Chapter One

THE PROBLEM AND ITS SETTING

Introduction:

Health is defined in the WHO constitution of 1948 as a state of

complete physical, social and mental well-being, and not merely the absence
of disease or infirmity. For happy living, it is necessary to remain healthy and
free from any diseases. Disease is a state of discomfort in which the normal
functioning of the body is disturbed. There are two kinds of disease
Communicable and Non-Communicable. The differences between the two is
that disease is said to be Communicable if it spreads from one person to the
other while Non-Communicable disease is if it does not spread from one
person to another. This study focus on the prevention precaution of some
Health Centers and Medical Clinics towards Communicable Disease. Now
days, Communicable disease is one of the leading cause of illness. The
young and elderly are susceptible to harbor different microorganisms.
Changes in environmental and social conditions, and the development of
new prevention technologies, influence the incidence of communicable
diseases and the community's ability to control them.

The best approach of prevention is education and anticipatory

guidance according to Perspective of Pediatric Nursing, 2005. Good infection
control measures are essential to protect both patient and Health
practitioner. This can only be achieved with education and awareness.
Prevention is involved less obvious aspects of care such as promoting mental
health. Transmission of Communicable disease is a quality issue. Effort were
made by the CDC (center for disease prevention and control) to reduce the
risk of having a Communicable disease through Universal Precautions.
 Nursing accounts for about 80% of the direct care. CDC (center for
disease prevention and conrol )shows that the exposure to patients with
Communicable disease can be very risky to the health care workers
especially to the nurses who were always been close to the patient.
Practicing Universal Precaution is the best way to Prevent having a
Communicable disease. There are many ways to prevent having a
communicable disease these are the use of Protective equipment, Proper
waste disposal, complete vaccines and of course proper handwashing.
One of the Nursing responsibilities is to Provide the safety of the
patient. This study primarily focus the preventive practices of some selected
medical clinics and health centers towards Communicable disease.Our
objectives are to determine the degree of compliance of the health
practitioner to the universal precaution guidelines, To evaluate the
effectiveness of the programs of the health center or medical clinic towards
the prevention of communicable diseases. To have a clear understanding on
how do the health center and medical clinic manage the prevention
precaution in communicable diseases. To provide further understanding and
knowledge in transmitting Communicable Disease .

BACKGROUND OF THE STUDY

Disease is not only a major problem nowadays but also during the ancient
time.During the ancient time, It is believed that illness is caused by
supernatural spirits. epidemics, contagious diseases and plagues, venereal
diseases, mental illness, and a host of the ills man falls prey to every year --
including such diseases as heart disease, cancer, and the "diseases of
civilization." During the ancient times, Egyptians prevent and control disease
by the use of herbs and plants as their medicines. The Egyptians were the
earliest to keep acurate health records during the ancient times. The rich
and powerful especially the pharaohs kept specialists. The priests were the
doctors and temples were used as hospitals. Magician were also healers and
they believed that demons cause the disease. The research on mummies has
revealed the existence of disease such as athritis, kidney stones,
asteriosclerosis. The Jewish however, avoided medical practices. They
concentrated on health rules concerning food and cleanliness. They also
enforced the day of rest. The Greeks were the first to study the cause of
diseases. Research helped them eliminate the beliefs on superstition.
Sanitary practices were also associated with the spread of the disease. The
emergence of the Roman medicine paved way to the beginning of public
health.

The ancient people discovered different methods of preventing and

controlling diseases such as acupuncture, which is one of the oldest and
most popular medical techniques in the world, originated in Chinese Culture
somewhere between 2,000 to 5,000 years ago. Acupuncture is most well
known for its ability to control pain but it is still used to prevent and treat
dozens of other ailments especially when combined with the use of herbal
supplements. Taking care of yourself, proper hygiene, exercising and
healthy diet is also one of their ways on prevention and control of diseases.

During the dark ages and middle ages terrible epidemics emerged such
as bubonic plague, small pox, diphteria, syphilis, measles, typhoid fever and
tuberculosis. Many people died because of this epidemic.

On the 1900’s, Acute infectious diseases such as diphtheria, TB,

rheumatic fever were very popular. No antibiotics, DDT for mosquitoes, rest
for TB, water sanitation to help stop spread of typhoid fever, diphtheria
vaccination.

On the year 1945 to 1975 immunizations were already common, new

antibiotic cures were discovered.

In the Philippines, However. During the Pre Spanish era there were no
records of Public Health Nursing in the Philipines. On the year 1577, Bro. Juan
Clemente started public health services through a dispensary in Intramuros.
During the Spanish Regime (1591-1898), The sanitation of water was started.
The small pox vaccine was also introduced. Creation of position of district,
provincial and national health officers paved way.

In the Public Health Nursing in the Philippines. Their efforts focus on

health promotion and disease prevention. Their goal is to prevent diseases,
prolonging life and promoting health and efficiency through organized
community efforts for the following: sanitation of the environment, control of
communicable diseases, the education of individual in the principles of
personal hygiene, organization of medical and nursing service for early
diagnosis and preventive treatment of disease and the development of the
social machinery which will ensure to every individual in the community a
standard of living adequate for the maintenance of health, so organizing
these benefits as to enable every citizen to realize his birthright of health
and longevity.

In 1975, the DOH considered alternative approaches to meet the health

needs of the people. This led to the formulation of NHP and RHCDS as it
adopted the primary health care approach that integrates the community
level all elements necessary to make impact upon the health status of the
people.

The early development of nursing can be traced to the beginnings of

humankind. Historical events in society at large have shaped nursing as a
whole and the development of public health nursing. The prevention and
control of diseases was also discovered.

THEORETICAL BACKGROUND

This study will be based on Nightingales theory focused on the

environment that a dirty environment is a source of infection through the
organic matter it contained. The community that has dirty environment was
prone in infection. The pathogens and bacteria is existing in the environment
can cause disease that are communicable diseases that it is easy to transfer
to another person especially those people are not complete in vaccines and
lack of knowledge , not doing the universal precaution and some ways to
prevent the contamination of pathogens that can cause diseases. To
prevent this communicable diseases the community must have a proper
waste disposal and of bodily excretion, to prevent contamination, to improve
the health of people and also people living in crowded area the environment
should be clean, has pure air, pure water and proper ventilation to prevent
communicable diseases.

Nightingales believed that a disease was a reparative process and the

manipulation of the surroundings- ventilation, warmth, light, diet and
cleanliness could contribute to reparative process and to the health of the
person. And to prevent communicable diseases the person should have a
proper eating diet, rest, sleep, exercise, clean body and clean environment
and should have complete immunization. Know the hand washing and all the
personal hygiene activities and processes. In Nightingales theory the
concepts of light is important that she knows light quite as real and tangible
effects upon the human body that direct sunlight as a particular need of
person.

Title: Preventive Practices of Selected Medical Clinic

And Health Center in Manila Towards
Communicable Diseases

Statement of the Problem:

In this study, the Preventive Practices of Selected Medical Clinic And

Health Center in Manila Towards Communicable Diseases will be determined.

Specifically, this study will seek to answer the following questions:

1. What are the Demographic Profile of the respondents in terms of:

1.1 Length of Service

1.2 Area of assignment

1.3 Occupation
 1.4 Age

1.5 Gender

1.6 Civil status

2. What are the Preventive and Control Practices of the respondents

towards Communicable diseases in terms of:

2.1 Handwashing

2.2 Waste Disposal

2.3 Personal Protective Equipments

2.4 Transmission Based Precaution

2.5 Vaccines

3. Is there any Significant Difference on the Preventive Practices and

demographic profile of the respondents?

Hypothesis:
There is no significant difference between the demographic profile and
the preventive procedures of some selected Medical Clinics and Heatlh
Centers .

Assumptions:
All Medical Clinics and Health Centers are given agency protocols to be
followed by the health practitioners. These are in accordance with Universal
Precaution.
Scope and Limitation of the study

This research will focus on the preventive practices of the selected

health center and medical clinic in manila about communicable diseases. Our
range for our respondents is anyone who is a health worker in a medical
clinic or health center in manila. We will have a total of 60 respondents.
Manila is the location where we will conduct our research.

Significance of the study

The important of this study is to provide knowledge on preventive

practices of some selected Heath Centers and Medical Clinics towards
Communicable disease that can acquire. Knowledge on this will greatly help
the people in manila. This research would educate the people living in manila
of some Communicable diseases can be prevented. Prevention efforts for
communicable diseases may be directed to any of these three elements.
Communicable diseases affect both individuals and communities, so control
efforts may be directed at both.

This would expectedly the individuals to be aware of what they can

acquire. Then they can reduce their exposure with preventive measures such
as avoiding risky behaviors or getting vaccinated. Methods of transmission
are usually well known, and can therefore be circumvented.

Health Practitioners- Its purpose is to help public health staff responds to

Communicable diseases. For each disease, a response protocol, specifying
the minimum actions that should follow notification or reporting has been
developed.

Patient- The important of this study is to provide knowledge of the

important personal health care services such as immunization, personal
hygiene. To be aware that this is very important to prevent diseases.

Community-These research will educate the people living in manila of

communicable disease can be prevented. The community must be aware of
the disease that they can acquire if they will not maintain cleanliness in the
community.

Clinical Institution- the purpose of the institution is to improve the human

condition by understanding, preventing, and treating disease, while
continually improving the health and quality of life in the community.

Definition of Terms:

• carrier is a person who has the infection, either without becoming ill
himself or following
recovery from it.
• contact is a person who may have been in contact with an infected
person.
• The isolation period signifies the time during which a patient suffering
from an infectious
disease should be isolated from others.
• Pathogen - a substance capable of producing disease.
• Communicable - when someone is capable of transmitting an
organism.
• Infectious - when someone is capable of transmitting a pathogen
which can result in disease.
• Period of Communicability - time during which the infection can be
transmitted.
• Incubation Period - period of time from exposure to the appearance of
1st signs and symptoms.
• Reservoir - The location where infectious agents grow, are nourished
and reproduce, such as the fluids and organs of the human body
• Portal of Exit - The opening through which the infectious agent leaves
the body (i.e. mouth, nose or cut)
• Means of Transmission - The vehicle by which the infectious agent
leaves the reservoir and enters the new host (airborne, direct/indirect
contact, enteric or vector)
• Portal of Entry - The opening through which the infectious agent
enters the new host (i.e.: mouth, nose or cut)
• Susceptible Host - The host organism or body that is vulnerable to the
infectious agent
• Pathophysiology - how physiologic functions are altered by disease
• Infection control - is the discipline concerned with
preventing nosocomial or healthcare-associated infection.

• Vaccines - are available to provide some protection to workers in a

healthcare setting.

• Sterilization - is a process intended to kill all microorganisms and is the

highest level of microbial kill that is possible.

• Disinfection - refers to the use of liquid chemicals on surfaces and at

room temperature to kill disease causing microorganisms.

• Hand washing - for hand hygiene is the act of cleansing the hands with
or without the use of water or another liquid, or with the use of soap ,
for the purpose of removing soil, dirt, and/or microorganisms.

• Pathogen - An agent that causes disease, especially a living

microorganism such as a bacterium or fungus.
- Microorganism that produces a communicable disease

• Disease - is any condition caused by the presence of an invading

organism or a toxic component that damages the host.

• Immune system - is a network of organs, glands, and tissues that

protects the body from foreign substances.

• Health center - a building or institution where medical services

are offered or a group of doctor’s practice

• Waste management - is
the collection, transport, processing, recycling or disposal, and
monitoring of waste materials
• Personal protective equipment (PPE) - refers to
the respiratory equipment, garments, and barrier materials used to
protect rescuers and medical personnel from exposure to biological,
chemical, and radioactive hazards.

o Respiratory protection - eg disposable, cartridge, air line, half or full

face
o Eye protection – eg spectacles/goggles, shields, visors
o Hearing Protection – eg ear muffs and plugs
o Hand Protection – eg gloves and barrier creams
o Foot protection – eg shoes/boots
o Head Protection – eg helmets, caps, hoods, hats
o Protection from falls - eg harness and fall arrest devices
o Skin Protection – eg hats, sunburn cream, long sleeved clothes
o Other personal protective equipment - eg protective clothing for
cryogenic work or environments with high temperatures.
 REVIEW
OF
RELATED
LITERATURE
 RELATED LITERATURE

This chapter discuss about the related literature involve in the study.
This also involves the related study and synthesis extracted from the related
literature used.

RELATED LITERATURE

Foreign

Current health care focuses on prevention of illness and maintenance

of health, rather than treatment of disease or disability. Nursing has kept
pace with this change. In 1965, Pediatric nurse practitioner programs were
developed and led to several specialized ambulatory or primary care roles
for nurses. Practitioner programs now prepare PNPs in areas such as school
health, acute care and oncology. Although the curriculum varies, the course
content includes history taking, physical diagnosis, growth and development,
health education, pharmacology, counseling, common childhood problems,
and care planning for individuals and groups. The best approach to
prevention is education and anticipatory guidance. Prevention is involved
less obvious aspects of care such as promoting mental health. One example
is not sufficient administering of immunizations without regarding for the
psychological trauma associated with administering children. (Perspective of
Pediatric Nursing, 2005)

Home areas with high germ concentration are the sinks, toilets,
doorknobs and other hard surfaces that people are frequently touch.
Thoroughly cleaning these spots is the most basic step to disease
prevention. (U.S Centers for Disease Control and Prevention, 2008).
Local

Communicable disease is most often the leading causes of illnesses in

the country today. Most often, they afflict the most vulnerable, the young
and the elderly. They have numerous economic, psychological, disabling,
and disfiguring effects to the afflicted individuals, families and communities.
What is doubtly threatening are the emergence of newly discovered diseases
and the re-emergence of old ones. In this situation, the need for information
about the diseases is very vital. (Public Health Nursing in the Philippines,
2007)

Communicable diseases can affect anyone and there is no exception.

But it can be prevented. There are new diseases that emerge like H1N1 and
the re-emergence of old ones with stringer strains. This is threatening, that is
why there should be regular information dissemination about the new
diseases so that the people will be aware and will be able to prevent it.

According to John Tomarro (USAID), Environmental Health is a branch

of public health that deals with the study of people preventing illnesses by
managing the environment and changing people’s behavior to reduce
exposure to biological and non-biological agents of disease and injury. it
deals with the disease agents, people and the environment. In the Man-
Disease Agent-Environment link man, by manipulating his environment, is
able to prevent contracting disease by blocking disease agents from entering
his body; thus the disease agents are unable to attack the body.

Environment affects the health of the people in major way because if

the environment is clean there will be no place for the disease agents to
grow and multiply. Environment is very important because this is the place
where live but this place can also be the cause of our diseases if not properly
taken care of.

The first strategy on changing people’s behavior is best exemplified by

the people’s use of safety practices such as use of safety water for drinking
and cooking, hand washing before cooking and eating, washing vegetables
properly, during food preparation, and storing cooked food in the right
temperature. These simply ways of doing food safety practices will prevent
people from contracting especial disease thrigh ingesting contaminating food
and water. The second strategy on preventing the production of the disease
agents is shown by the treatment of wastewater coming from domestic and
industrial sources prior to release in the environment, particularly in the
rivers. The third strategy on increasing a person’s resistance to infectious
diseases is clearly demonstrated in the various maternal and child health
programs of Expanded Program on Immunization (EPI) and Nutrition. The EPI
programs purpose is to immunize children from infectious disease of
tuberculosis, poliomyelkitis, diphtheria, prtussis, tetanus, hepatitis B and
measles; and to immunize pregnant mothers against tetanus inorder to
prevent tetanus neonatorum in their newly born infants. In addition, the
Nutrition’s Program’s goal is to provide proper nutrition to children and
mothers and help them become resistant to diseases. (Public Health Nursing
in the Philippines, 2007)

There are many ways and strategies on how to prevent communicable

diseases. Preparing foods properly, proper handwashing, immunization and
right nutrition are only simple strategies but very effective in preventing the
spread of communicable diseases. There should be health teaching done
about these strategies so that the people in community can practice it.
 Doubtless, healthy eating is one of the foundations of good health,
eating per se is not the problem, especially if you can eat anything you want;
it is eating sensibly that can prove to be a challenge. Each family has its own
nutritional needs based on aged, sex, activity level and medical conditions,
which have to be taken into account when planning meals for the family.
Teaching children about proper nutrition is important in developing their
attitude toward food. If, they start out eating healthy, they will carry it for the
rest of their lives. In general, anyone on balance diet need not use any
dietary supplement. However, for those with chronic disease needing special
diets, or vitamins, or mineral supplementation, ask a registered dietician to
assist in meal planning. Taking to heart all these nutritional will ensure that
your family will maintain a healthy, positive outlook and get the most out of
life. (Health Today, 2007)

Eating healthy foods is a big challenge to an individual. Health foods

are important so that there will be a stronger immune system and healthy
body. If this happen there will be more individual who is immune and there
will be decrease in susceptibility on communicable diseases.

Eight of the 10 leading causes of morbidity in the Philippines are

infectious in nature. Among them are pneumonia, diarrhea, bronchitis,
influenza, tuberculosis, malaria, chicken pox and measles. However,
advances in the fields of medicine, health technology and health care
delivery have reduced the number of deaths due to these communicable
diseases. A few communicable diseases like pneumonia and tuberculosis
continue to cause a significant number of deaths across the country and
persist to be among the 10 leading causes of mortality. It has been proven
that most communicable diseases can be prevented and controlled, or even
eradicated successfully by appropriate strategies and technologies such as
immunization, improved sanitation and personal hygiene, better nutrition,
early treatment and steady supply of antibiotics made available at the
community or at first level health facilities. The eradication of poliomyelitis in
the Philippines and the continuous decline in the incidence of measles,
tetanus, diphtheria and pertussis were brought about by the successful
nationwide immunization campaign undertaken over the years. Improved
sanitation, better nutrition and appropriate management with oral
dehydration resulted in the reduction of deaths from diarrheas, while early
diagnosis and treatment with appropriate antibiotics resulted in the
reduction of deaths from pneumonia, especially among children. Although
the burden of communicable diseases continues to decline in the past
decades, the burden on the cost of public health care is still heavy and the
financial strain on the family of those affected is also still considerable. The
fight against communicable diseases has not yet run its full course, and the
economic and social cost will remain high in the coming decades. However,
with the availability of cost-effective health technologies and strategies for
prevention and control, it is projected that over the coming years more
children will grow into adulthood with less risk from fatal infections and less
people will die from communicable diseases. Elimination of certain
communicable diseases, such as the vaccine-preventable diseases, leprosy,
malaria, filariasis and even tuberculosis, as major public health problems is
possible by improving the quality of public health work, patient care and
disease surveillance, and providing adequate and efficient resource
allocation. As the health sector eliminates certain communicable diseases as
major public health threats, it becomes more necessary to intensify disease
surveillance and health promotion activities. Pursuing such goal has become
necessary so that the health sector may, in due course, focus its efforts and
shift its limited resources towards the prevention and control of emerging
burdens of disease, most of which are non-communicable in nature.
Concerted efforts by the national and local governments, the private sector
and other stakeholders play a crucial role in providing financial, technical
and political support to national and international initiatives to rid the world
of deadly but preventable communicable diseases. (FHSIS 2002).

Communicable diseases cause almost all of the cause of morbidity in

the Philippines. These communicable diseases are can be prevented by the
strategies that was stated earlier. Immunization is the best way of these
diseases. If an individual was immunized he will have less chance of having
and be infected by these diseases.
Early diagnosis and steady supply of antibiotics are another ways of
preventing and treating communicable diseases. If there is a steady supply
of antibiotics there will be an early treatment and eradication of diseases.
Elimination of the communicable diseases also requires quality service
of public health worker, observation of diseases and further health teaching.
Quality service can provide security to the client that he is well taken care of
and can motivate him to get well. More health teaching is needed to give
information to the people of the community about the cause and mode of
transmission of these diseases so that they are aware on how and where do
they can get it.
Local government and private sectors should provide financial,
technical and political help for the programs that aims to eradicate or
prevent communicable diseases so that it will be successful.

In 2008–2009, WHO technical cooperation with the Government is

expected to focus on the following WHO strategic objectives. Strategic
objectives are to reduce the health, social and economic burden of
communicable diseases and to combat HIV/AIDS, tuberculosis and malaria.
The Office-specific Expected Result are policy and technical support provided
to national counterparts to maximize equitable access to all people to
vaccines of assured quality, including new immunization products and
technologies, and to integrated other child survival interventions; effective
coordination and provision of support to national counterpart to retain
certification of poliomyelitis elimination leading to simultaneous cessation of
oral polio vaccination; to support the Elimination of Lymphatic Filariasis by
2010 in the Philippines; country support in diseases control based on
epidemiological situation for STH; country support in diseases control and
elimination provided based on epidemiological situation; to further reduce
burden of leprosy in the Philippines; to utilize health information for
evidence-based health policy development and informed decision making;
programmes for the prevention and control of dengue and other neglected
diseases integrated at the regional and country levels; to achieve the
minimum capacity and function required by International Health Regulations
(2005) related to advocacy, National IHR Focal Point, national legislation and
points of entry; to achieve minimum capacity required for preparedness,
detection, assessment of and response to emerging diseases by
implementing the Asia Pacific; to provide support in strengthening national
capacity for communicable disease surveillance and response for the control
and prevention of communicable diseases especially EIDs and
implementation of the IHR 2005; to establish laboratory networking and
coordination with partner institutions and agencies as support for EID rapid
response and containment; development and implementation of
integrated/coordinated policies on HIV/AIDS/STI, malaria and TB; and
country support provided to strengthen partnerships in AIDS, TB and Malaria
prevention, treatment and care preventions as well as their scaling up
(2008–2009 PROGRAMME BUDGET PHILIPPINES).

RELATED STUDIES

Foreign

Hand washing which is done properly, is one of the best weapons

against germs and bacteria. Some simple steps are stated to do it right such
as lathering up well for 20-30 seconds, using plenty of soap; using lot of
friction to get rid of dead skin and dirt that harbor germs; rubbing all areas of
the hand, including the arms, in between fingers and under the nails; rinsing
thoroughly and dry hands well. If you are in the public restroom, don’t touch
any part of the sink with your clean hands; and the last is after drying, using
paper towel to turn of the faucet. (Christian Obmerga, 2008)

Local

According to Romella C. Acuitia, it doesn’t take a genius to see that

many people’s today aren’t healthy. Indeed, while modern science has shed
enough light on diseases and their prevention, it doesn’t seem enough to
keep the world’s population fit for much of their lives. Experts say that
staying healthy shouldn’t be this complicated. But it must be said that
keeping to the disciplined road of good health is hard with temptations
strewn along the way. Finally, prevention bats cure anytime. In the special
report of vaccination, it proved that it is best to save more money if we will
immunize our child against dangerous but preventable common childhood
diseases.