[John-paul]

Thinking of your current or a past practice area provide an example of the train of transmission specific to that area. Fill in all ‘links’ in the chain with an example for each link:

Infectious Agent:

Reservoirs:

Portals of Exit:

Modes of Transmission:

Portals of Entry:

Susceptible Host:

[Mauei Caela]

Hello Everyone. Here is my example of the train of transmission taken from my own experience on how I may have gotten positive for COVID during quarantine time while working in the hospital as a new grad.

Infectious Agent: COVID-19 virus.

Reserviours: Home shared items like the washroom, dining area, and living room. Hospital items like doorknobs, bedrails, medwows, shared room space like nursing break room, washroom. Person positive with the COVID-19 virus.

Portals of Exit: A Person positive with the COVID-19 virus sneezing and touching items without washing hands afterward or covering their mouth and nose when sneezing.

Modes of transfer: Using shared material without disinfecting it properly or missing areas where the infectious agent could be lying, like a dining table in the nursing breakroom, washroom at home, or work.

Portal of Entry: Mucous membrane like touching said unsanitized shared table, then rubbing eyes with unwashed hands.

Susceptible Host: Immunocompromised host due to stress at work and preparation for the licensing exam.

[Melissa]

Here is my example of the train of transmission taken from my own experience with the current Measles cases in Ontario, and my location currently as a “hot spot”.

Infectious Agent: The Measles virus, is a paramyxovirus of the genus Morbillivirus. It is known to be highly infectious and has the ability to remain viable in the air or on surfaces for up to 2 hours.

Reservoir: Humans are the sole reservoir for the measles virus. The virus does not survive in animals or the environment, which makes human- to- human transmission the primary concern

Portals of Exit: The virus exits the host through respiratory secretions, such as droplets expelled through coughing, sneezing.

Modes of transfer: Airborne transmission, through inhalation of contaminated droplets or contact with contaminated surfaces. The high contagion rate means that approximately 90 % of susceptible individuals in close proximity to an infected person will become infected.

Portal of Entry: Through mucous membranes

Susceptible Host: Individuals who are not fully vaccinated or have a compromised immune systems. Particularly infants, pregnant women and immunocompromised individuals are at a higher risk of severe complications.

[Esha]

Hello Melissa,

I had a similar encounter with the steadily increasing Measles cases in my location as well. Respiratory secretions I find now after COVID-19 are not being followed as strictly as they should since people have become accustomed to such viruses. I found that it was very difficult to enforce mask coverings amongst staff and many visitors. The measles outbreak also showed how much people value vaccinations and the need to enforce education regarding vaccinations. I find there is a lot of incorrect information being passed amongst non-healthcare professionals.

[Jessica]

Measles has also been a hot spot in my region.
I work in a rural community that had been identified as high risk due to location but also vaccine hesitancy.
My centre had a policy in place with how we triage, care and treat for query cases. Which involves the patient not entering our building and a remote work station is in place.
Our rural emergency was also overwhelmed as lack of family doctors lead people to seek care in emergency rooms. A huge part of my role working in primary care has been around health teaching regarding measles.

[Esha]

An example of a Chain of Transmission is my own experience of acquiring pneumonia while working as a nurse at a Complex care unit.

Infectious Agent: In my case, the infectious agent was streptococcus pneumoniae which is a common bacterial cause.

Reservoirs: A staff member I was working with was infected and due to not having enough sick time off the person had arrived to work with symptoms.

Portals of Exit: The staff member and I had our lunch breaks together in which we sat nearby and talked. The staff member also had a recurring cough.

Modes of Transmission: The two modes of transmission were droplet and contact precautions. There would also be contact with surfaces as we worked closely.

Portals of Entry: Through the respiratory tract, inhalation of droplets.

Susceptible Host: In this circumstance, I was the immunocompromised person at risk as I was just recovering from a sinus infection and my body was fighting off the bacteria. I had also been under a lot of stress due to starting a new position.

[Mahnoz]

Hi Esha,
Acquiring pneumonia from your coworker must have been very frustrating since it could’ve been very well avoided. Your situation demonstrates the spread of this infectious agent through the chain of transmission clearly. It also highlights the importance of recognizing each link in the chain, especially the role of the reservoir and mode of transmission and how important it is to interrupt that chain by using proper hand hygiene, PPE use and incorporating workplace policies. Your story is a strong reminder that it is a shared responsibility to prevent the spread of infections.

[Jessica]

I work in a community health centre and one of my roles is a triage nurse. I see a lot of patient’s with sore throats that require rapid strep tests. To do this test I need to assess the back of the throat and obtain a swab. When I swab the patient’s it usually induces a cough.
Primary transmission of strep is respiratory, droplet precautions are needed.

Infectious agents: streptococcus pyogensis

Reservoir: Patient- is coming into clinic to have sore throat assessed. My primary job is to assess need for rapid strep and obtain swab based of assessment.

Portal of exit: cough- while obtaining swab my patient coughs. Respiratory droplets have been produced.

Modes of transmission : droplet and mucus membrane. I always wear a mask but do not always wear eye wear.

Portals of entry: Respiratory droplets- when susceptible host inhales bacteria . In my case this is the most likely due how close I need to be to patient to obtain swab.
Mucus membrane: strep can be transmitted through mucus membranes. Eyes can be a portal and bacterial infection can occur.
Skin portal of entry- minor skin injuries. Bacteria can be transmitted through skin breakdown or integrity of skin disrupted.

Susceptible host : immunocompromised patient, pregnancy , infants.

In my setting of primary care I work with all ages and different ailments. Infection control is vital for patient safety. This course is going to provide so much great refreshing information for practise !
Jessica Allison RPN

[Mauei Caela]

Hi Jessica,

Your example resonates with me a lot since I work in a Long-Term Ventilator Unit and Trach unit. We deal with secretions by providing suctioning through open (system) catheter suctioning (for trachs) and closed (system) suctioning for vents. We also provide IN-EX, a machine that instills air through the trach to inflate the lungs, then suctions secretions. Oftentimes, in between interventions, patients cough and expel secretions. Due to our patient population, our unit mostly has droplet and contact precautions, making us use PPE despite the new masking policy. I sometimes get people in the elevator telling me that I do not need to wear a mask anymore, but I tell them where I work, and I appreciate having the protection to protect not just the patients, but also myself and my loved ones.

[Mahnoz]

Working in the community can be a challenge once flu season comes around.

Infectious Agent: Influenza
Reservoir: Nurse, patient, visitors
Portal of Exit: Coughing and sneezing
Modes of transmission: Droplet, contact – Visiting nurses are always required to wear masks and PPE if someone is sick or they themselves have symptoms
Portals of Entry: With the influenza it is very easy to spread, and providing direct care as a nurse just a simple task can cause the transfer of the infectious agent
Susceptible host: My immunocompromised, bedridden patient. Visitors who are not up to date with their vaccines.

[Maame]

Good evening everyone, my example of train of transmission is based off my work environment which is long term care.

Infectious agent: bronchitis virus

Reservoirs: unit shared spaces for examples :nursing stations’, washrooms, dining rooms, break rooms and recreation rooms. Contiminated bedrails, doorknobs and countertops.

Portals of exit: A co-worker on my unit had bronchitis and was coughing and sneezing and touching different surfaces, also not performing hand hyigene.

Mode of transfer: Not disinfecting shared equipment or cleaning shared spaces, examples : washrooms, nursing station and also medication cart.

Portal of entry : Coming into contact with contminanted surfaces.

Suspectible host: immunocompromised due to burn out due to short staff, in which made me an easy target.

[Author]

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