Chain of Infection

Chain of Infection Components
The chain of components has six sections. They include:
 Microorganisms: Disease producing, also called pathogens

o Virus, parasite, fungus, bacterium
o Risk factors: Virulence, pathogenicity, ability to enter host
 Reservoir/Source: Environment/habitat where a pathogen can live and multiply
o Environmental surfaces/equipment, body fluids (blood, saliva), urine/fecal material,
food/water, soil, skin, respiratory tract
 Portal of Exit: How the pathogen exits or leaves reservoir
o Skin to skin, skin to surface, blood, mucous membranes, oral cavity, fecal
o Other potentially infectious material (OPIM): Seminal fluid, joint fluid, saliva, urine/fecal
material, anybody fluid contaminated with blood
 Modes of Transport: How a pathogen moves from reservoir to susceptible host
o Direct Transmission: Airborne, droplet, contact (e.g., skin), bite, needlestick or other sharps
injury
o Indirect Transmission: Fomites – contaminated equipment or medication (multidose vials,
single dose vials), vectors, food, water
 Portal of Entry: Opening where the pathogen may enter
o Body openings (e.g., mouth, eyes, urinary tract, respiratory tract), incisions, wounds
 Susceptible Host: The person at-risk: patient or healthcare worker
o Factors affecting susceptibility (e.g., age, health, co-morbidities, immune system, nutrition,
infective dose, medications)
Pathology, in the broadest terms, is the study of disease. Disease occurs for many reasons. Some diseases
represent spontaneous alterations in the ability of a cell to proliferate and function normally, and in other cases,
disease results when external stimuli produce changes in the cell's environment that make it impossible for the cell to
maintain homeostasis. In such situations, cells must adapt to the new environment. These adaptations
include hyperplasia, hypertrophy, atrophy, and metaplasia, and can be physiologic or pathologic, depending upon
whether the stimulus is normal or abnormal. A cell can adapt to a certain point, but if the stimulus continues beyond
that point, failure of the cell, and hence the organ, can result. If cells cannot adapt to the pathologic stimulus, they can
die. This chapter will discuss cellular adaptation, cell injury, cellular accumulations, and cellular aging.
Overview: The four basic types of cellular adaptation to be discussed in this section are hyperplasia, hypertrophy,
atrophy, and metaplasia.
Hyperplasia
Basic description: Increase in the number of cells.
Types of hyperplasia
 Physiologic hyperplasia: Occurs due to a normal stressor. For example, increase in the size of the breasts
during pregnancy, increase in thickness of endometrium during menstrual cycle, and liver growth after partial
resection.
 Pathologic hyperplasia: Occurs due to an abnormal stressor. For example, growth of adrenal glands due
to production of adrenocorticotropic hormone (ACTH) by a pituitary adenoma, and proliferation of
endometrium due to prolonged estrogen stimulus.
Important point regarding hyperplasia: Only cells that can divide will undergo hyperplasia; therefore, hyperplasia
of the myocytes in the heart and neurons in the brain does not occur.
Hypertrophy
Basic description: Increase in the size of the cell.
Types of hypertrophy
 Physiologic hypertrophy: Occurs due to a normal stressor. For example, enlargement of skeletal muscle
with exercise.
 Pathologic hypertrophy: Occurs due to an abnormal stressor. For example, increase in the size of the
heart due to aortic stenosis. Aortic stenosis is due to a change in the aortic valve, which obstructs the orifice,
resulting in the left ventricle working harder to pump blood into the aorta.
Morphology of hyperplasia and hypertrophy: Both hyperplasia and hypertrophy result in an increase in organ size;
therefore, both cannot always be distinguished grossly, and microscopic examination is required to distinguish the
two (Figure 1-1)
Cross-section of the heart of a patient with systemic hypertension. The patient had high blood pressure, which
increased the workload of the left ventricle and resulted in concentric hypertrophy of the left ventricular myocardium.
In response to the increasing pressure load, the cardiac myocytes increased their content of contractile proteins,
resulting in enlargement of individual myocytes.
IV.Chain of infection:
A.Illustrate:
The chain of infection can be illustrated as a series of links that connect the different stages of disease
transmission. These links include the infectious agent, reservoir, portal of exit, mode of transmission,
portal of entry, and susceptible host.
B. Explain or describe: The chain of infection describes the process by which infectious diseases are
transmitted from one individual to another. It is important to understand this chain in order to prevent
the spread of infections. Each link in the chain represents a stage where interventions can be
implemented to break the transmission
V.Cellular Adaptations:
A. Used for: Cellular adaptations are mechanisms that allow cells to respond and adapt to changes in
their environment or physiological demands.
1. Used for: Cellular adaptations are used for maintaining homeostasis, promoting survival, and
ensuring proper functioning of tissues and organs.
2. Can adapt by changing in their growth by changing the: Cells can adapt by changing their growth
patterns, such as increasing or decreasing in size or number, in response to various stimuli.
3. Differentiate the following:
a. Atrophy: Atrophy refers to the decrease in cell size or tissue mass due to a decrease in workload,
disuse, or aging.
b. Hypertrophy: Hypertrophy refers to the increase in cell size or tissue mass due to anincrease in
workload or demand.
c.Hyperplasia: Hyperplasia refers to the increase in the number of cells in a tissue or organ, resulting in
an increase in tissue size.
d. Dysplasia: Dysplasia refers to the abnormal growth and development of cells, often associated with
precancerous changes.
e. Anaplasia: Anaplasia refers to the loss of cellular differentiation and organization, commonly seen in
cancer cells.
4. Using a flow chart or paradigm, discuss how the cell adapts to injury:
5. Can adapt by changing their type.
a. Differentiate the following:
- Metaplasia:
Metaplasia refers to the reversible change of one differentiated cell type into another, usually in
response to chronic irritation or inflammation.
6. Apoptosis: Apoptosis is a programmed cell death that occurs in a controlled and orderly manner. It is
a natural process involved in normal development, tissue homeostasis, and the elimination of damaged
or unwanted cells. Apoptosis is characterized by cellular shrinkage, nuclear fragmentation, and the
formation of apoptotic bodies.
It is different from necrosis, which is a form of cell death caused by injury or disease and involves
cellular swelling, membrane rupture, and inflammation.
VI.Cell Damage & Necrosis:
Explain: Cell damage refers to the structural or functional changes that occur as a result of injury or
disease. Necrosis is a type of cell death that occurs as a result of severe damage or injury to cells, leading
to the release of cellular contents and triggering an inflammatory response.
VII.Understanding Cause & Effect Relationships:
A. Purpose:
1. How normal organ structure & function are related:
The purpose is to understand the relationship between the normal structure and function of organs in
order to identify abnormalities and diagnose diseases. For example, in the case of the heart, its
structure, including the chambers and valves, is directly related to its function of pumping blood
efficiency.
C.Why is the route of blood flow extremely important to the human body?
The route of blood flow is extremely important to the human body because it ensures that oxygen and
nutrients are delivered to all cells and tissues, while waste products are removed. Without proper blood
flow, organs and tissues can't function optimally, leading to various health issues.

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Chain of Infection Components

The chain of components has six sections. They include:

 Microorganisms: Disease producing, also called pathogens

to production of adrenocorticotropic hormone (ACTH) by a pituitary adenoma, and proliferation of

endometrium due to prolonged estrogen stimulus.

3. Differentiate the following:

5. Can adapt by changing their type.

a. Differentiate the following:

VI.Cell Damage & Necrosis:

VII.Understanding Cause & Effect Relationships:

1. How normal organ structure & function are related:

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