Chapter 7: Infection Control and Outbreak
This chapter will cover:
- Role of the Nurse in Preventing Communicable Diseases
- Outbreak Investigation
- Population Health Nurse’s Role During an Infectious Disease Outbreak
7.1 Role of the Nurse in Preventing Communicable Diseases
Educating the public is the nurse’s first priority in preventing and mitigating many communicable diseases. Primary prevention of illness and disease focuses on the individual and the health and well-being of the entire community. [Table 7.1] The following sections show examples of primary, secondary, and tertiary prevention interventions for communicable diseases.
Primary Prevention
Educate individuals and communities on the importance of these disease-prevention behaviors.
| Seasonal Influenza and Pneumonia | Hepatitis A | Hepatitis B and Hepatitis C | HIV | |
| Vaccination |
|
Hep A | Hep B | None |
| Education |
|
|
|
|
Table 7.1 Primary Prevention of Communicable Diseases
Secondary Prevention
Identify diseases early via screening, before the onset of signs and symptoms, allowing for early treatment to delay or avoid potential complications and helping decrease potential transmission to others.
| Hepatitis B and Hepatitis C | Tuberculosis | HIV | |
| Referrals for | None. | None. | Pre-exposure prophylaxis (PrEP) for HIV-negative sex or drug-injecting partners |
| Screening |
|
|
|
Table 7.2 Secondary Prevention of Communicable Diseases
Tertiary Prevention
Treatment to manage the disease post-diagnosis to slow or stop disease progression:
- Referrals for Hep A, B, or C treatment
- Referrals for HIV treatment
- Referrals for TB treatment
7.2 Outbreak Investigation
A disease outbreak refers to more cases of a certain disease or health condition than expected. Gathering surveillance data is one method of establishing the existence of an outbreak. This process can occur at the local or state health department and in hospital facilities looking to identify any hospital-acquired infections. Similarly, the CDC regularly reviews surveillance data and laboratory patterns of disease-causing organisms to detect clusters of illness. Another way to detect an outbreak is when a health care provider alerts the local health department about unusual cases—unusual due to the frequency or type of condition. Community members may also call local health departments to report abnormal clusters of illness. An example is food borne-related illness where an individual calls the health department and reports that seven of their friends are ill with similar symptoms after eating at the same restaurant. Another example would be a concerned community member reporting a cancer cluster in their neighborhood. A health department’s decision to investigate a potential outbreak depends on many factors, such as illness severity, number of cases, mode of transmission, and availability of prevention and control measures.
7.3 Population Nurse’s Role During an Infectious Disease Outbreak
Nursing plays a distinct role in pandemics and other infectious disease outbreaks. As part of the three core functions of public health nursing, nurses are involved with assessment in terms of epidemiological surveillance and detection, such as contact tracing. A school nurse working in New York City is credited with first observing and notifying the CDC about the 2009 H1N1 flu pandemic (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). During the COVID-19 pandemic, nurses conducted most contact tracing at the local board of health, at the state level, and in school districts. Public health nurses assist with coordinating and implementing disaster plans at the local and state levels, an aspect of policy development. Preparedness is a multidisciplinary effort to understand a health care system’s capacity in advance of a public health emergency, including workforce capacity, access to personal protective equipment, and medical supplies, an aspect of assurance (NASEM, 2021).
During an evolving infectious disease outbreak, the nursing role may shift as health care shifts from routine care to public health care, emergency preparedness, and disaster response. Nurses working in various practice settings serve on the front line of public health emergencies, assisting individuals and communities through a crisis. Promoting health and well-being is one of the essential roles of nursing. Nurses engage and connect with individuals and communities to ensure they have what they need to be healthy (NASEM, 2021).
As the COVID-19 pandemic revealed, this engagement, ability, and willingness to respond to public health crises takes a toll on nursing; during that pandemic, many nurses reported feeling unsafe, unsupported, and unprepared, resulting in a profound mental health burden (NASEM, 2021). The COVID-19 pandemic required nurses to take on multiple roles: for example, outpatient endoscopy nurses were asked to care for medical-surgical clients, and non–critical care nurses were asked to care for critically ill clients. Nurses also provided end-of-life care and served as a means of communication between dying or ill clients and their families. This most recent pandemic has illustrated the vital importance of protecting nurses’ well-being and mental health so that they can respond to disasters effectively and safely (NASEM, 2021).
Nurses also have a role within the health promotion and disease prevention framework along the three levels of prevention. Within an infectious disease outbreak, the public health nurse plays a vital role in primary, secondary, and tertiary prevention.
Primary Prevention
- Administer immunizations if available
- Educate individuals and communities regarding disease transmission and how to protect oneself
Secondary Prevention
- Engage in contact tracing to identify those at high risk for the disease to screen them
- Screen for disease symptoms
- Perform lab-based screening tests
Tertiary Prevention
- Provide direct bedside care and treatment of impacted individuals
Reference
Centers for Disease Control and Prevention (2014). Sequence for putting on personal protective equipment and how to safely remove personal protective equipment. https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf
National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030. (2021). Nurses in disaster preparedness and public health emergency response. In J. L. Flaubert, S. Le Menestrel, & D. R. Williams (Eds.), The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK573904/
Content in this chapter is an adaptation of chapter section 13.2, 13.3, Population Health Nursing by Jessica Ochs, Sherry L. Roper, and Susan M. Schwartz in OpenStax, licensed CC BY.
