Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
THE CHAIN OF INFECTION
The Chain of Infection is fundamental to infection prevention and control. All
components of the chain of infection must be present for an infection to occur. If
one of the ‘links’ in the chain is missing or is deliberately broken, the spread of
disease to another is effectively controlled.
Hand hygiene is the single most effective way to break the chain of infection.
Links in the Chain of Infection
Infectious Agent
An infectious agent is a microorganism with the ability to cause an infectious
disease. The greater the organism’s virulence (ability to grow and multiply),
invasiveness (ability to enter tissue) and pathogenicity (ability to cause disease),
the greater the possibility the organism will cause an infection. Infectious agents
are bacteria, virus, fungi and parasites.
Reservoirs
Reservoirs are a place within which microorganisms can thrive and reproduce.
For example, microorganisms thrive in human beings, animals, and inanimate
objects such as water.
Portal of Exit
A portal of exit is a way for a microorganism to leave the reservoir. For example,
the microorganism may leave the reservoir through the nose or mouth when
someone sneezes or coughs, or can be carried away from the body by feces
from an infected bowel.
Mode (Means) of Transmission
The mode (means) of transmission is the route or method of transfer by which
the infectious microorganism moves or is carried from one place to another to
reach the new host. The modes (means) of transmission are: Contact (direct
and/or indirect), Droplet, Airborne, Vector and Common Vehicle.
Portal of Entry
The portal of entry is the means by which the infectious microorganisms gains
access into the new host. This can occur, for example, through ingestion,
breathing, or skin puncture.
Susceptible Host
A susceptible host is a person who is susceptible to the disease, lacking
immunity or physical resistance, to overcome invasion by the microorganism.
Section 3 _approved February 15, 2008
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Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
CHAIN OF INFECTION
Infectious
Agent
Susceptible Reservoirs
Host
Portal of Portal of
Entry Exit
Means of
Transmission
Hand hygiene is the single most effective way to break the chain of
infection.
Section 3 _approved February 15, 2008
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Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
Breaking the Chain of Infection
The transmission of any infectious microorganism can be controlled effectively by
breaking the chain of infection. Each disease/infectious microorganism presents
unique problems. Knowledge of the specific disease can break the chain at its
weakest link. Routine Practices, Additional Precautions, aseptic technique and
sterilization procedures prevent the spread of infectious microorganisms among
residents, healthcare workers, families and visitors by breaking the chain of
infection.
Section 3 _approved February 15, 2008
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Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
Transmission of Microorganisms
Microorganisms are transmitted in the following ways and in combination:
• Direct contact
• Indirect contact
• Droplet particles
• Airborne particles
• Common vehicle
• Vectorborne
a. Direct contact transmission:
Direct contact transmission occurs when microorganisms are transferred
by direct physical contact with an infected or colonized individual. Direct
contact is one of the most common modes of transmission.
b. Indirect contact transmission:
Indirect contact transmission involves transfer of microorganisms via an
object. Examples include, hands not washed between residents,
contaminated gloves, objects in the resident’s bed space or environment,
medical equipment, and/or contaminated instruments. Indirect contact is
also a common mode of transmission.
Section 3 _approved February 15, 2008
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Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
c. Droplet transmission:
Droplet transmission involves large droplets, ≥ 5 microns in diameter, that
comes from the respiratory tract during coughing or sneezing, or during
aerosol generating procedures such as suctioning. These droplets are
propelled a short distance, <1meter through the air, and enter the nasal or
oral mucosa of the new host. Some microorganisms transmitted by this
route, especially respiratory viruses, survive on objects in the immediate
environment of the resident. In these cases, droplets are also spread by
direct and indirect contact (Droplet/Contact transmission).
d. Airborne transmission:
Microorganisms transmitted by this route are carried by dust or other small
particles floating in the air and are <5 microns in size. These
microorganisms remain suspended in the air and are widely dispersed by
air currents. Susceptible hosts, who may be some distance away from the
source resident, even in different rooms inhale these microorganisms.
Control of airborne transmission is the most difficult, as it requires control
of airflow through special ventilation systems.
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Winnipeg Regional Health Authority
Personal Care Home/Long Term Care Facility
Infection Prevention & Control Manual
e. Common vehicle transmission:
Common vehicle transmission refers to transmission through a
contaminated source. Examples include food, medication, intravenous
fluid, or shared equipment that transmits infection to multiple hosts. This
transmission may result in a large-scale outbreak.
f. Vectorborne transmission:
Vectorborne transmission refers to infections caused by animals and
insects. Examples of these infections include, West Nile Virus and
Dengue Fever. Appropriate facility construction and maintenance, closed
or screened windows, and proper housekeeping prevent Vectorborne
transmission. This type of transmission has not been reported in
Canadian hospitals.
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