Fecal-oral route

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The fecal-oral route, or alternatively, the oral-fecal route or orofecal route is a route of transmission of diseases, in which they are
passed when pathogens in fecal particles from one host are introduced into the oral cavity of another potential host.
There are usually intermediate steps, sometimes many of them. Among the more common causes are:
 water that has come in contact with feces and is then inadequately treated before drinking;
 food that has been handled with feces present;
 poor sewage treatment along with disease vectors like houseflies;
 poor or absent cleaning after handling feces or anything that has been in contact with it;
 sexual fetishes that involve feces, known collectively as coprophilia (its eating is known as coprophagia)
Some of the diseases that can be passed via the fecal-oral route include:
 Giardiasis[1]
 Hepatitis A[2]
 Hepatitis E[3]
 Rotavirus
 Shigellosis (bacillary dysentery)[4]
 Typhoid fever[5]
 Vibrio parahaemolyticus infections[6]
 Enteroviruses, including poliomyelitis
 Cholera
 Clostridium difficile
 Cryptosporidiosis
 Ascariasis
Transmission of Helicobacter pylori by oral-fecal route has been demonstrated in murine models[7].
Summary of droplet precaution principles/elements:

Main mode of transmission Characteristics Prevention Strategy

Droplet  Coughing, sneezing, talking  Surgical mask

(limited distance 3 feet) for those with
 Splashing during procedure symptoms &
(could be further than 3 feet) healthcare
workers
(HCWs)
 Protective
eyewear
 Space out
patients/client
s ± barriers,
e.g. single
rooms
 Other PPE for
patient/client
care and
procedures
Contact Precautions

Contact Precautions are designed to reduce the risk of

transmission of organisms and specific diseases by direct
or indirect contact.
Direct contact transmission involves skin to skin contact
and physical transfer of microorganisms to a susceptible
host from an infected or colonized person, such as occurs
when personnel turn patients, bathe patients or perform
other patient care activities that require physical contact.
Direct contact can also occur between patients that may
have physical contact with each other.
Indirect contact transmission involves a susceptible host
with a contaminated intermediate object, usually
inanimate, in the patient's environment.
Contact Precautions are to added to Standard Precautions
for patients known or suspected to have organisms
and/or diseases easily transmitted via direct or indirect
contact.
Contact Precautions are required if:
A patient is colonized and/or infected with
multidrug-resistant organism. A multidrug-resistant
organism is an organism that is resistant to
treatment with standard first-line antibiotics.
A particular organism is identified as being
potentially hazardous to others and/or to the
ecology of the hospital environment because of its
antibiogram, pathogenicity, virulence, or
epidemiologic characteristics (i.e., VRE, MRSA).

Airborne Precautions
Airborne precautions are required to protect against airborne
transmission of infectious agents.
Diseases requiring airborne precautions include, but are not
limited to: Measles, Severe Acute Respiratory Syndrome (SARS),
Varicella (chickenpox), and Mycobacterium tuberculosis.
Preventing airborne transmission requires personal respiratory
protection and special ventilation and air handling.
How airborne transmission occurs:
Airborne transmission occurs through the dissemination of either:
 airborne droplet nuclei (small-particles [5 micrograms or
smaller] of evaporated droplets containing
microorganisms that remain suspended in the air for
long periods of time) or
 dust particles that contain an infectious agent
Microorganisms carried by the airborne route can be widely
dispersed by air currents and may become inhaled by a susceptible
host in the same room or over a long distance form the source
patient – depending on environmental factors such as temperature
and ventilation.
Airborne precautions include:
 Standard Precautions

PLUS
 Personal respiratory protection
o N95 respirator
Prior fit-testing that must be repeated annually
and fit-check / seal-check prior to each use.
 N95 Respirator
More information about N-95
respirators.
or
o Powered Air-Purifying Respirator (PAPR)
 PAPR
More information about PAPR
respirators.
 Airborne Infection Isolation Room (AIIR)
o At a minimum, AIIR rooms must:
 Provide negative pressure room with a
minimum of 6 air exchanges per hour
  Exhaust directly to the outside or
through HEPA (High Efficiency
Particulate Air) filtration
Airborne precautions apply to patients known or suspected to be
infected with microorganisms transmitted by airborne droplet
nuclei.
Contact Precautions
In addition to Standard Precautions, use Contact Precautions in the
care of patients known or suspected to have a serious illness easily
transmitted by direct patient contact or by indirect contact with
items in the patient’s environment.
Illnesses requiring contact precautions may include, but are not
limited to: Gastrointestinal, respiratory, skin or wound infections
or colonization.
How contact transmission occurs:
 Contact transmission can occur in two ways:
o Direct Contact Transmission
o Indirect Contact Transmission
Contact precautions are required to protect against either direct or
indirect transmission.
Contact precautions are indicated for persons with gastrointestinal
(diarrheal) illness, and incontinent persons including those who
use incontinent products.
Direct Contact Transmission
 Involves body-surface to body-surface contact and
physical transfer of microorganisms between a
susceptible person (host) and an infected or colonized
person.
 More often occurs between a healthcare worker and a
patient than between patients.
Indirect Contact Transmission
 Involves contact of susceptible person (host) with a
contaminated intermediate object such as needles,
dressings, gloves or contaminated (unwashed) hands.
 Disease is more likely to develop following direct or
indirect contact transmission when the pathogen is
highly virulent or has a low infectious dose or the patient
or healthcare worker is immunocompromised.
 Poor hand hygiene is most often cited as a cause of
contact transmission.
Contact precautions include:
 Standard precautions

PLUS
 Private room
or cohort, (room) patients infected or colonized with the
same organism.
 Gloves
for possible contact with an infected or colonized patient
and their environment.
o Gloves
More information about gloves.
 Gown
if substantial contact with the patient or their
environment is anticipated.
o Gowns
More information about gowns
Droplet Precautions

Droplets can be generated from the source person during

coughing, sneezing, talking and during the performance of certain
procedures such as suctioning or bronchoscopy.

Droplets may contain microorganisms and generally travel no

more than 3 feet from the patient. These droplets can be deposited
on the host’s nasal mucosa, conjunctivae or mouth.

Diseases requiring droplet precautions include, but are not limited

to: Pertussis, Influenza, Diphtheria and invasive Neisseria
meningitidis

Droplet precautions include:

 Standard Precautions

PLUS

 Surgical mask
when working within 3 feet of the patient.
o Masks and Respirators
More information about surgical masks.

llness: droplet ;)

The Common Cold

Season:

Year Round

Who is affected:

People of all ages are affected by the common cold with children,
the elderly and people with weakened immune systems being most
susceptible.

Causes:

Many different viruses can cause a cold. The most common types
are rhinovirus, coxsackievirus and coronavirus.

How the Common Cold is Spread:

You can contract a cold either by touch or air. If you touch

someone or something with a cold virus on it and then touch your
eyes, mouth, or open wound, you may become infected. You may
also inhale the droplets of virus in the air when someone coughs or
sneezes.

 Preventing Common Illnesses

  Staying Healthy at Work

What to Expect :

You may develop congestion, cough, runny nose, itchy eyes and
throat, watery eyes, tiredness, and occasionally fever. Fever is
more common in children than in adults. These symptoms usually
last 7 to 10 days.

 Signs and Symptoms of the Common Cold

Is There a Cure for the Common Cold? :

There is no cure for the common cold. You can treat the
symptoms with over-the-counter medications. You should also try
to get extra rest and drink plenty of fluids. This means more fluids
than usual! If your symptoms do not improve after 7 to 10 days,
you should see a doctor.

Illness:

The flu or influenza.

The flu virus may be classified as either Influenza A, B or C.

Flu Season:

Late fall to early spring, most prevalent from December to March.

Who is Affected by the Flu :

People of all ages can get the flu. Children, the elderly and people
with weakened immune systems are most susceptible and more
likely to have serious complications.

Causes of the Flu:

The flu is caused by the influenza virus. There are many different
strains of the virus and they mutate frequently. That is why people
continue to come down with the flu year after year.

How the Flu is Spread:

Influenza is spread by droplets from the mouth and nose. If a
person with the flu sneezes or coughs, the virus is then released
into the air, and whatever the person touches, and can then be
passed on to others.

The flu can be spread from 1 day before symptoms appear to 5

days after becoming sick. It is possible to spread the flu before
you even know you have it.

 Preventing Common Illnesses

 Staying Healthy at Work

What to Expect From the Flu :

The flu generally lasts anywhere from 2-7 days, with 4-5 days
being the most common. People with the flu usually run a fever,
have aches and pains throughout their bodies, feel exhausted,
experience severe headaches and may have cold symptoms. These
symptoms come on more rapidly than they do with a cold. People
with the flu are typically unable to perform daily activities due to
the illness.

 Flu Signs and Symptoms

 Stomach Flu vs. Seasonal Flu

Is There a Cure for the Flu?:

There is no cure for the flu. There are some prescription antiviral
medications, such as Tamiflu(TM), that may help shorten the
duration of the illness. However, Tamiflu(TM) is only effective if
taken within the first two days of the onset of symptoms. Your
doctor will determine if these medications are right for you.

What Should I Do if I Have the Flu?:

The most important thing to do when you get the flu is to get
plenty of rest. Because the flu is highly contagious, you should
avoid other people until you are feeling better. Other tips for
taking care of yourself when you have the flu:

 Drink plenty of fluids - water and sports drinks

 Take over the counter medications to relieve symptoms
 Sleep as much as possible
 Eat when you feel like it, but don't worry about it as long
as you are drinking plenty of water
 Avoid alcohol and tobacco use

Airborne:

Related concepts:

Captain of the Men of Death, Consumption, Phthisis, TB, White

plague

Introduction to tuberculosis:

The World Health Organization estimates that about 1/3 of the

world’s population – 2 billion people – are infected with
tuberculosis.

What is tuberculosis?

Tuberculosis, or TB, is a disease caused by bacteria called

Mycobacterium tuberculosis. It can infect any part of the body, but
classically attacks the lungs.

Tuberculosis has been aptly called the "Captain of the Men of

Death." TB disease was once the leading cause of death in the
United States. It remains the most significant infectious disease in
the world in terms of human suffering and death. Evidence of
tuberculosis has been found in the earliest human remains, from
Neanderthal skeletons to Egyptian mummies. As the planet
becomes progressively more crowded and more mobile, this
contagious disease becomes even more of a problem.

Who gets tuberculosis?

Anyone can get tuberculosis. Children are most likely to get it

from infected adults. This is most likely to happen in crowded or
mobile conditions. In the United States about 10 to 20 million
people are currently infected with tuberculosis – many fewer than
found in most countries.

Children in elementary school and middle school are less likely to

get tuberculosis than are younger children or older teens. Children
with HIV are especially susceptible.

What are the symptoms of tuberculosis?

Most children who are infected with TB do not feel sick, do not
have any symptoms, and cannot spread TB. This is often called a
latent infection.

Those who are infected may go on to develop active TB disease at

some time in the future. The symptoms vary depending on what
parts of the body are infected, but classic symptoms include
fevers, chills, night sweats, cough, and weight loss.

Sometimes active disease shows up with a completely different set

of symptoms, as in tuberculous meningitis or arthritis.

Is tuberculosis contagious?

Yes, but young children almost never spread the disease. Children
are most likely to catch it from adults. The bacteria are put into the
air when an adult or older child with TB disease of the lungs or
throat coughs or sneezes. People nearby may breathe in these
bacteria and become infected. Often prolonged or repeated
exposure is needed. Most children catch the illness from a
household or family member.

How long does tuberculosis last?

This is a chronic infection, lasting many years unless treated.

How is tuberculosis diagnosed?

Exposure to TB may be suspected based on positive TB skin tests.

The diagnosis may be confirmed by identifying the
Mycobacterium tuberculosis bacteria in a body fluid specimen.

There is a new blood test that may be useful in detecting

tuberculosis, called the Quantiferon TB Gold test. Unlike the TB
skin test, this does not require a repeat visit to the doctor’s office
in 2 to 3 days.

How is tuberculosis treated?

People with TB disease can be treated with a specific
combination of antibiotics. The various combinations of drugs
used depend on the part of the body infected and the
antibiotic resistance of the bacteria, since Extensively Drug
Resistant Tuberculosis (XDR TB) is becoming a more
prevalent problem worldwide (www.cdc.gov/tb).

Children who have latent TB infection but are not yet sick
can take a prescribed course of medication so that they will
never develop TB disease.

How can tuberculosis be prevented?

Finding and treating individuals with tuberculosis is the

best way to prevent tuberculosis in their close contacts.

The TB skin test is used to discover TB exposure in

people before symptoms develop.

CONTACT precautions

Introduction to diarrhea:

Normal baby stool can look a lot like an adult's

diarrhea stool. Healthy baby poop is often soft and
runny, and (especially in the first month) quite
frequent. One 2-week-old with 10 runny stools a day
may be perfectly healthy, while another 4-month-old
with 3 stools a day, all firmer than the other baby's,
may have diarrhea. So how can a parent tell?

What is diarrhea?

When children lose more fluid and electrolytes in the

stool than is healthy, they have diarrhea. Diarrhea can
be caused by a change in diet (including a change in
mother's diet if the baby is breastfed), by infection, by
antibiotic use, or by a number of rare diseases. Each
year there are about one billion cases of diarrhea in
children worldwide. In most cases (more than 990
million of them), the diarrhea will resolve by itself
within a week or so. Still, more than 3 million young
children die each year from diarrhea (about 400-500 in
the United States).

Who gets diarrhea?

Most children will have diarrhea several times

throughout childhood. Most children with diarrhea
have a viral infection in the gastrointestinal tract.
Rotavirus, adenovirus, and the Norwalk virus are
common causes. Bacteria, such as campylobacter or
salmonella, and parasites, such as Giardia, can also
cause diarrhea.

Diarrhea hits hardest in children 3 to 24 months old,

although it can happen at any age.

Viral diarrhea is most common between November and

May in the temperate climates of the Northern
hemisphere.

What are the symptoms of diarrhea?

Look for a sudden increase in the frequency of the

stools. Each child has her own stool frequency pattern
that changes slowly over time. If it changes noticeably
within only a few days, she may have diarrhea.

Any baby who has more than one stool per feeding
should also be suspected of having diarrhea, even if
this isn't a sudden change.

Also, look for a sudden increase in the water content of

the stool. Other signs of illness in your baby, such as
poor feeding, a newly congested nose, or a new fever,
make the diagnosis of diarrhea more likely.

Is diarrhea contagious?

Most infections that cause diarrhea are quite

contagious, spread by the fecal-oral route and by
fomites.

How long does diarrhea last?

The duration of diarrhea will depend on the underlying

cause. Diarrhea caused by antibiotic use may last as
long as the child is taking the antibiotics.

An average diarrhea virus lasts for 5 to 7 days.

How is diarrhea diagnosed?

Diarrhea is diagnosed by history, physical exam, and

by examining the stool. If there is blood or pus in the
diarrhea, or if the diarrhea is not improving as
expected, stool studies may be performed to determine
the specific cause.

These might include stool cultures, viral studies, and tests

for parasites.

How is diarrhea treated?

The central concern with diarrhea is the possibility of

dehydration from loss of body fluids. Treatment is
aimed at preventing dehydration, the real culprit. Most
children with diarrhea can be treated safely at home.

If your baby is breastfed, don't stop. Breastfeeding

helps prevent diarrhea (making diarrhea only half as
likely) and it also speeds recovery. If your baby still
seems thirsty after or between nursing sessions, you
can supplement with an oral rehydration solution such
as Pedialyte.

If your baby is formula-fed, you might want to switch

to a soy-based formula while the diarrhea lasts. A soy
formula containing fiber (Isomil DF) can be even more
effective at slowing down the stool. Do not dilute the
formula. As with breastfed babies, supplementation
with an oral rehydration solution can help replenish the
fluids and electrolytes that have been lost in the
diarrhea stools.

If your baby is already big enough to be taking solid

foods, carrots, rice cereal, bananas, potatoes, and
applesauce can help slow down the stools. Avoid fruit
juices, peas, pears, peaches, plums, prunes, and
apricots until the stools are back to normal, which
should be within a week or so.

Yogurt and other sources of beneficial bacteria can

help to actively treat diarrhea from any cause.

If the diarrhea lasts longer than a week, or is

accompanied by more than 72 hours of fever, get in
touch with your pediatrician. Contact your pediatrician
right away, however, if your baby won't drink or
appears to be getting dehydrated (dry mouth, crying
without tears, sunken soft spot, lethargic, or going 8
hours without producing urine) or if your baby is under
two months old and has diarrhea with a fever.
Vomiting for 24 hours, 8 stools in 8 hours, or the
presence of blood, mucus, or pus in the stool should
also prompt a call to your pediatrician.

How can diarrhea be prevented?

Most diarrheas are infections spread primarily via the

fecal-oral route. Invisible organisms from the stool
hide on hands, toys, and surfaces. From there, they
make it into someone’s mouth.

Children whose stool overflows diapers or toilets

should be kept out of day cares and schools. General
fecal-oral and fomite precautions also decrease the
spread of diarrhea germs. Every child eventually gets
some, but cleaning and hand washing can delay
infections and make them milder and briefer.

Eating active culture yogurt or other sources of

beneficial bacteria can also minimize diarrhea,
especially diarrhea caused by antibiotics or infections