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Jones AM. Infection control in cystic fibrosis: evolving perspectives and challenges. Curr Opin Pulm Med 2022; 28:571-576. [PMID: 36101908 DOI: 10.1097/mcp.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the impact of some of the most recent changes in clinical care management in cystic fibrosis on infection prevention practice and advice for people with cystic fibrosis. RECENT FINDINGS People with cystic fibrosis (CF) consistently highlight infection control as one of their major concerns. Infection prevention guidance and practice has facilitated successful decreases in rates of many transmissible CF pathogens. The coronavirus disease 2019 pandemic highlighted the clinical significance of respiratory viral infections and has accelerated the implementation of remote monitoring and telemedicine consultations as standard practice in CF. The continued improvement in health of the CF population is being further augmented by the introduction of new therapies, in particular cystic fibrosis transmembrane conductance regulator modulators. Infection prevention will remain pertinent to CF care, but these recent changes in clinical practice will have ongoing implications for infection prevention guidance in CF. SUMMARY Recent changes in CF clinical care have implications that will lead to further evolution of infection control practice and advice.
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Stockwell RE, Wood MEL, Ballard E, Moore V, Wainwright CE, Bell SC. Current infection control practices used in Australian and New Zealand cystic fibrosis centers. BMC Pulm Med 2020; 20:16. [PMID: 31952502 PMCID: PMC6969421 DOI: 10.1186/s12890-020-1052-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2013 update of the Infection Prevention and Control (IP&C) Guideline outlined recommendations to prevent the spread of CF respiratory pathogens. We aimed to investigate the current infection control practices used in Australian and New Zealand (NZ) CF centers. METHODS Two online surveys were distributed to Australian and NZ CF centers regarding the uptake of selected IP&C recommendations. One survey was distributed to all the Medical Directors and Lead CF Nurses and the second survey was distributed to all the Lead CF Physiotherapists. RESULTS The response rate was 60% (60/100) for medical/nursing and 58% (14/24) for physiotherapy. Over 90% (55/60) of CF centers followed CF-specific infection control guidelines and consistent infection control practices were seen in most CF centers; 76% (41/54) had implemented segregation strategies for ambulatory care and no CF centers housed people with CF in shared inpatient accommodation. However, the application of contact precautions (wearing gloves and apron/gown) by healthcare professionals when reviewing a CF person was variable between CF center respondents but was most often used when seeing CF persons with MRSA infection in both ambulatory care and hospital admission (20/50, 40% and 42/45, 93% of CF centers, respectively). Mask wearing by people with CF was implemented into 61% (36/59) of centers. Hospital rooms were cleaned daily in 79% (37/47) of CF centers and the ambulatory care consult rooms were always cleaned between consults (49/49, 100%) and at the end of the clinic session (51/51, 100%); however the staff member tasked with cleaning changed with 37% (18/49) of CF centers responding that CF multidisciplinary team (MDT) members cleaned between patients whereas at the end of the clinic session, only 12% (6/51) of the CF MDT cleaned the consult room. CONCLUSIONS Overall, Australian and NZ CF centers have adopted many recommendations from the IP&C. Although, the application of contact precautions was inconsistent and had overall a low level of adoption in CF centers. In ~ 25% of centers, mixed waiting areas occurred in the ambulatory care. Given the variability of responses, additional work is required to achieve greater consistency between centers.
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Affiliation(s)
- Rebecca Elizabeth Stockwell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Michelle ELizabeth Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Adult Cystic Fibrosis Center, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - Emma Ballard
- Statistical Support Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Vanessa Moore
- Adult Cystic Fibrosis Center, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - Claire Elizabeth Wainwright
- Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Respiratory and Sleep Medicine, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Scott Cameron Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia. .,Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia. .,Adult Cystic Fibrosis Center, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
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Tomlinson OW, Shelley J, Trott J, Bowhay B, Chauhan R, Sheldon CD. The feasibility of online video calling to engage patients with cystic fibrosis in exercise training. J Telemed Telecare 2019; 26:356-364. [DOI: 10.1177/1357633x19828630] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Physical activity, including structured exercise, is an essential component in the management of cystic fibrosis. The use of telehealth such as video-calling may be a useful method for the delivery of exercise and physical activity interventions, though the feasibility of this remains unknown. Methods Nine patients with cystic fibrosis (three female, six male, 30.9 ± 8.7 years) volunteered to participate. Participants completed an eight-week exercise training intervention conducted via Skype, using personalised exercises, with all sessions supervised by an exercise therapist. Feasibility was assessed by demand, implementation, practicality and acceptability. Changes in anthropometric, pulmonary, physical activity and quality of life variables were also assessed. Results Two male participants withdrew from the study, citing lack of available time. The remaining participants found use of Skype useful, with a mean satisfaction rating of 9/10, and three participants requesting to continue the sessions beyond the duration of the study. Mean compliance with sessions was 68%, with mean duration of sessions being 20 min. A total of 25% of calls suffered from technical issues such as video or audio lags. Anthropometric, pulmonary, physical activity and quality of life variables remained unchanged over the course of the study period. Discussion The use of Skype to deliver an exercise intervention to patients withcystic fibrosis was found to be technologically feasible, and acceptable among participants. Findings have implications for clinical practice and could allow care teams to engage patients remotely in exercise. Further research is required to assess the efficacy of this modality on increasing physical activity and associated health outcomes.
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Affiliation(s)
- Owen W Tomlinson
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Sport and Health Science, University of Exeter, UK
| | - James Shelley
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
- Department of Physiotherapy, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Jayne Trott
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Department of Physiotherapy, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Ben Bowhay
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Department of Physiotherapy, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Rohan Chauhan
- Research and Development Directorate, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Christopher D Sheldon
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
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Wood ME, Stockwell RE, Bell SC. Reply to Zuckerman and Saiman: Use of Masks in Patients with Cystic Fibrosis. Am J Respir Crit Care Med 2018; 198:1589-1590. [PMID: 30235006 DOI: 10.1164/rccm.201808-1476le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michelle E Wood
- The Prince Charles HospitalBrisbane, Australia.,QIMR Berghofer Medical Research InstituteBrisbane, Australiaand.,University of QueenslandBrisbane, Australia
| | - Rebecca E Stockwell
- QIMR Berghofer Medical Research InstituteBrisbane, Australiaand.,University of QueenslandBrisbane, Australia
| | - Scott C Bell
- The Prince Charles HospitalBrisbane, Australia.,QIMR Berghofer Medical Research InstituteBrisbane, Australiaand.,University of QueenslandBrisbane, Australia
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Athanazio RA, Silva Filho LVRFD, Vergara AA, Ribeiro AF, Riedi CA, Procianoy EDFA, Adde FV, Reis FJC, Ribeiro JD, Torres LA, Fuccio MBD, Epifanio M, Firmida MDC, Damaceno N, Ludwig-Neto N, Maróstica PJC, Rached SZ, Melo SFDO. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis. ACTA ACUST UNITED AC 2017; 43:219-245. [PMID: 28746534 PMCID: PMC5687954 DOI: 10.1590/s1806-37562017000000065] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Alberto Andrade Vergara
- . Hospital Infantil João Paulo II, Rede Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | | | | | | | - Fabíola Villac Adde
- . Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Francisco José Caldeira Reis
- . Hospital Infantil João Paulo II, Rede Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | - José Dirceu Ribeiro
- . Hospital de Clínicas, Universidade Estadual de Campinas, Campinas (SP) Brasil
| | - Lídia Alice Torres
- . Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Marcelo Bicalho de Fuccio
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | - Matias Epifanio
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Neiva Damaceno
- . Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo (SP) Brasil
| | - Norberto Ludwig-Neto
- . Hospital Infantil Joana de Gusmão, Florianópolis (SC) Brasil.,. Serviço de Fibrose Cística e Triagem Neonatal para Fibrose Cística, Secretaria Estadual de Saúde de Santa Catarina, Florianópolis (SC) Brasil
| | - Paulo José Cauduro Maróstica
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil.,. Universidade Federal do Rio Grande do Sul Porto Alegre (RS) Brasil
| | - Samia Zahi Rached
- . Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Knibbs LD, Johnson GR, Kidd TJ, Cheney J, Grimwood K, Kattenbelt JA, O'Rourke PK, Ramsay KA, Sly PD, Wainwright CE, Wood ME, Morawska L, Bell SC. Viability of Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis. Thorax 2014; 69:740-5. [PMID: 24743559 PMCID: PMC4112489 DOI: 10.1136/thoraxjnl-2014-205213] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Person-to-person transmission of respiratory pathogens, including Pseudomonas aeruginosa, is a challenge facing many cystic fibrosis (CF) centres. Viable P aeruginosa are contained in aerosols produced during coughing, raising the possibility of airborne transmission. Methods Using purpose-built equipment, we measured viable P aeruginosa in cough aerosols at 1, 2 and 4 m from the subject (distance) and after allowing aerosols to age for 5, 15 and 45 min in a slowly rotating drum to minimise gravitational settling and inertial impaction (duration). Aerosol particles were captured and sized employing an Anderson Impactor and cultured using conventional microbiology. Sputum was also cultured and lung function and respiratory muscle strength measured. Results Nineteen patients with CF, mean age 25.8 (SD 9.2) years, chronically infected with P aeruginosa, and 10 healthy controls, 26.5 (8.7) years, participated. Viable P aeruginosa were detected in cough aerosols from all patients with CF, but not from controls; travelling 4 m in 17/18 (94%) and persisting for 45 min in 14/18 (78%) of the CF group. Marked inter-subject heterogeneity of P aeruginosa aerosol colony counts was seen and correlated strongly (r=0.73–0.90) with sputum bacterial loads. Modelling decay of viable P aeruginosa in a clinic room suggested that at the recommended ventilation rate of two air changes per hour almost 50 min were required for 90% to be removed after an infected patient left the room. Conclusions Viable P aeruginosa in cough aerosols travel further and last longer than recognised previously, providing additional evidence of airborne transmission between patients with CF.
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Affiliation(s)
- Luke D Knibbs
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Timothy J Kidd
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Joyce Cheney
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston, Queensland, Australia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Jacqueline A Kattenbelt
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Peter K O'Rourke
- QIMR/RBWH Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kay A Ramsay
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Claire E Wainwright
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston, Queensland, Australia
| | - Michelle E Wood
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott C Bell
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
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Jain M, Saiman LM, Sabadosa K, LiPuma JJ. Rebuttal From Dr Jain et al. Chest 2014; 145:683-684. [DOI: 10.1378/chest.13-2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Shepherd SL, Goodrich EJ, Desch J, Quinton PM. Rebuttal From Mr Shepherd et al. Chest 2014; 145:684-685. [DOI: 10.1378/chest.13-2407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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