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The Infection Prevention and Control (IP&C) Guideline for CF were recently updated. The updated guideline provides recommendations for how to prevent transmitting and/or acquiring respiratory tract pathogens among people who have CF in ambulatory care and inpatient settings. Recommendations for non-healthcare settings are included in an effort to respond to questions and concerns voiced by people with CF and their caregivers. The goal is to educate the CF community about potential risks and to help people with CF and their families and friends make informed choices in their personal lives.1

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Below are some examples of what's recommended by the CF Foundation, including some of the new updates.

Healthcare personnel1

  • Clean their hands (alcohol-based hand rub or wash hands with antimicrobial soap and water) in the following situations:
    • Before entering the room and when leaving the room of any CF patient
    • Before and after direct contact with any CF patient
    • Before putting gloves on and after removing gloves. This is for both sterile and nonsterile procedures
    • After contact with a CF patient's skin, mucous membranes, respiratory secretions, or other body fluids
    • After contact with inanimate objects (including medical equipment) in the vicinity of the CF patient that could have respiratory secretions on them
  • Disinfect their stethoscopes before and after use on each CF patient
  • Take contact precautions. Wear a gown and gloves when caring for all people with CF. Do this regardless of respiratory tract culture results and in ambulatory and inpatient settings

General guidelines for people with CF and family members/friends1

  • Stay at least 6 feet (2 meters) away from other people with CF. Do this regardless of the patient's respiratory tract cultures. If you live in the same household as a person with CF, this recommendation does not apply
  • Clean your hands (alcohol-based hand rub or antimicrobial soap and water) in settings where your hands may come into contact with pathogens. These settings include:
    • Entering and exiting CF clinics, exam rooms, or hospital rooms
    • Coming into contact with any respiratory secretions
  • Wear a surgical (procedure, isolation) mask if you are in a healthcare facility to reduce the risk of catching CF pathogens
  • Perform all respiratory interventions in the patient with CF's room when in a healthcare setting
  • Use airway clearance devices for 1 patient with CF only
  • Follow the suggestions below for nebulizers (used in a hospital setting):
    • Use nebulizers for 1 patient only
    • Rinse out handheld, disposable nebulizers after each use. Use sterile water. Wipe mask and mouthpiece with an alcohol pad
    • Discard nebulizer every 24 hours

Recently added recommendations1:

Surveillance

  • The CF Foundation and European CF Society (ECFS) recommend that screening cultures for nontuberculous mycobacteria (NTM) should be performed annually in individuals with a stable clinical course

Scheduling in CF clinics

  • CF clinics should schedule and manage people with CF in ways to minimize time in common waiting areas. Such as:
    • Stagger clinic schedule
    • Place people with CF in an exam room immediately upon arrival to the clinic
    • Keep a person with CF in one exam room while the CF care team rotates through the exam room

Pulmonary functioning test (PFT)

  • It's recommended that if PFTs are performed in a PFT laboratory without HEPA filtration, 30 minutes must elapse before the next person with CF can enter the PFT laboratory

Environmental practices

  • Exam rooms need to be cleaned and disinfected between patients using a 1-step process and Environmental Protection Agency (EPA)–registered hospital-grade disinfectant/detergent designed for housekeeping in accordance with institutional IP&C policies

Room placement

  • People with CF should be placed in a single-patient room. Only people with CF who live in the same household may share a hospital room

Animals

  • The CF Foundation recommends that people with CF participate in animal-assisted (pet) therapy in accordance with institutional policies

Events and activities

  • Only 1 individual with CF should attend a camp or educational retreat unless they live in the same household
  • Only 1 person with CF should attend CF Foundation-sponsored, healthcare-sponsored, or CF center-sponsored indoor events
  • People with CF can attend CF Foundation-sponsored, healthcare-sponsored, or CF center-sponsored outdoor events as long as they maintain a distance of 6 feet (2 meters) from others with CF

Leisure activities

  • People with CF should avoid exposure to construction and renovation activities that generate dust to decrease exposure to potential pathogens
  • People with CF should avoid activities in hot tubs, whirlpool spas, and stagnant water
  • People with CF should avoid cleaning stalls, pens, or coops
Reference: 1. ‭Saiman L, Siegel JD, LiPuma JJ, et al. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infect Control Hosp Epidemiol. 2014;35(suppl 1):S1-S67.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬

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