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©2013 UpToDate ® Print Email Summary of infection control recommendations for healthcare settings for patients with cystic fibrosis Setting Recommendation Category* General principles Assume all patients with CF could have transmissiblepathogens and apply Standard precautions IA Implement transmission-based precautions according toCDC/HICPAC published recommendations IA Healthcare workers should use approved methods of handhygiene IA Gloves should be worn when caring for patients who require Contact or Droplet precautions IA Published recommendations for sterilization anddisinfection of patient care equipment should be followed IA Gowns should be worn as defined by Standard or pathogenspecific precautions IB Wall humidifiers and "in-line" and hand-held nebulizersshould be cleaned and dried according to manufacturer'srecommendations; disposable and single-use items should be discardedafter use IB In ambulatory care settings, examination room surfaces shouldbe cleaned after the room is vacated; regular cleaning ofother surfaces should be on a regular basis and as soiling occurs IB PFTequipment should use disposable in-line bacterial filters in between each patient; disposable mouthpieces arepreferred; sterilization of the internal machinery of PFT machines isnot needed between patients II Microbiology and surveillance Molecular typing using approved genotyping methodsshould be performed as epidemiologically indicated IA Respiratory tract cultures should be performed at leastquarterly and processed for culture and susceptibility accordingto CF-specific guidelines IB All Burkholderia cepacia complex isolates should beconfirmed and speciated at the Cystic Fibrosis Foundation Burkholderiacepacia Research Laboratory and Repository (University of Michigan) IB Surveillance strategies should be developed incollaboration with the institutional infection control team IB

Respiratory tract cultures should be performed at leastquarterly and processed for culture and susceptibility accordingto CF-specific guidelines IB All Burkholderia cepacia complex isolates should beconfirmed and speciated at the Cystic Fibrosis Foundation Burkholderiacepacia Research Laboratory and Repository (University of Michigan) IB Surveillance strategies should be developed incollaboration with the institutional infection control team IB CF: cystic fibrosis; HICPAC: Hospital Infection Control Practices Advisory Committee; MRSA: methicillin-resistant staphylococcus aureus; PFT: pulmonary function testing; VRE: vancomycin-resistant enterococcus. * Categories are based on the CDC/HICPAC system. Category IA: strongly recommended for implementation and strongly supported by well designed experimental, clinical, or epidemiologic studies. Category IB: strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretic rationale. Category II: suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretic rationale. Reproduced with permission from: Gibson, RL, Burns, JL, Ramsey, BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 2003; 168:918. Copyright © 2003 American Thoracic Society.

Respiratory tract cultures should be performed at leastquarterly and processed for culture and susceptibility accordingto CF-specific guidelines IB All Burkholderia cepacia complex isolates should beconfirmed and speciated at the Cystic Fibrosis Foundation Burkholderiacepacia Research Laboratory and Repository (University of Michigan) IB Surveillance strategies should be developed incollaboration with the institutional infection control team IB CF: cystic fibrosis; HICPAC: Hospital Infection Control Practices Advisory Committee; MRSA: methicillin-resistant staphylococcus aureus; PFT: pulmonary function testing; VRE: vancomycin-resistant enterococcus. * Categories are based on the CDC/HICPAC system. Category IA: strongly recommended for implementation and strongly supported by well designed experimental, clinical, or epidemiologic studies. Category IB: strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretic rationale. Category II: suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretic rationale. Reproduced with permission from: Gibson, RL, Burns, JL, Ramsey, BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 2003; 168:918. Copyright © 2003 American Thoracic Society. Summary of infection control recommendations for healthcare settings for patients with cystic fibrosis (continued) Setting Recommendation Category* Ambulatory Encourage hand hygiene and have waterless antisepticsor other products available for use by patients IA Observe Contact plus Standard precautions forepidemiologically important pathogens (eg, B. cepacia complex, MRSA,multidrug-resistant Pseudomonas aeruginosa) IA Develop a reliable method for tracking patients' mostrecent culture and susceptibility testing results IB Alert other diagnostic areas of patients' transmissionprecautions IB Segregate patients infected with B. cepacia complex,andplace patients with multidrug-resistant P. aeruginosa in roomimmediately IB Manage scheduling to minimize time in common waitingareas II Discourageuse of common items in waiting area that cannot be cleaned betweenpatients (eg, toys, computer) II Inpatient All patients with CF with B. cepacia complex, MRSA, orVREshould be housed in single-patient rooms that do not share commonfacilities (eg, bathroom, shower)•

Manage scheduling to minimize time in common waitingareas II Discourageuse of common items in waiting area that cannot be cleaned betweenpatients (eg, toys, computer) II Inpatient All patients with CF with B. cepacia complex, MRSA, orVREshould be housed in single-patient rooms that do not share commonfacilities (eg, bathroom, shower)• IA Patients with CF, and without the above organisms mayshare rooms with patients without CF who are low risk for infection• II Patients not on transmission-based precautions may beevaluated for activity outside their hospital room as long as they areeducated according to hand hygiene and avoidance of direct contact withother patients with CF, and with appropriate disinfection of surfaces. II CF: cystic fibrosis; HICPAC: Hospital Infection Control Practices Advisory Committee; MRSA: methicillin-resistant staphylococcus aureus; PFT: pulmonary function testing; VRE: vancomycin-resistant enterococcus. * Categories are based on the CDC/HICPAC system. Category IA: strongly recommended for implementation and strongly supported by well designed experimental, clinical, or epidemiologic studies. Category IB: strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretic rationale. Category II: suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretic rationale. • Patients with CF who sleep in the same room at home may share a hospital room (Category II). Reproduced with permission from: Gibson, RL, Burns, JL, Ramsey, BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 2003; 168:918. Copyright © 2003 American Thoracic Society.