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