Infection prevention and control

In 2001, the Cystic Fibrosis Foundation gathered a team of experts to review the current scientific evidence regarding infection prevention and control practices for patients with CF; the foundation published their recommendations in 2003.

These recommendations are available to CF Centers to use as a guideline in caring for their patients with cystic fibrosis. The recommendations are qualified as a “work in progress” because as new information on infection prevention and control becomes available, changes in the way we do things may be necessary.

Infection prevention and control practices are especially important to follow for people who have CF. People with CF are born with an altered CF gene that causes an abnormal movement of salt and water in and out of the cells that line their lungs. As a result, the mucus layer lining the lungs is thick and sticky, and it is more difficult to clear this mucus from the lungs. Germs like this environment!

Germs are everywhere. Germs are the bacteria, viruses, molds and fungi that make us sick if we “catch” them. Viruses, for example, are germs that cause the common cold. Everyone catches a cold now and then, and it generally runs its course without too much trouble, even for a person with cystic fibrosis. However, a person with CF is more vulnerable to bacterial growth and infection, so it is important to try and prevent catching or spreading germs as best you can.

There are many types of germs. The germs called Pseudomonas aeruginosa and Burkholderia cepacia, for example, are bacteria that get particular attention in CF. Pseudomonas aeruginosa shows up in many places and is commonly found in the environment, especially wet places. It can be found in contaminated respiratory equipment, on surfaces, in sinks and in showers. For reasons that are not known, Pseudomonas is a common lung infection among people with CF; 30 percent of one-year-old children and 80 percent of 18-year-old teens have Pseudomonas in their lungs. It is not clear where Pseudomonas comes from, and there are no specific recommendations about avoidance ance in the household.

Burkholderia cepacia (B. cepacia) is a germ that infects plants but also people. It can infect the lungs of people with CF and has been found on contaminated respiratory equipment. In the United States, three to four percent of people with CF are infected with Burkholderia cepacia , which makes it a less common bacterial infection in CF. However, it is very serious because it can lower lung function quickly and can be easily passed between people with CF.

The goal in practicing infection prevention and control measures is to minimize exposure to germs. Less exposure means means less chance of infection. Your healthcare team at Children's Memorial Hospital wants to work with you to reduce the spread of germs. There are ways to do this in the outpatient setting, in the hospital, at school, at home, and in public.

The spread of germs

Let's begin with a review of the basics about the spread of germs that can cause infection. The three main ways germs spread are through contact, droplet and airborne transmission.

Contact transmission

Contact transmission is the most common way germs are spread. There is direct contact and indirect contact:

• Direct contact happens when a person transfers their germs to you by actually touching you with their germs. Kissing, hugging, and shaking hands are good examples of direct contact.
• Indirect contact happens when you touch something that already has germs on it. Sharing a toothbrush or touching an item that may have germs on it—such as money, toys and doorknobs—are examples of indirect contact. If you touch your eyes, your nose, or your mouth with dirty hands, you could indirectly have contact with these germs. That is why it is so important to wash your hands often.

Droplet transmission

Germs can spread to others by traveling in the air on very small drops of liquid. When a person is coughing, sneezing, talking, laughing, or even singing, droplets from their secretions can go into the air. These droplets can only travel only a short distance, usually up to three feet, the length of an average adult's arm. Droplet transmission happens if the droplets are carrying germs, and you are close enough for the germs to get in your eyes, nose, or mouth. If you are within three feet, these droplets can land on you. Some germs in the droplets that land on surfaces can live for hours on a surface.

Airborne transmission

Airborne transmission happens when germs are carried on tiny particles that are small enough to float in the air for a long time and travel long distances and a person breathes in the airborne germs. Some examples of diseases that are spread this way are tuberculosis (TB), measles, SARS and chickenpox. Molds and fungi can also infect a person through airborne transmission. (Pseudomonas and Burkholderia cepacia are not spread this way.)