Air Contamination with Bacteria in Cystic Fibrosis Clinics: Implications for Prevention Strategies

Zuckerman, Jonathan B.; Clock, Sarah A.; Prato, B. Stephen; McDevitt, James; Zhou, Jia; Leclair, Laurie W; Lucas, F. Lee; Saiman, Lisa

doi:10.1164/rccm.201410-1877le

Cited by 15 publications

(25 citation statements)

References 12 publications

(5 reference statements)

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“…Again surgical masks were found to be more comfortable than the N95 ones. However, Zuckerman et al [75] compared room contamination rates between patients wearing surgical masks and those without and found similar contamination rates between the two groups. The Stockwell and Wood studies support the recommendation, made in US infection control guidelines for CF [50] which says that masks should be worn by CF patients while they are in a health-care facility.…”

Section: Face Masksmentioning

confidence: 99%

Infection prevention and control in cystic fibrosis: a systematic review of interventions

Rowbotham

Palser

Smith

et al. 2019

Expert Review of Respiratory Medicine

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Introduction: Cystic fibrosis is a life-limiting genetic condition characterized by recurrent pulmonary infection. Acquisition of infection can occur from environmental reservoirs, person-to-person transmission and from the healthcare environment. Primary prevention of infections through infection prevention and control measures is an important strategy in cystic fibrosis care. Areas covered: Here we present a systematic review of the evidence base around infection prevention and control in cystic fibrosis. We found 36 studies and 7 guidelines that met our inclusion criteria. Strategies covered include cohort segregation, individual segregation, hand hygiene, facemasks, combination strategies, equipment strategies, and adherence. Quality of evidence overall was deemed low or very low. Most guideline recommendations have little or no evidence to support them. Expert opinion: Although low quality, there is an abundance of evidence suggesting segregation is beneficial in reducing pathogen spread. Undertaking high-quality studies may, therefore, be ethically challenging. Large-scale registry studies may provide a better strategy for answering questions on the efficacy of infection control policy. With the rise of antibiotic resistance, effective eradication of cystic fibrosis pathogens is becoming more difficult so primary prevention through infection control will become increasingly important over the coming years. ARTICLE HISTORY

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Section: Face Masksmentioning

confidence: 99%

Infection prevention and control in cystic fibrosis: a systematic review of interventions

Rowbotham

Palser

Smith

et al. 2019

Expert Review of Respiratory Medicine

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“…following nebulization and performing physiotherapy and spirometry) High rates of air contamination observed during outpatient spirometry manoeuvres Simulation experiments of coughing have demonstrated droplet nuclei aerosols of P. aeruginosa.…”

Section: Risk Of the Spread Of Organisms From Hcwcf To Others In The mentioning

confidence: 99%

“…Masks worn during cough procedures by patients with CF reduce room air contamination with P. aeruginosa by 86% Room contamination was low in patients wearing surgical masks and surgical masks reduced viable bacterial contamination via cough in patients with CF by ~90% Potentially infectious bacterial aerosols generated during coughing were dramatically reduced (to 5% of the bacterial concentrations seen during unmasked cough) suggesting short‐term benefit of mask wearing.…”

Section: Risk Of the Spread Of Organisms From Hcwcf To Others In The mentioning

confidence: 99%

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Work environment risks for health care workers with cystic fibrosis

Bell

Armstrong

Harrington³

et al. 2018

Respirology

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In Australia and New Zealand, >50% of people with cystic fibrosis (CF) are adults and many of these people are pursuing vocational training and undertaking paid employment. More than 6% of adults with CF are working in health care. There is limited guidance in literature to support health care workers with CF (HCWcf) in training and in employment to support safe practice and to provide protection for themselves and their patients from the acquisition of health care associated infection. A multidisciplinary team of CF and Infectious Disease Clinicians, Infection Prevention and Control Practitioners, HCWcf, academic experts in medical ethics and representatives from universities, appraised the available evidence on the risk posed to and by HCWcf. Specific recommendations were made for HCWcf, CF health care teams, hospitals and universities to support the safe practice and appropriate support for HCWcf.

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“…Studies have isolated S. aureus, including MRSA, from air samples in CF care related areas within hospital facilities (Ferroni et al 2008;Zuckerman et al 2009;Zuckerman et al 2015).…”

Section: Clinical Significance Acquisition and Transmission Of S Aumentioning

confidence: 99%

Infectious airborne transport in individuals with cystic fibrosis and mitigation strategies to reduce aerosol dispersal

Wood¹

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Background and Aims Cystic fibrosis (CF) is characterised by repeated bacterial respiratory infections and progressive lung disease. While Pseudomonas aeruginosa is the most prevalent organism recovered from the respiratory secretions of people with CF, other species including Staphylococcus aureus, Stenotrophomonas maltophilia, Achromobacter species, Burkholderia cepacia complex species, and Mycobacterium abscessus may also be detected. The majority of these pathogens are found in the natural environment and the identification of genetically diverse bacterial strains infecting people with CF would suggest that this is the most common acquisition source. However, epidemiological studies have demonstrated that some people with CF may harbour genetically indistinguishable (shared) strains of organisms. Common environmental reservoirs have not been identified for many shared strains, suggesting that person-to-person transmission may be a method of acquisition, although the exact mechanisms involved are unclear. The airborne route, involving inhalation of microbe-containing droplet nuclei, has been speculated as a possible transmission pathway. Previous studies have demonstrated that people with CF can generate droplet nuclei containing P. aeruginosa, which can survive for up to 45-minutes and can travel up to 4-metres from their source and therefore potentially capable of airborne transmission. The survival of other common CF pathogens over distance and time is not known. Recent updates to CF infection control guidelines in some countries recommend the use of a surgical face mask for people with CF to minimise risk of transmission and acquisition of such pathogens. The effectiveness of face masks in a CF population has not been studied extensively. To address the knowledge gaps highlighted above, this thesis had two key aims: i) To determine if CF pathogens other than P. aeruginosa can be aerosolised during coughing, and to investigate their survival in the air over distance and time and; ii) To examine the effectiveness of face masks and cough etiquette in reducing the outward dispersal of cough generated aerosols containing P. aeruginosa in people with CF. iii Methods i) Cough aerosolisation of cystic fibrosis respiratory pathogens (other than P. aeruginosa) Thirty-three participants with CF were enrolled, according to a recent history of infection with: 1) Gram-negative bacteria (GNB) other than P. aeruginosa; 2) S. aureus and; 3) M. abscessus complex. Using two validated systems for aerosol sampling, the viability and survival of cough aerosols were measured over distance and time. ii) Effectiveness of face masks and cough etiquette to reduce aerosol concentration of Pseudomonas aeruginosa Twenty-five participants with CF and chronic P. aeruginosa infection were enrolled. Six respiratory activities of talking and coughing, with and without face masks were undertaken within an aerosol sampling device. Aerosols were collected at 2-metres and quantitative analysis performed on bacterial colony forming units (CFU) f...

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Air Contamination with Bacteria in Cystic Fibrosis Clinics: Implications for Prevention Strategies

Cited by 15 publications

References 12 publications

Infection prevention and control in cystic fibrosis: a systematic review of interventions

Infection prevention and control in cystic fibrosis: a systematic review of interventions

Work environment risks for health care workers with cystic fibrosis

Infectious airborne transport in individuals with cystic fibrosis and mitigation strategies to reduce aerosol dispersal

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