Infection Prevention for Cystic Fibrosis Patients

1. Infection Prevention for Cystic Fibrosis Patients Kathy Mathews RN, CIC LPCH Infection Control Department

2. Why is Infection Prevention Important? • Cystic Fibrosis makes the lungs more susceptible to chronic infection • There is a spectrum of organisms that affect patients with CF • Some of the organisms are resistant to certain antibiotics • Acquisition of certain organisms can limit treatment options.

3. How are infections spread? • Patient to patient transmission is one way that patients develop infection • The environment can harbor infectious organisms • Family and friends who are sick can transmit infection

4. Does routine “social contact” pose a risk? • Patient-to-patient transmission of Burkholderia cepacia was proven in 1990 • Extensive evidence from studies that person-to-person spread of infection occurs • Verified spread through “social contact” among children with CF attending summer camps

5. Documented Outbreaks • 1989: Exercise class resulted infection transmitted to 9 patients • 1990-92: Cross infection from Europe to North America at summer camp in Ontario • 1991: Manchester Christmas Party resulted in 7 cases

6. Lessons Learned • Separating B. cepacia negative from positive patients led to a drop in incidence of cases since 1994 in Manchester • CF summer camps were closed • Inpatient isolation policies standardized • Outpatient- discourage congregating in waiting rooms

7. Lessons Learned in Boston • 2001: Infections in CF patients from Boston Children’s Hospital (BCH) suggested that transmission of B. cepacia occurred in inpatients and outpatients who had overlapping visits with previously infected patients. • Standard Precautions alone didn’t prevent transmission.

8. Actions Taken at BCH • Environmental surveillance • Revised cleaning practices • Intensified cohorting of infected patients • Contact Precautions in addition to Standard Precautions • Partial segregation of all CF patients whether or not they had the virulent bacteria • RESULT: Incidence of new cases ceased

9. What about MRSA? • What is it? • How does a person get it? • What is the best way to prevent it? • How is MRSA handled in the hospital?

10. Goal of Infection Prevention at LPCH • SAFETY FIRST for ALL • Protect ALL patients from acquiring an infection during inpatient and outpatient visits

11. What is the risk? • Strong evidence that patient-to-patient transmission of infections can occur to CF and non-CF patients • LPCH has a large number of immunocompromised patients who are at risk for acquiring infection due to their underlying illness e.g., cancer, organ transplant

12. What Measures Reduce the Risk? • Hand Hygiene • Standard Precautions • Transmission-Based Precautions

13. How are germs spread? • Literature reports that Pseudomonas aeruginosa and Burkholderia cepacia in sputum from CF patient were transmissible by handshaking for 180 minutes • Careful hand hygiene is necessary to prevent spread of germs. • How is my “hand hygiene”? • How is my care givers hand hygiene?

14. Infection Prevention Measures • What is “Standard Precautions”? • What are “Transmission-based Precautions”? • Droplet Precautions • Contact Precautions • How long are they required?

15. Outpatient Infection Prevention • Minimize time in the waiting room • Observe the “3 foot rule” in the waiting room and all social situations • When multi-drug resistant organisms have been identified go directly to the exam room • Keep the environment disinfected particularly high touch surfaces • Disinfect equipment between patient contacts

16. Cleaning Equipment and the Environment • Nebulizers and airway clearance devices become contaminated • Master proper cleaning and disinfection • Remove organic debris AND • Disinfect according to manufacturer for appropriate amount of time.

17. Infection Prevention is in OUR HANDS! • QUESTIONS? • To reach the Infection Control Department call 650-497-8447