Infection Control
Infection control is a method of protecting patients, healthcare workers and visitors from getting infections in the hospital and in the home. Infection control is important because people with CF can unknowingly spread germs (bacteria) to other people with CF.
People with CF should be aware that their lungs can become infected with bacteria very easily. In a young person with CF, bacteria such as Staphylococcus aureus and Haemophilus influenzae are most common. As people with CF grow older Pseudomonas aeruginosa is most common. Pseudomonas aerouginosa affects two thirds of adults with CF. Some other less common bacteria are methicillin resistant Staphylococcus aureus (MRSA) and Burkholderia cepacia complex (B. cepacia).
People with CF related lung disease often have bugs (bacteria) in the lungs. Read more about the different bacteria and infection control practices below.
About Bacteria
Bacteria May Be Transmitted In One Of Three Ways:
- Direct Contact occurs through activities such as touching, hugging and kissing.
- Indirect Contact occurs through touching surfaces or objects that have germs on them, such as door handles, respiratory equipment, toys, and computers.
- Droplet Transmission occurs when small droplets exit the mouth or nose of a person when he/she coughs or sneezes. These droplets are projected a distance of up to 2m (or 6 feet) and these droplets containing bacteria can enter the eyes, nose, or mouth of another individual or fall onto surfaces such as tables.
All individuals with CF should give a sputum sample at each clinic visit. The sputum sample will tell your doctor what bacteria you are growing in your sputum and help the doctor to treat you when you are sick.
The thick and sticky nature of mucous in the airways of individuals with CF makes it difficult to get rid of bacteria from the lungs. These individuals may have more frequent lung infections and require hospital admissions to receive IV antibiotics. Some individuals require treatment with inhaled antibiotics twice daily to help keep the bacteria in their lungs under control.
Infection control is a method of protecting patients, healthcare workers and visitors from getting infections in the hospital and in the home. Infection control is important because people with CF can unknowingly spread germs (bacteria) to other people with CF.
People with CF should be aware that their lungs can become infected with bacteria very easily. In a young person with CF, bacteria such as Staphylococcus aureus and Haemophilus influenzae are most common. As people with CF grow older Pseudomonas aeruginosa is most common. Pseudomonas aerouginosa affects two thirds of adults with CF. Some other less common bacteria are methicillin resistant Staphylococcus aureus (MRSA) and Burkholderia cepacia complex (B. cepacia).
People with CF related lung disease often have bugs (bacteria) in the lungs. Read more about the different bacteria and infection control practices below.
Pseudomonas aeruginosa are strains of bacteria that are widely found in the environment and can cause lung infections in people with cystic fibrosis. The bacteria thrive in moist environments and equipment, such as humidifiers and in kitchens, bathrooms, pools, hot tubs, saunas and sinks. The prevalence of infection with Pseudomonas aeruginosa increases with age.
Pseudomonas infections are known as opportunistic. This means the bacteria typically cause infections when a person has CF or another condition that weakens the body’s immune system. The chronic growth of Pseudomonas can damage the airway and is associated with decreases in lung function.
Pseudomonas bacteria are among the most common bacteria found in people with CF. Approximately half of all people with CF have Pseudomonas, including most Canadian adults with CF. It is a major cause of acute infection, lung inflammation and long term damage to the lungs of CF patients.
The number of people with CF with Pseudomonas has been decreasing over the past few years due to increased infection control measures and eradication treatments.
Research has shown that people with CF can get Pseudomonas from others who are infected with these bacteria. This is called cross-infection and involves direct or indirect contact. Direct contact includes activities like kissing. Indirect contact (droplet contact) means touching objects that have been touched by a person who has the germ, such as doorknobs or pens. Cross-infection can happen in social settings like events or meetings.
The majority of infections with Pseudomonas cannot be traced back to exposure to another infected person. In these cases, infection is believed to have occurred by exposure to Pseudomonas in the natural environment.
At the Toronto Adult CF clinic, the care team works to prevent the spread of Pseudomonas between people with CF by taking infection prevention and control measures. These include:
- Frequent cleaning of hands using soap and water or hand sanitizer
- Wearing PPE such as gowns and gloves
- Sanitizing clinic room surfaces after a clinic visit
- Helping people with CF keep a safe distance from each other when they visit the care centre and when they are admitted to the hospital
- Checking your sputum every time you come to clinic
CF Canada-accredited care centres also follow strict procedures when cleaning clinic rooms, pulmonary function labs, and respiratory therapy equipment to reduce the risk of spreading germs.
Remember, you are an important member of your CF care team. If you are worried about your risk of getting or spreading germs at your care center or in the hospital, or if you have questions about the precautions you need to take, please speak to a member of your care team. Talk to your team about their efforts to minimize the risk of cross-infection between people with CF.
After a doctor or nurse gets a throat or sputum culture from a person with CF, the laboratory tests the culture in a specific way to help find any Pseudomonas species. At the St. Michael’s hospital laboratory, it takes an average of 5-7 days to receive a final culture and sensitivity report. Sputum cultures completed at a local laboratory can take up to one week to receive a final result. Ask your CF nurse to tell you the results of your last throat or sputum culture.
Once Pseudomonas is established in the airways, it is very difficult to eliminate. However, prompt and aggressive treatment can often delay the development of long-term chronic infection. This may include using inhaled antibiotics inhaled directly to the lungs which you would typically take for 1 to 3 months in an effort to eliminate the bacteria from your lungs. If you are growing Pseudomonas it is important to take the antibiotics even if you are feeling well or if your breathing test is normal for you. Please contact your team if you have any problems performing the therapy or obtaining the medication. You will be asked to follow up with the team to assess the effects of the therapy and monitor your sputum results.
Pseudomonas and CFTR Modulators
Research indicates that people with CF on CFTR modulators (e.g. Trikafta and Ivacaftor) have lower rates of acquisition for Pseudomonas. However, it is still unclear how modulator therapy affects Pseudomonas over time. As such, it is critical that we monitor sputum samples and continue with inhaled antibiotic therapies if you are on modulator therapy.
Reynolds, D., & Kollef, M. (2021). The epidemiology and pathogenesis and treatment of Pseudomonas aeruginosa infections: an update. Drugs, 81(18), 2117-2131.
Ribeiro, C. M., Higgs, M. G., Muhlebach, M. S., Wolfgang, M. C., Borgatti, M., Lampronti, I., & Cabrini, G. (2023). Revisiting Host-Pathogen Interactions in Cystic Fibrosis Lungs in the Era of CFTR Modulators. International Journal of Molecular Sciences, 24(5), 5010.
Zemanick, E. T., & Bell, S. C. (2019). Prevention of chronic infection with Pseudomonas aeruginosa infection in cystic fibrosis. Current Opinion in Pulmonary Medicine, 25(6), 636.
Burkholderia cepacia complex is like a “family” of bacteria. This family is made up of 17 different family members or species. Regular testing in the lab does not allow us to distinguish between all members of the family and thus specialized testing is required to determine the species of BCC. We use the Burkholderia cepacia reference and research lab in Michigan to test which species of BCC are present.
- Know what type of bacteria grows in your lungs so can attend clinic on the appropriate day
- Be sure to maintain a distance of 6 feet or more from others with CF
- Throw away tissues immediately after use
- Always cover your mouth when you cough
- Avoid people who are sick whenever possible
- Persons with CF should avoid long, close physical contact with each other
- Do not share personal items such as cups, utensils, toys, computers, compressors and nebulizers with other CF patients
- Clean and disinfect your nebulizer and physiotherapy device daily
- Ask your health care provider if they have washed their hands and cleaned any equipment before they examine you
- Wash your hands or use an alcohol based hand sanitizer:
- After coughing, sneezing and blowing your nose
- Throughout your clinic visit and as you leave clinic
- After using ATMs, handrails, grocery carts etc
- Before and after eating
Non-tuberculous mycobacteria (NTM), also known as atypical mycobacteria, are a group of bacteria commonly found in the environment, including in soil and water. There are over 200 species, or types, of NTM. The most common species are Mycobacterium Avium Complex (MAC) and Mycobacterium Abscessus. NTM organisms are related to, but are not the same as, tuberculosis. Infection with NTM is not contagious.
Who can get lung infection with NTM?
Everyone comes into contact with NTM by breathing these bacteria into their lungs but NTM is more likely to cause infection in people who already have lung disease (like CF, bronchiectasis or COPD) or people with weakened immune systems or in those over age 65 years. In vulnerable people, the bacteria can get into lung tissue and cause infection, inflammation and scarring. Symptoms of NTM infection can include chronic cough, increased sputum production, fatigue, fever, night sweats and weight loss. Diagnosis of NTM infection in CF involves a combination of imaging studies (e.g. CT scans), sputum tests, and clinical evaluation. At the Adult CF clinic at St Michael’s Hospital, the sputum collected at every clinic visit is sent for NTM testing.
Not all people with CF who grow NTM in their sputum sample will become symptomatic or require treatment. They may be able to clear NTM from the lungs without the help of antibiotics and so, before treatment is started, NTM must be found in multiple sputum cultures and be deemed to be causing worsening lung disease and symptoms.
How is NTM treated?
Treatment of NTM infection typically involves a combination of antibiotics for an extended period of time, often up to 18-24 months or more. Treatment also involves chest physiotherapy to improve clearance of sputum from the lungs as well as other supportive therapies to help manage symptoms and improve lung function.
How to avoid non-tuberculous mycobacterium?
Non-tuberculous mycobacteria (NTM) are commonly found in the environment, including soil, tap water, and household plumbing systems (shower heads, drains). While it is not possible to completely avoid exposure to NTM organisms, there are some steps you can take to reduce your risk of infection by minimizing your exposure to NTM if you are known to grow NTM in your sputum:
– Wash your hands frequently with soap and water or use an alcohol-based hand sanitizer.
– Avoid Brita filters, hot tubs, saunas, indoor swimming pools and use caution with humidifiers.
– Keep your time in the shower brief (less than 10 minutes) and make sure the bathroom is well-ventilated (e.g. fan on, window open).
– Avoid exposure to soil dust. For example, use a mask when gardening and get others to help with activities that may produce dust (e.g. pouring topsoil).
If you have more questions, talk to your CF team doctors at your next clinic visit.
How To Clean Your Hands With Hand Sanitizers
Put a nickel sized amount in palm of hand.
Rub your hands together. Make sure all parts of your hands, fingers and nails are rubbed with the gel.
Briskly rub your hands together until dry, often about 15 seconds
Do not rinse or dry hands with a towel
What We Are Doing To Protect You?
Infection Control Is One Of Our Priorities.
Read more about steps we have taken to protect you during a ward admission, including use of SmartPumps for monitoring compliance, and for when you visit clinic. You can also review the PDF document of hand hygiene tips for patients, families and friends prepared by St. Michael’s Hospital
- Separate clinics are provided for people with CF based on what type of bacteria grows in their sputum. To learn about the different clinics, please visit the clinic schedule.
- When you arrive to clinic you will be given a mask to wear and assigned a clinic room. While waiting for this room, you should wear the mask and keep a distance of 6 feet or more between yourself and other individuals with CF.
- When you are in the clinic room, you do not need to wear the mask. You can leave your room for testing but otherwise you should remain in your room. The CF team will come to see you in your assigned room.
- A sputum specimen is collected from each individual on every visit and sent to the microbiology laboratory for analysis. A sputum induction may be performed on those who have been unable to produce a sputum sample in the past year.
- Your breathing test is usually done in your clinic room. Occasionally you will be taken to the Pulmonary Function Lab and will have you breathing test done in a clean room and you will not be tested in the same room as someone with different bacteria. All individuals will be asked to clean their hands before and after performing their breathing test.
- Staff will wear a yellow gown and gloves upon entering your room and discard the gown and gloves upon leaving the clinic room.
- Staff will wash their hands, or use hand sanitizer upon entering and exiting your clinic room. Feel free to ask them if they remembered to wash their hands.
- Staff will clean all contact surfaces of clinic rooms with disinfectant wipes before a new patient enters the room.
- An Infection Control Practitioner provides continuous monitoring on the ward for evidence of cross contamination. Environmental swabs are performed on a regular basis.
- Individuals with CF do not share a room or bathroom with other admitted patients. All rooms have their own showers and bathroom facilities.
- Staff are required to wash their hands and then put on a yellow gown and gloves upon entering your room and examining you. The gown and gloves are