Infection Prevention and Control Cystic Fibrosis
Partnering with Institutional IP&C Teams
- a. Single-patient-use, disposable items
- b. Cleaning and disinfecting multiuse items (eg, patient care equipment, oximeters, iPads and similar tablets, and computers)
- c. Cleaning and disinfecting surfaces in the healthcare environment (eg, CF clinics, PFT rooms, hospital rooms, and sinks and showers).
Practices for Healthcare Personnel
The CF Foundation recommends that all healthcare facilities caring for people with CF ensure ready availability of alcohol-based hand rub or antimicrobial soap and water in all patient rooms, PFT rooms, and waiting areas.(IA)
- a. Before entering the room and when leaving the room of any patient
- b. Before and after direct contact with any patient
- c. Before putting gloves on and after removing gloves, for both sterile and nonsterile procedures
- d. After contact with patient’s skin, mucous membranes, respiratory secretions, or other body fluids
- e. After contact with inanimate objects (including medical equipment) in the vicinity of the patient that may be potentially contaminated with respiratory secretions.
- a. Surgical (procedure, isolation) masks are worn by healthcare personnel caring for any patient under Droplet Precautions with suspected or confirmed pathogens that are transmitted by the droplet route (eg, adenovirus, rhinovirus, influenza virus, or Mycoplasma pneumoniae).
- b. Masks and eye protection should be worn by healthcare personnel if splashes or sprays of respiratory tract secretions are anticipated as per Standard Precautions.
- c. N-95 respirators (masks) or powered air-purifying respirators (PAPRs) are worn by healthcare personnel caring for any patient under Airborne Precautions (in an airborne infection isolation room [AIIR]) for suspected or confirmed infection with Mycobacterium tuberculosis.
Practices by People with CF and Family Members/Friends
- a. Entering and exiting CF clinics, clinic exam rooms, or hospital rooms
- b. Hands become contaminated with respiratory secretions (eg, after coughing or performing PFTs or chest physiotherapy).
- a. Social contact between people with CF
- b. Physical contact between people with CF (eg, handshakes, kissing, and intimate contact)
- c. Car rides with another person with CF
- d. Sharing hotel rooms with another person with CF
- e. Fitness class with another person with CF.
Activities that all people with CF, including those who live in same household, should avoid include the following:
- a. Sharing personal items (eg, toothbrush and drinking utensils) with another person with CF
- b. Sharing respiratory therapy equipment.
- a. Tap water or well water that meets local public health standards, distilled water, or bottled water may be used by people with CF
- i. For drinking
- ii. For bathing
- iii. For cleaning nebulizers and other respiratory equipment (eg, airway clearance devices, spacers, and neti pots) if followed by disinfection
- iv. For the water needed for heat disinfection (eg, boiling, microwaving, and steam sterilizing)
- b. Only sterile water be used for nasal rinses (eg, neti pots), filling of humidifier reservoirs, and as a final rinse of respiratory equipment (eg, after cold disinfection)
Recommendations for Microbiology and Molecular Epidemiology
Review Center-Specific Microbiology Data
- a. All initial isolates from every patient
- b. At least 1 isolate per patient per year
- c. Any isolates suspected of being associated with transmission or an outbreak
- d. Any other nonfermenting gram-negative organism for which species identification remains equivocal after routine analysis should be sent for confirmation of identification.
III. Recommendations for CF Clinics and Other Ambulatory Care Settings
Scheduling in CF Clinics
- a. Stagger clinic schedule
- b. Place people with CF regardless of their respiratory culture results in an exam room immediately on arrival to the clinic
- c. Use a pager system or personal cell phone to alert people with CF that an exam room is available
- d. Keep a person with CF in one exam room while the CF care team rotates through the exam room
- e. Do not share common items (eg, clinic computer and toys), and request that people with CF bring their own recreational items to clinic appointments.
Pulmonary Function Testing
- a. In the exam room at the beginning of the clinic visit
- b. In a negative-pressure room (AIIR)
- c. In a PFT laboratory with either portable or integrated HEPA filters
- d. In a PFT laboratory without HEPA filtration, allowing 30 minutes to elapse before the next person with CF enters the PFT laboratory
Designing a New CF Clinic
- a. Provision for management of people with CF who require Airborne Precautions
- b. Appropriate number of exam rooms
- c. Single-person restrooms
- d. Adequate space for personal protective equipment (eg, masks, gowns, and gloves) at the point of use
Recommendations for Inpatient Settings
Practices for People with CF and Their Families
- a. Perform hand hygiene and put on a mask immediately before leaving patient rooms
- b. After a person with CF has left a hospital activity room, clean surfaces and touched items with an EPA-registered hospital disinfectant/detergent
Care of Nebulizers in the Hospital
- a. Nebulizers are for single-patient use only
- b. Aseptic technique is always followed when handling the nebulizer and dispensing medications
- c. Single-dose vials of medication used in nebulizers are always preferred
- d. Handheld disposable nebulizers are managed as follows:
- i. After each use, rinse out residual volume with sterile water and wipe mask/mouthpiece with an alcohol pad
- ii. Discard the nebulizer every 24 hours.
- e. Handheld reusable nebulizers (eg, home equipment) are managed as follows:
- i. After each use, clean, disinfect, rinse with sterile water (if applicable, following cold disinfection method), and air dry away from sink
- ii. After each use, the nebulizer can be reprocessed (eg, by steam sterilization) if the reprocessing is performed according to the manufacturer’s instructions and the CF Foundation recommendations for home care (rec. 59) and if the nebulizer can be returned to the patient in time for the next treatment.
Designing New Inpatient Facilities
- a. Provides an adequate number of single-patient rooms to care for people with CF
- b. Includes a provision for people with CF who require possible Airborne Precautions
- c. Provides access to exercise during hospitalization (eg, adequate space for exercise equipment)
- d. Provides adequate space for personal protective equipment (eg, masks, gowns, and gloves) at the point of use.
Recommendations for Nonhealthcare Settings
Families with More than 1 Person with CF
Events and Activities
Nebulizers: Cleaning and Disinfecting
- a. Clean the nebulizer parts with dish detergent soap and water
- b. Disinfect the nebulizer parts using one of the following methods:
a. Place in boiling water and boil for 5 minutes
b. Place in a microwave-safe receptacle submerged in water and microwave for 5 minutes
c. Use a dishwasher if the water is more than or equal to 70°C or 158°F for 30 minutes
d. Use an electric steam sterilizer.
a. Soak in 70% isopropyl alcohol for 5 minutes
b. Soak in 3% hydrogen peroxide for 30 minutes
i. Rinse off the cold-method disinfectant using sterile water, not tap water; the final rinse must be with sterile or filtered (less than or equal to 0.2-micron filter) water
ii. Air dry the nebulizer parts before storage.
Contact with Pets or Farm Animals
Recommendations for Healthcare Personnel with CF
b. Ability to use barrier precautions and adhere to IP&C guidelines, Centers for Medicare & Medicaid Services, HICPAC, and CDC guidelines; and
c. Risk of transmission of pathogens by healthcare personnel with CF in the context of specific job duties.
Recommendations for Psychosocial and Medical Impact of IP&C
Infection Prevention and Control Cystic Fibrosis
August 1, 2014
External Publication Status
Country of Publication
Female, Male, Adult, Older adult
Health Care Settings
Emergency care, Hospital, Outpatient
Respiratory therapist, nurse, nurse practitioner, physician, physician assistant
D003550 - Cystic Fibrosis
cystic fibrosis, infection prevention