Infection control

Question

Infection control seems very important in the care for patients with cystic fibrosis.
What is the standard of care?

Answer

Dear questioner,
Thanks for this relevant question. “Care for cystic fibrosis patients” is a broad term and it is not fully clear if your question concerns home or hospital care. Therefore both aspects are briefly touched.
In general, it has to be said in advance, that there are no uniform guidelines on the exact measures for "infection control" taken and advised by the different centers in the different countries, as there is lack of data on the efficacy of many measures. Therefore we would like to give you an overview on the way it is handled in our center.
In the hospital care it is very important to prevent cross infection between patients. Almost all cystic fibrosis patients have chronic lung infection with specific bacteria (Staphylococcus aureus, Pseudomonas aeruginosa,…). These bacteria or germs can be passed on by “contact” or “droplet infection”. By contact infection we mean the crossing over of bacteria by direct contact with a patient or with objects contaminated by the patient (for example: pep-mask or nebulizer). Infections can be passed on by small droplets spread in the air by coughing, sneezing or talking and this form of infection is called droplet infection. These droplets can infect other persons over a distance of 3 feet or 1 meter and this via mucosa (nose or eye, mouth and hands), these droplets do not stay airolised in the air.
When caring for cystic fibrosis patients; hand hygiene is the most important measure to prevent transmission of micro-organisms from one person to the other, this includes thorough handwashing after every patient contact. Normal soap is sufficiently effective. When the hands are not soiled, a disinfecting hand alcohol solution can be used and should be available in every patient room. Not only the care-taker but also the patient himself has to wash his hands whenever he leaves the room and also after coughing up of sputa with physiotherapy. Wearing gloves when caring for cystic fibrosis patients is only indicated if there is contact with blood, secretions or direct contact with mucosa for example when examining the mouth or damaged skin. For physiotherapy with patients coughing up large amounts of sputa, the use of gloves is indicated. When CF patients use common rooms in the hospital (for example hospital school or play ward), a distance of at least one meter within the patient should be respected. Depending on the chronic airway bacteria, cystic fibrosis patients should be cared for in different cohorts depending on the presence of chronic Pseudomonas infection or infection with multiresistent germs (for example MRSA or B-cepacia).
In the home situation there is a rule no contact with other CF patients. The most important worry of parents is the risk for Pseudomonas infection from the environment. Patients and their family usually overestimate this risk of infection and often perform unnecessary hygenic measures. We are not aware of any scientific study that proves that thorough hygiene in the home situation decreases the chance of Pseudomonas infection. Most of these hygienic measures in the home situation are unnecesary and time consuming. An exception is the care of inhalation material (nebulizer equipment, PEP-mask, etc.). Because patients use this equipment daily and inhale directly from these inhalers or PEP-mask, strict hygiene of this material is important. We advise to follow the guidelines provided by your CF-centre.

Are there possible sources of high risk Pseudomonas exposition ?
A normal swimming pool that is sufficiently chlorinated prevents the growth of Pseudomonas aeruginosa and does not form a specific risk. However, subtropical swimmingpools may be a reservoir for Pseudomonas aeruginosa.
We hope this answer was helpful, more information can be found on the following websites:
www.cdc.gov/flu/protect/covercough.htm


www.cff.org/UploadedFiles/LivingWithCF/StayingHealthy/Germs/StoppingTheSpread/Stopping-the-Spread-of-Germs.pdf


Kind regards
M. Proesmans

20.10.2009