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SECTION 2 CHAIN OF INFECTION Introduction Infectious Agent Reservoirs Portal of Exit Means of Transmission Portal of Entry Susceptible Host Developed by In conjunction with Date developed Approved by Reference number Revision date Responsibility for review Niamh Mc Donnell, Liz Forde, Patricia Coughlan and Máire Flynn -----------August 2012 Cork and Kerry Infection Prevention and Control Committee Kerry Infection Prevention and Control Committee IPCG 2/ 2012 Revision number 0 2015 or sooner if new evidence becomes available Infection Prevention and Control Nurses Guidelines on Infection Prevention and Control 2012 HSE South (Cork & Kerry) Community and Disability Infection Control Services Chain of Infection Page 1 of 3 Introduction The above diagram is used to explain the infection process and is referred to as the chain of infection. All links in the chain must be present and in sequential order for cross infection to occur. Understanding the characteristics of each link provides the healthcare worker with methods to prevent the spread of healthcareassociated infection (HCAI). The links are; Infectious agent is a bug or micro-organism with the ability to cause disease. The greater the micro-organism's virulence (ability to grow and multiply) and pathogenicity (ability to cause disease), the greater the possibility that the microorganism will cause an infection. Infectious agents are bacteria, virus, fungi, and parasites. There are two sources of infection: A. Endogenous or self infection: Occurs when organisms which are harmless in one site cause infection when transferred to another (e.g. E. coli transferred from the gastrointestinal tract to the urinary tract where it causes a urinary tract infection). B. Exogenous or cross infection: occurs when organisms are transferred from another source (e.g. eating food contaminated with Salmonella species). Reservoirs A place within which micro-organisms can thrive and reproduce. For example, micro-organisms thrive in human beings, animals, and inanimate objects such as water, on equipment and in the environment. Portal of Exit A place of exit providing a way for a micro-organism to leave the reservoir. For example, the microorganism (e.g. Flu) may leave the reservoir through the nose or mouth when someone sneezes or coughs. Means of Transmission In healthcare there are three main modes of transmission, Contact (example via the hands of healthcare workers), Droplet (example flu) and Airborne (example TB) these are discussed in detail in section - transmission based precautions. Guidelines on Infection Prevention and Control 2012 HSE South (Cork & Kerry) Community and Disability Infection Control Services Chain of Infection Page 2 of 3 Portal of Entry An opening allowing the micro-organism to enter the host. Portals include body orifices, mucus membranes, or breaks in the skin. Portals also result from tubes placed in body cavities, such as urinary catheters. Susceptible Host A person who cannot resist a micro-organism invading the body, multiplying, and resulting in infection. The host is susceptible to the disease, lacking immunity or physical resistance to overcome the invasion by the pathogenic micro-organism. The purpose of Standard and Transmission-Based Precautions is to break the “chain of infection” focusing primarily but not exclusively on the mode of transmission, portal of entry and susceptible host sections of the chain. References and Bibliography Ayliffe, G AJ (2009) Control of Healthcare –associated Infection. Fifth Edition, Great Britain. Centre for Disease Control and Healthcare Infection Control Practices Advisory Committee (2003) Guidelines for Environmental Infection Control in Healthcare Facilities. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf Infection Control for Nursing Students (2001) Chain of Infection http://faculty.ccc.edu/trinfectioncontrol/chain.htm Guidelines on Infection Prevention and Control 2012 HSE South (Cork & Kerry) Community and Disability Infection Control Services Chain of Infection Page 3 of 3