What is the Chain of Infection?

What is the Chain of Infection in Health and Social Care?

Infection Control

Care Learning

2 mins READ

The chain of infection is a model used to understand how infectious diseases are transmitted from one host to another.

Breaking any link in this chain can effectively prevent the spread of infection. It is important to understand the chain of infection in health and social care settings.

Below, we detail each component of the chain of infection:

1. Infectious Agent

The first link is the pathogen, or microorganism, that causes the disease. This can be a virus, bacterium, fungus, or parasite. The infectious agent must be present for the disease to occur.


  • Viruses: Influenza, HIV
  • Bacteria: Tuberculosis, E. coli
  • Fungi: Candida (which can cause thrush)
  • Parasites: Plasmodium (which causes malaria)

2. Reservoir

The reservoir is the natural habitat where the infectious agent lives, grows, and multiplies. This can be a human, animal, or environmental source.


  • Humans: Carriers of diseases like hepatitis B
  • Animals: Carriers of diseases like rabies (in dogs) or avian flu (in birds)
  • Environment: Contaminated water, soil, or surfaces can act as reservoirs for organisms like Legionella bacteria.

3. Portal of Exit

The portal of exit is the path by which the infectious agent leaves the reservoir. This is necessary for the organism to find a new host.


  • Respiratory tract: Coughing and sneezing spread the flu and tuberculosis.
  • Gastrointestinal tract: Vomiting and diarrhoea spread illnesses like cholera or norovirus.
  • Blood: Needlestick injuries or blood transfusions can spread hepatitis B and HIV.

4. Mode of Transmission

The mode of transmission is how the infectious agent is transferred from the reservoir to a new host. Transmission can be direct or indirect.

  • Direct Transmission: Includes direct contact (touching, kissing), droplet spread (sneezing, coughing).
  • Indirect Transmission: Involves an intermediary:
  • Airborne: Pathogens carried in dust or droplets, e.g., tuberculosis.
  • Vehicle-borne: Food, water, and objects like medical equipment can carry pathogens, e.g., Salmonella via contaminated food.
  • Vector-borne: Insects like mosquitoes (malaria) or ticks (Lyme disease) serve as carriers.

5. Portal of Entry

The portal of entry is the route through which the infectious agent enters a new host. The portals of entry are often similar to the portals of exit.


  • Respiratory tract: Inhalation of airborne droplets.
  • Gastrointestinal tract: Ingestion of contaminated food or water.
  • Skin/mucous membranes: Open wounds, insect bites, or mucous membranes in the eyes, mouth, nose.

6. Susceptible Host

The final link is a susceptible host—someone who is not immune to the infectious agent. Various factors can affect susceptibility, including age, health status, vaccination status, and immune system function.


  • Newborns and older adults are often more susceptible to infections because of weaker immune systems.
  • Individuals with chronic illnesses or those receiving immunosuppressive treatments are also at increased risk.

Breaking the Chain of Infection

To prevent the spread of diseases, interventions can be targeted at any point in this chain:

  1. Infectious Agent: Use anti-microbial agents and practice good hygiene to kill or reduce pathogens.
  2. Reservoir: Eliminate or sanitise sources of infection; isolate infected individuals.
  3. Portal of Exit: Use protective measures, such as masks and proper disposal of medical waste, to block exit routes.
  4. Mode of Transmission: Regular handwashing, safe food practices, wearing personal protective equipment (PPE), and using insect repellent can disrupt transmission.
  5. Portal of Entry: Use barriers like gloves, masks, and protective clothing to block entry points.
  6. Susceptible Host: Increase host resistance through vaccinations, proper nutrition, and medical treatment.

By understanding and interrupting the chain of infection, health professionals and individuals can reduce and control the spread of infectious diseases.

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