Infection Control in Cystic Fibrosis: Cohorting, Cross-Contamination, and the Respiratory Therapist

Department of Respiratory Care, Children's Memorial Hospital, 2300 Children's Plaza, Box 58, Chicago, IL 60614, USA.
Respiratory care (Impact Factor: 1.84). 06/2009; 54(5):641-57. DOI: 10.4187/aarc0446
Source: PubMed


Cystic fibrosis (CF) is a complex genetic disease characterized by lung infections that lead to early morbidity and death. Pathogens that commonly infect the lungs of patients with CF include Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, and Burkholderia cepacia. Aggressively treating pulmonary infection with antibiotics has contributed to improved survival in patients with CF but has also promoted multiple-drug-resistant bacteria. Other complexities include the ability of bacteria to form biofilms, which makes them more resistant to antibiotics, and emerging pathogens in CF, of which the clinical importance is not yet clear. Increasing evidence of patient-to-patient transmission of CF pathogens led the Cystic Fibrosis Foundation to produce evidence-based infection-control recommendations, which stress 4 principles: standard precautions, transmission-based precautions, hand hygiene, and care of respiratory equipment. Respiratory therapists need to know and follow these infection-control recommendations. Cohorting patients infected with B. cepacia complex is one of several interventions successful at keeping the spread of this pathogen low, but cohorting patients who are infected/colonized with other microbes is controversial, the main argument of which is not being certain of a patient's present respiratory culture status at any given patient visit.

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    • "It is characterized by abnormal transport of chloride and sodium across epithelium, leading to thick, viscous secretions [1]. The hallmark pulmonary symptoms of CF are accumulation of thick, sticky mucus , frequent chest infections and coughing or shortness of breath [2]. Such pulmonary infections are the primary cause of morbidity and mortality among patients with CF; endobronchial infection with Pseudomonas aeruginosa is difficult to treat since aminoglycosides active against P. aeruginosa penetrate sputum poorly. "
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    • "The presence of this defective channel in the body leads to diverse symptoms involving many organ systems and tissues, mainly due to the buildup of fluids throughout the body. The backup of fluid contributes to other serious ailments including increased susceptibility to infections and various breathing problems [20]. "
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