Controlling communicable diseases 1. Control the ______ (bacteria, virus, fungus, parasite) - cause of the disease 2. Control the ______ - where an agent survives/multiplies - Eradicate nonhuman reservoir - Control human reservoir - Control portals of entry/exit - Improve host resistance and immunity

1. Control the agent (bacteria, virus, fungus, parasite) - cause of the disease 2. Control the reservoir - where an agent survives/multiplies - Eradicate nonhuman reservoir - Control human reservoir - Control portals of entry/exit - Improve host resistance and immunity

w6 Flashcards by Garrett Anderson

Communicable vs Infectious

________ disease – when living organism enters the body and causes disease (ex: Lyme disease)

_________ disease – when the disease can be transmitted from one person/non-human to another (covid, flu)

All communicable diseases are infectious?
All infectious diseases are communicable?

Infectious disease – when living organism enters the body and causes disease (ex: Lyme disease)

Communicable disease – when the disease can be transmitted from one person/non-human to another (covid, flu)

All communicable diseases are infectious
Not all infectious diseases are communicable

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Communicable diseases and pandemics throughout history

1918 – influenza
1980’s – HIV, antibiotic resistance, casual connections between infectious organisms/chronic disease
1990’s – food supply concerns, hantavirus pulmonary syndrome, bovine spongiform encephalopathy (mad cow disease), variant crutzfeldt Jakob disease, VRSA, avian influenza, west nile virus
2000’s – viral hemorrhagic fevers (ebola and Marburg), SARS (select agent = has potential to cause great harm), E-coli, salmonella, listeria, new influenza strain, MERS-COV, zika, COVID-19

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Factors influencing new infectious diseases
- Societal events
- Health care
- Food production
- Human behavior
- Environmental
- Public health
- Microbial adaption

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Epidemiological triangle

Agent – cause of disease
- _____– bacteria, virus, fungus, parasite
- Ability to cause injury or illness to the host
- _____ – agents ability to enter the host and multiply
- ______ – agents ability to spread through the host
- _______ – agents ability to cause disease in host
- _______ – measure of the serverity of disease caused by agent
- ______ – – ability to produce damaging poison/toxin
- ______ – ability to stimulate an immune response in the host

pathogenicity
Toxigenicity
type
virulence
invasiveness
Antigenicity
infectivity

Type – bacteria, virus, fungus, parasite
Ability to cause injury or illness to the host
Infectivity – agents ability to enter the host and multiply
Invasiveness – agents ability to spread through the host
Pathogenicity – agents ability to cause disease in host
Virulence – measure of the serverity of disease caused by agent
Toxigenicity – ability to produce damaging poison/toxin
Antigenicity – ability to stimulate an immune response in the host

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Epidemiological triangle

_____ – person/animal that harbors disease causing agent
- Exposure
- susceptibility
- response

Host – person/animal that harbors disease causing agent
- Exposure
- Host susceptibility
- Host response

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Epidemiological triangle

_________– external conditions that influence the interaction between the agent and hots
- Physical
- Biological
- Psychosocial

Environment – external conditions that influence the interaction between the agent and hots
- Physical
- Biological
- Psychosocial

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Epidemiological triangle

________ – where an agent survives/multiplies
- External or internal
- Inanimate – water, soil, food
- Animate (human) – symptomatic or non-symptomatic carrier
- Animate (animal) – zoonosis – agents harbored by non-human vertebrate animal reservoirs

Reservoir – where an agent survives/multiplies
- External or internal
- Inanimate – water, soil, food
- Animate (human) – symptomatic or non-symptomatic carrier
- Animate (animal) – zoonosis – agents harbored by non-human vertebrate animal reservoirs

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Modes of transmission

Direct – immediate transfer of agent from one human to another, distance is 3 feet or ______
- contact or droplet transmission? – direct transfer with very close contact (STIs, athletes foot)
- contact or droplet transmission? – expelled large droplets from one person and picked up by another (flu, RSV, diptheria)

Modes of transmission

Direct – immediate transfer of agent from one human to another, distance is 3 feet or less
- Contact transmission – direct transfer with very close contact (STIs, athletes foot)
- Droplet transmission – expelled large droplets from one person and picked up by another (flu, RSV, diptheria)

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Modes of transmission

Indirect – transfer of agent from one human to another, distance is 3 feet or _______

air, vehicle, or vector?

_______ borne
o Animate objects – poor hand washing
o Inanimate objects – shared equipment/toys
o Food/liquid – food borne illness
_______ borne
o Usually arthropods/invertebrates
o Mosquitos with west nile virus
_____ borne
o Expelled through small droplets – cough, sneeze, singing
o TB, COVID, chicken pox, cold

Indirect – transfer of agent from one human to another, distance is more than 3 feet
- Vehicle borne
o Animate objects – poor hand washing
o Inanimate objects – shared equipment/toys
o Food/liquid – food borne illness
- Vector borne
o Usually arthropods/invertebrates
o Mosquitos with west nile virus
- Airborne
o Expelled through small droplets – cough, sneeze, singing
o TB, COVID, chicken pox, cold

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Patterns of transmission

____directional – nonhuman to human
____directional – nonhuman to human, human to nonhuman

______ – parent to child during fetal development, birth, breast feeding (HIV)
_____ – person to person

____genous – internal source (present and asymptomatic in the body, ex: E coli. Can exist in gut with no symptoms but if it gets into urinary tract it causes problems)
_____genous – external source (eating contaminated food and getting botulism)

Patterns of transmission

Unidirectional – nonhuman to human
Bidirectional – nonhuman to human, human to nonhuman

Vertical – parent to child during fetal development, birth, breast feeding (HIV)
Horizontal – person to person

Endogenous – internal source (present and asymptomatic in the body, ex: E coli. Can exist in gut with no symptoms but if it gets into urinary tract it causes problems)
Exogenous – external source (eating contaminated food and getting botulism)

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Stages of infection

Latent
Transmissibility
Incubation
Communicability

________ period – period between an infectious agent entering a host and finding conditions favorable, replicating, shedding

_________ period – period of time the person is contagious/can infect others

________ period – period between invasion of agent and symptoms appearing

________ period – estimations of the basic reproductive number

Stages of infection

Latent period – period between an infectious agent entering a host and finding conditions favorable, replicating, shedding

Communicability period – period of time the person is contagious/can infect others

Incubation period – period between invasion of agent and symptoms appearing

Transmissibility – estimations of the basic reproductive number

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Common ports of ______
- Mucous membranes – syphilis
- Respiratory tract – flu, cold
- Skin – hook worm
- Blood vessels – HIV, Hep B
- Placenta – HIV, Hep B

Common ports of ______
- Intestinal tract (feces) – cholera
- Respiratory tract (cough, sing, sneeze) – COVID, TB
- Skin (lesions) – scabies
- Blood – Hep B
- Semen and vaginal fluids – STIs
- Wound exudate – MRSA

Common ports of entry
- Mucous membranes – syphilis
- Respiratory tract – flu, cold
- Skin – hook worm
- Blood vessels – HIV, Hep B
- Placenta – HIV, Hep B

Common ports of exit
- Intestinal tract (feces) – cholera
- Respiratory tract (cough, sing, sneeze) – COVID, TB
- Skin (lesions) – scabies
- Blood – Hep B
- Semen and vaginal fluids – STIs
- Wound exudate – MRSA

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Controlling communicable diseases

Control the ______ (bacteria, virus, fungus, parasite) - cause of the disease
Control the ______ - where an agent survives/multiplies
- Eradicate nonhuman reservoir
- Control human reservoir
- Control portals of entry/exit
- Improve host resistance and immunity

Control the agent (bacteria, virus, fungus, parasite) - cause of the disease
Control the reservoir - where an agent survives/multiplies
- Eradicate nonhuman reservoir
- Control human reservoir
- Control portals of entry/exit
- Improve host resistance and immunity

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Controlling communicable diseases

Contact tracing
Quarantine
Isolation

_________– individual level, for communicable diseases

________ – population level, for communicable diseases to natural/chemical disasters
3 levels
- Shelter in place
- Targeted restrictions on movement/activities
- Compulsory widespread restriction of movements/activities

________ – finds new cases quickly so they can be isolated to stop further spread

Isolation – individual level, for communicable diseases

Quarantine – population level, for communicable diseases to natural/chemical disasters
3 levels
- Shelter in place
- Targeted restrictions on movement/activities
- Compulsory widespread restriction of movements/activities

Contact tracing – finds new cases quickly so they can be isolated to stop further spread

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Disease ________ process
- Outbreak control team
- Determine coverage in affected surrounding areas
- Enhance surveillance
- Notify appropriate people
- Educate patients and their contacts
- Case management
- Lab confirmation
- Control activities to limit transmission
- Collect data on cases and outbreak response

Disease Outbreak process
- Outbreak control team
- Determine coverage in affected surrounding areas
- Enhance surveillance
- Notify appropriate people
- Educate patients and their contacts
- Case management
- Lab confirmation
- Control activities to limit transmission
- Collect data on cases and outbreak response

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Disease rates

_______ – number of NEW cases of disease (at a given time period)

________ – number of ALL/CURRENT cases of disease (at a given time period)

Disease rates

Incidence – number of NEW cases of disease (at a given time period)

Prevalence – number of ALL/CURRENT cases of disease (at a given time period)

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Focus of public health

Control
Elimination
Prevention
Eradication

__________– reduce/eliminate exposure or susceptibility to a disease

__________ – reduce incidence/prevalence of a disease

__________ – control of a disease within a specific geographical area

_______ – reduce incidence worldwide to 0

Focus of public health

Prevention – reduce/eliminate exposure or susceptibility to a disease

Control – reduce incidence/prevalence of a disease

Elimination – control of a disease within a specific geographical area

Eradication – reduce incidence worldwide to 0

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__________ - Ongoing systemic collection, analysis, and interpretation of health data
- Purpose – detect, monitor, and control spread of communicable disease

Organizations
- Health care provider
- Local health depts
- State health depts – state laws prevail over federal laws
- CDC
- WHO

Surveillance

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Pandemics
Endemic
Epidemic

__________ - When a disease growth is exponential
- Focus is on how far it reaches (not severity)
- Spreads to international boundaries
- Unpredictable
- Ex: black death, small pox, spanish flu, bird flu, AIDS

________– occurrence of disease in a community/region in excess of normal expectancy

________ – constant presence of a disease with a geographic area/population
- Provides baseline for establishing a public health problem

Pandemics - When a disease growth is exponential
- Focus is on how far it reaches (not severity)
- Spreads to international boundaries
- Unpredictable
- Ex: black death, small pox, spanish flu, bird flu, AIDS

Epidemic – occurrence of disease in a community/region in excess of normal expectancy

Endemic – constant presence of a disease with a geographic area/population
- Provides baseline for establishing a public health problem

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Medical mistrust

J Marion Sims
- Research on enslaved black women without anesthesia
- Believed black people didn’t feel pain

Henrietta Lacks
- Her cells (Hela cells) taken without consent
- Used in a petri dish to advance science

Tuskegee syphilis study
- Not notified of syphilis treatment
- Did not give informed consent
- Used to study syphilis in black men

Current racism in healthcare
- Pain ignored, denied, believed to be less than white pts
- Higher rates of misdiagnosis
- Poorer health outcomes
- Cheaper/less desirable procedures

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_________ – any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources
- Multiple casualty (3-99 individuals)
- Mass casualty (100+)
- _________ = injured or dead, direct victims, indirect victims, displaced person, or refugee
- Effects populations, environment, food/water supply, infrastructure, psychological/social/economic stability

Disaster

Casualties

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human vs natural

________ disaster
- Sudden impact or acute onset
- Slow or chronic impact

_________ disaster
- Unintentional or intentional
- Biologic
- Nuclear
- Incendiary
- Chemical
- Explosive
- Technologic

Natural

Human generated

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Disaster management
4 phases
1. ______ – plan for risk
2. ________ – build for risk, mitigate risk
3. ________ – respond to events
4. _______ – recover and improve

Disaster management
4 phases
1. Prepare – plan for risk
2. Prevent – build for risk, mitigate risk
3. Respond – respond to events
4. Recover – recover and improve

Disaster management
4 phases: Prevent, prepare, respond, recover

__________
- Identify potential hazards
- Vulnerabilities
- Strengthen capacity – resources, organization, resilence

Prevent
- Identify potential hazards
- Vulnerabilities
- Strengthen capacity – resources, organization, resilence

Disaster management 4 phases: Prevent, prepare, respond, recover __________ - Timely warnings - Protective factors - Emergency management activities - Evacuating populations pre-disaster

Prepare - Timely warnings - Protective factors - Emergency management activities - Evacuating populations pre-disaster

Disaster management 4 phases: Prevent, prepare, respond, recover ___________ - Disaster management team leader - Clear roles of team - Triage system - Life saving actions – START, decontamination - Surveillance – quarantine, isolation - Evacuating populations post disaster

Respond - Disaster management team leader - Clear roles of team - Triage system - Life saving actions – START, decontamination - Surveillance – quarantine, isolation - Evacuating populations post disaster

Disaster management 4 phases: Prevent, prepare, respond, recover ___________ - Illness and injury d/t post disaster environment - Re-establish health services - Debrief - Evaluate disaster management response - Improve

Recovery - Illness and injury d/t post disaster environment - Re-establish health services - Debrief - Evaluate disaster management response - Improve

Disaster management: respond ______________ – chemical exposure - Prevents further absorption and spreading of chemical by victim - Prevents spreading to others - Avoid skin to skin contact - Wear PPE – latex gloves not adequate, chemical protective gloves required - Do not attempt mouth to mouth resuscitation without proper shields for protection Process - Remove articles, seal in double bag - Neutralize agent - Wash, flush eyes 5-10 mins - Dispose of contaminated articles and wash water - For ingestion – don’t induce emesis

Decontamination

Disaster Hazards in KY - Sherwin wiliams paint plant - Carpet factories - Farms - Railroads - Toyota - Breweries - Tobacco warehouse - Coal processing plants - Structure fires - Blue grass army depot ____________ Chemical weapon stores Nerve agents (organophosphate) – readily absorbed by inhalation, ingestion and dermal contact, rapidly fatal systemic effects - Lowered acetylcholinesterase levels are indicators of nerve agent intoxication in victims

blue grass army depot

s/s organophosphate poisoning - salivation - urine incontinence - diarrhea - GI cramps - Emesis - Miosis - lacrimation immediate response - protect self, scene safety – don’t enter scene with unknown chemicals - remove victims from exposure as fast as possible - decontaminate - drug therapy o atropine sulfate for anticholinergic properties o 2 pam chloride pralidozime salts to restore acetylcholinesterase activity o Mechanical vent for respiratory failure o Diazepam for convulsions

_________ poisoning Originates from release of hydrogen cyanide gas and cyanide salts, certain meds Causes histotoxic hypoxia - h/a - dizzy - seizure - SOA - Low BP - Death Antidote - Amyl nitrate - Cyanokit hydroxocobalamin

Cyanide

_________ poisoning Common in winter – poorly vented furnaces s/s - h/a - dizzy - seizure - SOA - Vomit - Chest pain Treatment - Pulse ox that measures CO - Pt will read 100% O2 even when they aren’t - High flow O2 via nonrebreather mask - Hyperbaric chamber and oxygen washout

Carbon monoxide

Industrial exposure - Acids - Bases - MSDS - Placards – on vehicles, tanks, packaging - Safety officer or hazmat tech - Call poison control

Hazmat zones _____________ - Contamination present – everything inside contaminated - PPE - Limited # of personnel _____________ - Contamination control zone - PPE - Decontamination corridor - Life saving emergency care ___________ - CP location - Treatment/transport areas - Staging - Medical monitoring/rehab

Hot zone/red zone Warm zone/yellow zone Cold zone/green zone

National incident management system (NIMS) Standard approach to incident management and response in the US - Established by dept of homeland security - Result of 9/11 - Incidents include: natural disasters, terrorism, failing infrastructure, transportation incidents

Benefits of NIMS - Standardized and organized process - National standard for training - Personnel qualification standards - Interoperable communication - Information management systems with commonly accepted architecture - Supporting technologies and infrastructure

(1) Level 1 role Incident commander - Responsible for creating a unified command between responding agencies - Evaluates incident - Creates/oversees plan of action - Determines needs Benefits - Common language and clear communication - Point of command limits duplication - Final operational control

(3) Level 2 roles Safety officer - Responsible for monitoring hazards for daily operations - Enforcing safety plans for scene operations - Helps develop emergency response plans if further incidents ensue Public information officer - Responsible for communicating info to public - Facts and viewpoints of responding agency - Speaks to response efforts/operations - Death disclosure Liaison officer - Relays info between incident commander, general staff, and other agencies - Group of officers that report to chief officer - Assist in communication between departments and field response efforts

(4) Level 3 roles Operations section - Manage and plan day to day response - Oversee all field operations - Chain of command – field operations back to command Planning section - Problem solving issues as they come up during response - Predicting and planning next phase of incident response - Develop demobilization plan and emergency action plan Logistics section – service branch and support branch - Facilities - Medical response - Food and water - equipment - movement of equipment – may be contracted by FEMA before disaster, trucking and utility companies, generator and heavy equipment rentals, medical evacuation Finance/admin. Section - Responsible for documenting all expenses that need reimbursed (federal and state dollars) - Tracks hours worked, cost of supplies, cost of compensation

Standardized communication - All responding units use a standardized ________ frequency for incident response - Naming ________ assets is standardized

Standardized communication - All responding units use a standardized radio frequency for incident response - Naming equipment assets is standardized

Mobilization and deployment - Identify needed resources – sourced locally and nationally - Expected response time given - Each resource tracks cost to submit to finance - Incident commander briefs individuals as they arrive to scene

Medical incident command - response to medical emergency is broken down to _____, _____, ____ - Over seen by medical director - Staging supervisor – runs staging location, establishes entrance/exit, prevent traffic congestion - Physician on scene – provides medical direction - Rehabilitation supervisor – in charge of onsite rehab, monitors staff for stress and fatigue

triage, treatment, transportation

Medical incident command 1. _________ The process of prioritizing or sorting sick/injured people for treatment according to seriousness of the condition or injury - Triage and tag all pts - Provide very limited treatment – manually open airway, clear airway w/ finger sweep or head position, instruct to control major bleeding - Collab with treatment and extrication supervisor - Quickly and efficiently assess pts (30 secs or less per patient) - Establish morgue - Document triage process

Triage

Primary vs Secondary ________ triage - on scene prior to transport - at hospital if arrived by foot/personal vehicle _________ triage - incident dependent, probably prior to/during transport - at receiving facility - triage is an ongoing process

Primary triage - on scene prior to transport - at hospital if arrived by foot/personal vehicle Secondary triage - incident dependent, probably prior to/during transport - at receiving facility - triage is an ongoing process

Triage type - START (Simple, Triage, And, Rapid, Treatment) - Developed by Newport beach fire dept - Easy to use - Focus is on _______ - Fast - Jump START – for kids 4 focus areas of START - Ability to follow direction and ______ - _________ effort - ______/perfusion - _________ status

Triage type - START (Simple, Triage, And, Rapid, Treatment) - Developed by Newport beach fire dept - Easy to use - Focus is on s/s - Fast - Jump START – for kids 4 focus areas of START - Ability to follow direction and walk - Respiratory effort - Pulse/perfusion - Mental status

Tags/triage categories: Black/expectant, Red/Immediate, Delayed/yellow, Minor/green __________ - Unlikely to survive - Palliative care and pain relief

Black/expectant

Tags/triage categories: Black/expectant, Red/Immediate, Delayed/yellow, Minor/green ____________ - Victim can be helped with immediate intervention and transport - Requires medical attention within minutes

Red/Immediate

Tags/triage categories: Black/expectant, Red/Immediate, Delayed/yellow, Minor/green ___________ - Transport can be delayed - Includes serious or potentially life threatening injuries but status not expected to deteriorate significantly over several hours

Delayed/yellow

Tags/triage categories: Black/expectant, Red/Immediate, Delayed/yellow, Minor/green ___________ - Relatively minor injuries - Status unlikely to deteriorate over days - “walking wounded” - May be able to assist in own care

Minor/green

Medical incident command 2. __________ - Separate pts into priority groups - Assign staff to treat pts - Ensure supplies and personnel - Maintain security and decontamination - Work with transport to hospital - Provide updates to EMS director

Treatment

Medical incident command 3. __________ - All pt movement from area of treatment - Establish loading zone for pt transport - Determine destination based on needs - Work with local resources to find transport - Document all pt transport

Transportation

___________ - 3-99 patients - Requires mutual aid and strains resources - Declare if more resources are needed

Multiple casualty incidents (MCI)

Multiple vs mass ________ casualty = 3-99 patients _______ casualty = 100+ patients

Multiple casualty incidents (MCI) = 3-99 patients Mass casualty = 100+ patients

Closed vs Open incident ___________ incident - Unknown causalities - Search and rescue required - Long and ongoing __________ incident - Number of patients known, not expected to change - Patients triaged, treated, and removed from scene

open Closed

Critical incident stress management (CISM) - Emergency workers may suffer from psychological impact of MCI - Disaster plans must include resources for debriefing responders - CISM team available all times during response efforts - Participation not required, highly encouraged

After action review - Detailed review of response and actions, for learning purposes - Observations documented for future review - Never accuse someone of wrong doing during response

Emergency responses: nurses role Plan - Develop community response plan - Education on prevention and response plans Scene response - Provide triage and primary care - Help with home searches and provide medical assessment Hospital response - Assist in influx - Executing emergency plan Community response - Respond to shelters to assist in medical care After care - Help return community to normal - Reestablish resources in community - Medical care and mental care to responders Disaster response plan - Be familiar with facility plan for different types of disasters - Know local resources for disaster management – emergency services, hospital capabilities - Be familiar with threats - Practice