Infection Control Practice in Cystic Fibrosis Centers
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.
References (186)
Pseudomonas cepacia infection in cystic fibrosis: an emerging problem
J Pediatr
(1984)Pseudomonas cepacia in the hospital setting: lack of transmission between cystic fibrosis patients
J Pediatr
(1986)Person-to-person transmission of Pseudomonas cepacia between patients with cystic fibrosis
Lancet
(1990)Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. Summer Camp Study Group
J Pediatr
(1994)Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis
Lancet
(1993)Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis
J Pediatr
(2001)Evidence of transmission of Burkholderia cepacia, Burkholderia multivorans and Burkholderia dolosa among persons with cystic fibrosis
FEMS Microbiol Lett
(2003)Of isolates and isolation: Pseudomonas aeruginosa in adults with cystic fibrosis
Lancet
(2001)Epidemiology of chronic Pseudomonas aeruginosa infections in cystic fibrosis
Int J Med Microbiol
(2001)- et al.
Dynamics of bacterial colonisation in the respiratory tract of patients with cystic fibrosis
Infect Genet Evol
(2001)
Pulmonary function and clinical course in patients with cystic fibrosis after pulmonary colonization with Pseudomonas aeruginosa
J Pediatr
Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in the Danish Cystic Fibrosis Centre
J Hosp Infect
Pseudomonas aeruginosa in cystic fibrosis: cross-infection and the need for segregation
Respir Med
Evidence against transmission of Pseudomonas aeruginosa by hands and stethoscopes in a cystic fibrosis unit
J Hosp Infect
Pseudomonas carrier rates of patients with cystic fibrosis and of members of their families
J Pediatr
Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P aeruginosa
Lancet
Environmental contamination with an epidemic strain of Pseudomonas aeruginosa in a Liverpool cystic fibrosis centre, and study of its survival on dry surfaces
J Hosp Infect
Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic
Lancet
Epidemiology and clinical impact of Pseudomonas aeruginosa infection in cystic fibrosis using AP-PCR fingerprinting
J Infect
Spread of a multiresistant strain of Pseudomonas aeruginosa in an adult cystic fibrosis clinic
Lancet
Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in a cystic fibrosis clinic
J Hosp Infect
Epidemiology of Pseudomonas aeruginosa in cystic fibrosis and the possible role of contamination by dental equipment
J Hosp Infect
Cleaning home nebulizers used by patients with cystic fibrosis: is rinsing with tap water enough?
J Hosp Infect
Pseudomonas species contamination of cystic fibrosis patients' home inhalation equipment
J Pediatr
Low bacterial contamination of nebulizers in home treatment of cystic fibrosis patients
J Hosp Infect
Low level of bacterial contamination of mist tents used in home treatment of cystic fibrosis patients
J Hosp Infect
Methicillin-resistant Staphylococcus aureus in a cystic fibrosis unit
J Hosp Infect
Infection control and the significance of sputum and other respiratory secretions from adult patients with cystic fibrosis
Ann Clin Microbiol Antimicrob
Pseudomonas cepacia: decrease in colonization in patients with cystic fibrosis
Am Rev Respir Dis
Linkage analysis of geographic and clinical clusters in Pseudomonas cepacia infections by multilocus enzyme electrophoresis and ribotyping
J Clin Microbiol
Burkholderia cepacia: current clinical issues, environmental controversies and ethical dilemmas
Eur Respir J
An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis
J Infect Dis
Cross infection between cystic fibrosis patients colonised with Burkholderia cepacia
Thorax
Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: survival linked to genomovar type
Am J Respir Crit Care Med
Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation
Am J Respir Crit Care Med
Should patients with cystic fibrosis infected with Burkholderia cepacia undergo lung transplantation?
Thorax
Epidemiology of Pseudomonas aeruginosa in cystic fibrosis in British Columbia, Canada
Am J Respir Crit Care Med
Outcome of Burkholderia (Pseudomonas) cepacia colonisation in children with cystic fibrosis following a hospital outbreak
Thorax
Differentiation of Burkholderia species by PCR-restriction fragment length polymorphism analysis of the 16S rRNA gene and application to cystic fibrosis isolates
J Clin Microbiol
Disproportionate distribution of Burkholderia cepacia complex species and transmissibility markers in cystic fibrosis
Am J Respir Crit Care Med
Proposal to accommodate Burkholderia cepacia genomovar VI as Burkholderia dolosa sp. nov
Int J Syst Evol Microbiol
Impact of Burkholderia dolosa on lung function and survival in cystic fibrosis
Am J Respir Crit Care Med
Psychological consequences of segregation resulting from chronic Burkholderia cepacia infection in adults with CF
Thorax
Evaluation of antimicrobial sensitivity patterns as markers of Pseudomonas aeruginosa cross-infection at a cystic fibrosis clinic
Br J Biomed Sci
Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing
J Clin Microbiol
Epidemiology and clinical outcomes of patients with multiresistant Pseudomonas aeruginosa
Clin Infect Dis
Genome macrorestriction analysis of diversity and variability of Pseudomonas aeruginosa strains infecting cystic fibrosis patients
J Clin Microbiol
Genome fingerprinting of Pseudomonas aeruginosa indicates colonization of cystic fibrosis siblings with closely related strains
J Clin Microbiol
Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission
Infect Control Hosp Epidemiol
Cited by (5)
Developmental and Psychosocial Issues in Cystic Fibrosis
2011, Pediatric Clinics of North AmericaCitation Excerpt :Before the mid-1990s, children with CF were encouraged to attend CF-related summer camps and other venues for peer support, and although empirical evidence is lacking, research with other chronic illnesses suggests that these experiences were beneficial for increasing adjustment.34 However, in the mid-1980s CF medical communities became cognizant of Burkholderia cepacia, a particularly treatment-resistant constellation of bacteria that can be contracted from environmental sources and person-to-person transmission, and that often corresponds with rapid decline in lung functioning for patients with CF. It was soon determined that CF summer camps were the setting for epidemic spread of this bacteria, and these programs were closed.35 Other treatment-resistant bacteria have since been identified, and evidence of epidemic spread has been found within outpatient CF clinics as well as on inpatient hospital wards.35
Developmental and psychosocial issues in cystic fibrosis
2010, Child and Adolescent Psychiatric Clinics of North AmericaCitation Excerpt :Before the mid-1990s, children with CF were encouraged to attend CF-related summer camps and other venues for peer support, and although empirical evidence is lacking, research with other chronic illnesses suggests that these experiences were beneficial for increasing adjustment.34 However, in the mid-1980s CF medical communities became cognizant of Burkholderia cepacia, a particularly treatment-resistant constellation of bacteria that can be contracted from environmental sources and person-to-person transmission, and that often corresponds with rapid decline in lung functioning for patients with CF. It was soon determined that CF summer camps were the setting for epidemic spread of this bacteria, and these programs were closed.35 Other treatment-resistant bacteria have since been identified, and evidence of epidemic spread has been found within outpatient CF clinics as well as on inpatient hospital wards.35
Bacterial contamination of cystic fibrosis clinics
2009, Journal of Cystic FibrosisCitation Excerpt :Respiratory tract pathogens from CF patients can survive on inanimate surfaces and contaminate the inpatient hospital environment where patient residency is prolonged [16–20]. Direct and indirect evidence of patient-to-patient spread of Burkholderia dolosa and Pseudomonas sp., respectively, within CF clinic populations has been reported [21,22]. However, fewer studies have directly assessed the risk of contamination of outpatient facilities [23].
This work was supported by grant no. ZUCKER03A0 from the Cystic Fibrosis Foundation.