Infection Control Practice in Cystic Fibrosis Centers

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In this article, the authors outline some of the major historical events that signaled the need to better understand mechanisms of infection in cystic fibrosis (CF). The authors discuss general principles of infection control, focusing on issues of particular importance to patients who have CF. The authors also describe the major pathogens associated with the CF airway, provide a review of findings from inpatient and outpatient studies of infection control, and provide an outline of future directions for investigation.

Section snippets

Major historical events in cystic fibrosis infection control

Since its early characterization and subsequent description, the Burkholderia cepacia complex (BCC) has had a unique place in the psychology of the CF community. Widely present in many surroundings, it can be contracted de novo from an environmental source or through direct or indirect patient contact. The importance of these pathogens relates to the effect on life expectancy of patients who have CF, the frequency of severe infection, and the innate antimicrobial resistance of the organisms.

Transmission of selected respiratory pathogens to patients who have cystic fibrosis

There is strong evidence that nosocomial PTP spread of infection may occur in CF and non-CF patients. However, many questions remain. For example, how pervasive is the problem of PTP spread in patients who have CF relative to rates of environmental acquisition? How much of an impact do innate features of an organism have on transmissibility? It has only been relatively recently that the CF community has had the tools and collective data to fully address such questions.

When reviewing the

General infection control recommendations

A set of general guidelines for infection control has been promulgated by the Healthcare Infection Control Practices Advisory Committee, an organization formed in 1991 by the Centers for Disease Control and Prevention to check nosocomial infections. A key mandate of this group was to develop practical protocols for isolation precautions in the hospital setting. Hand hygiene guidelines were developed in collaboration with the Society for Healthcare Epidemiology of America, the Association of

Selected infection control issues for patients who have cystic fibrosis

A number of infection control matters are of special concern to patients who have CF, their families, and CF care teams. In some instances, there is little evidence on which to base firm recommendations, although a recently published, comprehensive consensus document provides a generous set of guidelines that can inform discussions and local planning [32]. The following topics are frequent sources of questions.

Clues in the Cystic Fibrosis National Registry

The health care community is armed with powerful tools that can be brought to bear in the fight against CF. One such instrument is the CF National Registry, which provides a wealth of information to direct future approaches to disease management and quality improvement. With respect to infection control, the registry tracks local prevalence of airway pathogens at the CF center level. Fig. 3, Fig. 4, Fig. 5, Fig. 6 provide a picture of apparently wide regional variation in the prevalence of the

Acknowledgments

The authors thank John LiPuma for instructive comments and suggestions during his review of the manuscript and David Waltz for his helpful input and provision of radiograph and pathology images.

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