevention and control (IPC) is a scientific approach and a practical solution designed to
prevent harm caused by infections to both patients and health workers. It is not always possible to
identify individuals who may spread infection to others; therefore, standard precautions must be
followed at all times.

General
Universal precautions shall be observed to prevent contact with blood and other potentially
infectious materials. Universal precautions means that all patients shall be assumed to be infectious with
HIV/AIDS and other bloodborne pathogens.

Engineering and work practice control

1. Employees shall wash their hands immediately as soon as possible after removal of gloves or
other personal protective equipment (PPE) and after hand contact with blood or other
potentially infectious materials.
2. All PPE shall be removed immediately upon leaving the work area or as soon as possible if
overtly contaminated and places in an appropriately designated area, or container for storage,
washing, decontamination, or disposal.
3. Used needles and other sharps shall not be sheared, bent, broken, recapped, or re-sheathed by
hand. Used needles should not be removed from disposable syringes.
4. Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses are
prohibited in work areas where there is potential for occupational exposure.
5. Food and drinks shall not be stored in refrigerators, freezers, or cabinets where blood or other
potentially infectious materials are stored or in other areas of possible contamination.
6. All procedures involving blood or other potentially infectious materials shall be performed in
such a manner as to minimize splashing, spraying, and aerosolization of these substances.
7. Mouth pipetting/suctioning is prohibited.

If it is decided that action is required, possible interventions include:

1. improve outcomes by providing appropriate care;
2. trace the source in order to provide advice or preventive measures;
3. prevent others from being exposed to the source; and
4. identify the source so that appropriate action can be implemented.

Suggested control measures for primary care clinics in the community setting emphasizes the use of
barrier apparel, personal hygiene, and cleaning the environmental in addition to universal precautions.
 1. Use of masks
● All staff members should wear a mask.
● Patients should be asked to wear a mask if they have respiratory problems.
2. Handwashing is the single most important part of infection control.
● Practice proper hand washing using of soap and water
● Wash hands before and after patient contact and after removing gloves.
● Alcohol hand gels and rubs are a practical alternative to handwashing with soap, but
dirty or contaminated hands must be washed with soap and water.
● The nails should be kept short, and rings should not be worn.
3. Gloving
● Gloves are used for all direct patient contact.
● Change gloves in between patients and wash hands after degloving,
4. Gowning
● Gowns are used during procedures that are likely to generate splashes or sprays of blood
and body fluids, secretions, or excretions.
5. Eye protection (goggles)
● Goggles are used for aerosol/splash-generating procedures.
● Avoid generating aerosols.
6. Environmental disinfection
● Clean surfaces daily with disinfectant (diluted household bleach, 70% alcohol)

Tips to do proper hand washing

Wash your hands for at least 20 seconds. A good way to ensure you are washing for long enough
is to sing a little song while you're at the sink. 'Happy Birthday, sung twice, is the perfect length.
ASPECTS OF CARE OF PATIENTS WITH COMMUNICABLE DISEASES PREVENTIVE ASPECT

1. Health education

Educate the client and the family about the:

● availability and importance of prophylactic immunization;
● manner in which infectious illness are spread and methods to avoid contracting
infections;
● to seek medical advice at the first signs of health problems;
● the importance of environmental cleanliness and personal hygiene; and
● ways and means to prevent contamination of food and water supply.

2. Immunization is the introduction of specific protective antibodies to a susceptible person or

animal, or the production of cellular immunity in such a person or animal.

Among the biologicals used in the National Immunization Program (NIP) formerly known
as Expanded Program on Immunization (EPI), the measles vaccine and oral polio vaccines (OPV)
are highly sensitive to heat, requiring storage in the freezer.
 Unused portions of other biologicals in NIP may be given until the end of the day.
● Only BCG is discarded four hours after reconstitution
● This is why BCG immunization is scheduled only in the morning.

3. Immunity is the ability of an individual to resist disease, either through the activities of
specialized blood cells or antibodies produced within the body in response to natural exposure
(such as in cases of viral disease) or by the injection of antiserum. Immunity can also include the
transfer of antibodies from a mother to her baby via the placenta or breast milk.
 Types of Immunity
1. Natural or inherent
a. Passive - acquired through placental transfer; immunity that is acquired by a
fetus when it receives maternal antibodies in utero
b. Active - immunity that is acquired in response to the entry of a live pathogen
into the body (such as after recovery from a viral disease)
2. Artificially acquired
a. Passive - acquired through the administration of antitoxin, antiserum,
convalescent serum, and gammaglobulins
b. Active-acquired through the administration of vaccine and toxoid
3. Sub-clinical immunity is acquired through constant exposure to a particular disease or
organism.

Types of Antigen
1. Inactivated (killed organism)
● The immunity conferred by this type does not last long.
● Multiple doses are needed.
● A booster dose is needed.
2. Attenuated (live/weakened organism)
● Only single dose is needed.
● It confers long lasting immunity.
All vaccines lose their potency after a certain time. The expiry date should be noted on
the label or printed on the vaccine.

What Damages Vaccines?

1. Heat and light damage vaccines, especially the live ones.
2. Freezing damages the killed vaccines and toxoids.
3. When cleaning the refrigerator/freezer, use water only because antiseptics, disinfectants and
detergents or alcohol may lessen the potency of vaccines.

The Cold Chain System

The cold chain system is the system of transporting or storing vaccines within the safe
temperature range of 2 °C to 8 °C (strive for 5 °C-the midway point).
Maintenance of correct temperature for vaccines starts from the manufacturer, down to the
airport, the central vaccine store, to the regional store, district hospital, health centers or outreach
service, dispensary, to the immunizing staff, and to the client.
Cold chain breach is the exposure of vaccines to temperatures outside the recommended range
of 2 °C to 8 °C, excluding fluctuations up to 12 °C lasting less than 15 minutes when restocking, cleaning
the fridge, or stock taking.
 Cold chain breaches must be reported to the department as soon as possible using the Cold
Chain Breach Report form. This form is also used to report light exposure breaches for light-
sensitive vaccines.

Environmental Sanitation as Preventive Measures

The Department of Health through the Environmental Health Services (EHS) has the authority to
act in all issues and concerns in environmental health including the Code of Sanitation of the Philippines
(PD 856, 1978) (DOH 2000).

1. Water Supply Sanitation Program

The DOH, through the EHS set some policies on the following areas:
a. Approved types of water facilities such as:
i. Level I (Point of source) is a protected well or a developed spring with an outlet but
without distribution system generally adoptable to rural areas.
Ii. Level II (Communal faucet system or stand-posts) is a system composed of a source
reservoir, a piped distribution network and communal faucets.
iii. Level III Waterworks system or individual house connection
b. Unapproved types of water facilities refers to water from doubtful sources such as an
open dug well, unimproved springs, and wells that need priming. These are not
recommended for drinking unless treated through proper container disinfection.
c. Access to safe and potable drinking water. All households should have access to safe
and adequate water supply.
d. Water quality and monitoring surveillance

i. Examination of drinking water shall be performed only in private and government

laboratories duly accredited by the DOH.
ii. Certification of potability of an existing water source is issued by the Secretary of
Health or his/her duly authorized representative.
iii. Disinfection of water supply sources applies to the following:
● a newly constructed water supply facilities;
● water supply facility that has been repaired or improved;
● water supply sources found to be bacteriologically positive by laboratory
analysis;
● waterworks/water system and well construction;
● well sites shall require the approval of the Secretary of Health or his/her
duly authorized representative;
● well construction shall comply with the sanitary requirement of the
DOH;
● water supply system shall supply safe and potable water in adequate
quality; and
● water shall be made readily available to consumers/users.
2. Proper excreta and sewage disposal
Policies
a. Approved types of toilet facilities
● Level I-Non-water carriage toilet facility (pit latrines, reed odorless earth closet) -
toilet facility requiring small amount of water to wash the waste into receiving
space (pour flush, acqua privies)
● Level II - Water sealed and flush type with septic vault/tank disposal facilities
● Level III - Water carriage toilet connected to septic tanks or to sewerage system
to treatment plant
b. In rural areas, "blind drainage" type of waste water collection and disposal facility
c. Health hazards associated with improper disposal of excreta are:
● soil pollution,
● pollution,
● contamination of food, and
● propagation of flies which will bring about diseases like GIT infections and
parasitism.

3. Food Sanitation Program

Policies
a. Food establishments shall be appraised as to the following sanitary conditions
● inspection/approval of all food sources, containers, transport vehicles;
● compliance to sanitary permit requirements for all food establishments;
● provision for updated health certificates for food handlers, cook and cook
helpers
● destruction/banning of food unfit for human consumption; and
● training food handlers and operators on food sanitation.
b. Ambulant food vendors shall also comply with the requirements, such as obtaining a
health certificate.
c. Household food sanitation must be promoted and monitored and food hygiene
sanitation to be intensified.

4. Hospital Waste Management Policies

a. All newly constructed/renovated government and private hospitals shall prepare and
implement a hospital waste management program as requirement for registration/
renewal of licenses.
b. The use of appropriate technology and indigenous materials for HWM shall be adopted.
c. Training of hospital personnel involved in waste management shall be an essential part
of hospital training program.
d. Local ordinances regarding collection and disposal techniques, especially incinerators,
shall be institutionalized.
Categories of Health Care Wastes

1. General waste refer to household and administrative wastes, like food and domestic wastes, and
office papers.
● These are wastes that do not require special handling and usually not hazardous to
human health.
2. Infectious wastes are usually those that contain pathogens, like viruses, bacteria, fungi and
other microorganisms in sufficient amounts.
● .These are strictly disposed of in yellow and leak-proof containers.
3. Pathological wastes includes human body parts (tissues, blood, fluids, secretions, and
has excretions).
4. Sharps include items or materials that can cause cuts or wounds, such as scalpels, blades.
infusion sets, needles, and syringes.
● These are considered as highly hazardous wastes.
● Such objects should be handled with extra care and should be disposed of in puncture-
proof containers with fitted covers.
5. Pharmaceutical wastes refer to expired, contaminated, and unused drugs. This also include
vaccines of the same condition.
● It is recommended that any expired drug that has been overlooked or stocked in the
hospital should be returned to the pharmacy, who then dispose of the expired drugs
appropriately.
6. Genotoxic wastes are derived from drugs generally used in oncology or radiotherapy units that
have a high hazardous mutagenic or cytotoxic effect. Examples are feces, vomitus, or urine from
patients treated with cytotoxic drugs or chemicals.
Black - Non-infectious dry waste
Green - Non-Infectious wet waste
Yellow - Infectious/pathological waste
Orange - Radioactive
Red - Sharps

Nursing Responsibilities and Activities related to Environmental Health

1. The community health nurse is in the best position to do health education activities such as:
● develop and disseminate IEC materials, and ensure their distribution and utilization.
● provide individual and group counseling, and facilitate community assemblies and bench
conferences.
● encourage other nursing staff as well as personnel in other government and private
agencies to be responsible in imparting effective and efficient environmental sanitation
practices
2. Nurses must actively participate in training/workshops related to environmental health.
 3. He/she must act as an advocate or as a facilitator for families in matters of programs/projects or
activities on environmental health
4. Nurses should participate in environmental sanitation campaigns and projects in the community.
5. Health care workers can be a role model for others by embodying cleanliness in the home and
surroundings.
6. Nurses must help in the integration and implementation of P.D. 856, commonly known as Code
of Sanitation of the Philippines.

Control System
Infectious disease control is one of the important components of patient care which can assist in
reducing morbidity and mortality.

● Isolation and quarantine

Source isolation is described as one of the strategies used to prevent the spread of
contagious and infectious diseases. Use isolated rooms for patients with known or suspected
cases of disease that can spread through the air, droplets, or contact with others.
● Disinfection (concurrent and terminal)
● Disinfestation is the killing of undesirable small animals by physical or chemical means.
● Fumigation/disinfectant fogging is the application of gaseous agent to kill or drive away
organisms and insects, respectively.

Curative Aspect
a. Medical management (carried out by physicians)
● Request/orders for laboratory
● Treatment of specific diseases
● Diagnosis
b. Nursing management
● Independent nursing function is any aspect of nursing practice for which the nurse
alone is responsible, acting on his or her own initiative and without instructions from
any other discipline.
● Dependent nursing actions require orders or direction from another health care
professional.
● Collaborative, also known as interdependent nursing interventions, are actions that are
implemented in collaboration or consultation with other health care professionals.

Rehabilitative Aspect
● Activity refers the set of restorative or rehabilitative actions that the patient may undertake after
discharge from a health care facility.
● Nutrition refers to the appropriate diet of the client once they are discharged from the hospital
or health care agency.
Means of Controlling the Spread of Communicable Diseases
1. Eliminate of the source of infection
2. Interrupting the transmission
3. Protecting the susceptible host

ISOLATION
Isolation is the practice of separating a patient with a communicable disease from other people
to prevent or reduce the transmission of infectious agents, whether directly or indirectly.

Purposes of Isolation
The basic purpose of isolation in the hospital is to confine the infectious agent to a circumscribed
area and to prevent its escape from said area.

Seven Categories recommended in Isolation

1. Strict isolation is used to prevent the spread of highly contagious or virulent infections.
● Wash hands after every contact with the patient or potentially contaminated articles and
before taking care of another patient.
● Articles contaminated with infectious materials should be appropriately discarded or
bagged and labeled before being sent for decontamination and processing.
● Private rooms may be used
● Use mask, gown, and gloves.
● Negative pressure to surrounding area is desirable.
2. Contact isolation is the separation of the patient to prevent the spread of diseases that can be
transmitted through direct contact with open wounds or contaminated articles. Health care
workers caring for a patient on contact isolation are required to wear gloves, and in some
instances, a gown.
3. Respiratory isolation prevents transmission of infectious diseases over short distances through
the air or droplets.
4. Tuberculosis (TB) isolation is carried out for TB patients with positive smear or chest X-ray that
strongly suggests active TB, both pulmonary and extrapulmonary
5. Enteric isolation means that the patient has a type of microorganism that can be spread to
others directly or indirectly through contact with clothing, hands, surfaces, or objects that are
contaminated with microorganisms that are still alive, specifically from GIT secretions or
excretions.
6. Drainage/secretions precaution aims to prevent infections that are transmitted by direct or
indirect contact with purulent materials or drainage from the affected body site.
7. Universal precaution refers to blood and body fluids precautions.
● It applies to individuals with human immunodeficiency virus (HIV) or hepatitis B virus
(HBV).
 ● It is intended to prevent parenteral, mucous membrane, and non-intact skin exposure of
health care workers to bloodborne pathogens.
● Universal precautions prevent infections that are transmitted by direct contact through
infected blood or body fluids.
● It applies to blood, semen, vaginal secretions, and other body fluids (CSF, synovial fluid,
pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid), and tissues containing
visible blood.

Pathogenesis of Infectious Diseases

1. Entry of the pathogen into the body
2. Attachment of pathogen to some tissues within the body
3. Multiplication of the pathogen
4. Invasion/spread of the pathogen
5. Evasion of host defenses.

Multiple choice: Write the correct answer on the space provided.

1. A disease that is easily transmitted from an infected patient to a susceptible person through
direct and indirect means.
a. Contagious disease
b. Communicable disease
c. Infectious disease
d. Tropical disease
2. The implantation and successful replication of the organisms in the tissues of the host.
a. Injury
b. Inflammation
c. Infection
d. Isolation
3. The destruction of pathogenic and nonpathogenic organisms outside the body by physical or
chemical means.
a. Sterilization
b. Disinfection
c. Disinfestation
d. Decortication
4. These are considered as the most common portals of entry of organisms into the host.
a. Gastrointestinal and respiratory tract
b. Gastrointestinal and genitourinary tract.
c. Respiratory tract and the integument
d. Respiratory tract and genitourinary tract
5. The following are the preventive aspects of nursing care for a patient suffering from a
communicable disease, EXCEPT
a. Proper supervision of food handlers
b. Immunization
c. Isolation and quarantine of suspected and infected individuals
d. Health education
6. Roman sustained a vehicular accident and had a big cut on his arm. He was given 6,000 'u'
anti-tetanus serum ATS that was inoculated around the wound ANST. The main action of this
drug to:
a. kill the organism.
b. prevent the spread of the organism.
c. inhibit the growth of the organism.
d. neutralize the toxin released by the organism.
7. The type of immunity the person acquires after administration of anti-tetanus serum (ATS) is
a. Natural active
b. Artificial active
c. Natural passive
d. Artificial passive
8. Mrs. Ruiz is receiving regular insulin 20 "u" s/c before breakfast. Which of the following level of
prevention she is in?
a. Primary
b. Tertiary
c. Secondary d. Any of these
9. A pneumonia patient was admitted to a respiratory unit in a tertiary hospital. The nurse called
up the X-ray department as the patient is for chest PA. This is
a. Independent nursing care
b. Dependent nursing action
c. Interdependent nursing function
d. None of these
10. In a medical hand scrub, the water runs off the
a. Elbow
c. Fingers
b. Arms
d. Either a, b, or c
11. The presence of a microorganism and its toxic substances in the bloodstream is known as
a. Bacteremia
b. Viremia
c. Toxemia
d. Septicemia
12. The period of communicability is best defined as:
a. when body discharges are positive of the infectious agent. b. the duration when the patient is
still a source of infection. c. when fever is persistently high.
 d. when signs and symptoms are still present
13. A pathogen is best defined as
a. a disease-causing organism
b. a unicellular organism seen with a microscope
c. most abundant life on earth
d. a device used to sterilize
14. The following are the functions of a cell-mediated immune response, except
a. cancer surveillance
b. production of antibodies
c. tissue rejection
d. exhibits memory
15. Your infection control department tells you that a patient can be managed using routine
practices as mandated by the hospital. This means that:
a. The patient does not have infectious organisms and does not pose a risk to staff or other
patients.
b. Any care being provided is routine in nature and presents no risk of
infection.
c. A risk assessment should be done before providing care and PPE worn as appropriate to the
situation and the care being provided.
d. Ask the client or his/her significant others about the patient's recent travel history.
16. When using hand sanitizers or alcohol-based hand rub, you should:
a. apply the hand sanitizer and blow or wave hands until dry.
b. apply a sufficient amount of hand sanitizer, making sure to cover all areas of the hands, front,
back, and between fingers.
c. apply the hand sanitizer and rub palms together for 10 seconds.
d. apply hand sanitizer only when caring for a highly contagious patient.
17. Which of the following situations or medical interventions pose factors that affect risk of
infection?
a. Indwelling devices
b. Types of disinfectants used
c. Staffing ratios
d. Lengths of stay
e. All of these
18. What is the single most effective means of preventing health care-associated infections in the
hospital?
a. Periodic fumigation
b. Use of personal protective equipment
c. Prophylactic antibiotic therapy
d. Hand hygiene
19. Hospital-acquired urinary tract infections (UTIs) are often related to poor hand washing and?
a. Poor urinary output
b. Urinary drainage bags
 c. Poor perineal hygiene
d. Improper catheter care
20. If a client who is receiving IV fluids develops tenderness, warmth, erythema, and pain at the site,
the nurse should suspect:
a. Sepsis
b. Phlebitis
c. Infiltration
d. Fluid overload