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 These infections may have high adverse public health impact also. The agents are classified into A, B, C categories.Category A agents are considered the highest risk and Category C agents are those that are considered emerging threats for disease.

Agents/Diseases

Category A

·       High transmissibility

·       Cause high mortality rates

·        cause of panic

·       require special action for public health preparedness.

Anthrax (Bacillus anthracis)

Botulism (Clostridium botulinum toxin)

Plague (Yersinia pestis)

Smallpox (variola major)

Tularemia (Francisella tularensis)

Viral hemorrhagic fevers, including

Filoviruses (Ebola, Marburg)

Category B

These include agents which:

·        may moderately easy to disseminate;

·       Cause moderate morbidity rates and low mortality rates

·       require specific enhanced disease surveillance.

Agents/Diseases including in B category

Brucellosis (Brucella species)

Epsilon toxin of Clostridium perfringens

Food safety threats (Salmonella species, Escherichia coli O157:H7, Shigella)

Glanders (Burkholderia mallei)

Melioidosis (Burkholderia pseudomallei)

Psittacosis (Chlamydia psittaci)

Q fever (Coxiella burnetii)

Ricin toxin from Ricinus communis (castor beans)

Staphylococcal enterotoxin B

Typhus fever (Rickettsia prowazekii)

Viral encephalitis (alphaviruses, such as eastern equine encephalitis, Venezuelan equine encephalitis, and western equine encephalitis])

Water safety threats (Vibrio cholerae, Cryptosporidium parvum)

Category C

This category includes emerging pathogens that could be engineered for mass dissemination in the future because of

·       availability

·       ease of production and dissemination

·       potential for high morbidity and mortality rates

Agents

Emerging infectious diseases such as Nipah virus and hantavirus

 Infection prevention and control

 It is very important to prevent the transmission of communicable diseases in all health care settings. Infection prevention and control demands a basic understanding of the epidemiology of diseases; risk factors that increase patient susceptibility to infection; and the practices, procedures and treatments that may result in infections. 

·      Guideline for Hand Hygiene in Health-Care Settings 

  Health-care--associated pathogens can be recovered not only from infected or draining wounds, but also from frequently colonized areas of normal, intact patient skin. Diabetes patients and patients undergoing dialysis for chronic renal failure, and those with chronic dermatitis are likely to have areas of intact skin that are colonized with S. aureus.  Viable microorganisms are shed daily from normal skin, patient gowns, bed linen, bedside furniture, and other objects in the patient's immediate environment and can easily become contaminated with patient flora. Such contamination is particularly likely to be caused by staphylococci or enterococci, which are resistant to desiccation.

·        Health care workers [HCWs]can contaminate their hands with gram-negative bacilli, S. aureus, enterococci, or Clostridium difficile etc. while doing "clean procedures" or touching intact areas of the skin of hospitalized patients.

·       Studies have documented those subungual areas of the hand harbor high concentrations of bacteria, most frequently coagulase-negative staphylococci, gram-negative rods (including Pseudomonas spp.), Corynebacteria, and yeasts.

·       CDC has recommended that HCWs wear gloves to

1)    reduce the risk of personnel acquiring infections from patients, 2) prevent health-care worker flora from being transmitted to patients, and 3) reduce transient contamination of the hands of personnel by flora that can be transmitted from one patient to another.

Hand washing guidelines

When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water.

If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations. Alternatively, wash hands with an antimicrobial soap and water in all clinical situations.

Decontaminate hands before having direct contact with patients.

Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter.

Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure.

Decontaminate hands after contact with a patient's intact skin.

Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled.

Decontaminate hands if moving from a contaminated-body site to a clean-body site during patient care.

Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.

Decontaminate hands after removing gloves.

Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water.

Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs, they are not a substitute for using an alcohol-based hand rub or antimicrobial soap.

Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.

No recommendation can be made regarding the routine use of nonalcohol-based hand rubs for hand hygiene in health-care settings.

Hand-hygiene technique

When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry . Follow the manufacturer's recommendations regarding the volume of product to use.

When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis.

Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used .

Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings.

References

1.    https://emergency.cdc.gov/agent/agentlist-category.asp

2.    https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm