Bacterial contamination in the environment of hospitalised children with cystic fibrosis

Abstract

Pathogenic bacterial colonisation in Cystic Fibrosis patients is associated with a poor prognosis; thus, protective measures need to be taken to prevent their transmission. We studied the extent of contamination in the environment of hospitalised children with cystic fibrosis (CF) associated with specific activities. We assessed the levels of bacterial contamination in 432 air and surface samples collected from various locations in our CF centre over a three-month period: the bedrooms, corridor, communal showers, school, leisure centre and the respiratory functional explorations (RFE) unit. Staphylococcus aureus and Pseudomonas aeruginosa strains found in bedrooms and the RFE were compared with those found in patient expectorations using pulsed field gel electrophoresis. In all sampling locations, there were high levels of airborne contamination just after the presence of patients or nursing staff. In the bedrooms, the amount of S. aureus or P. aeruginosa in the air, at wake-up and after physiotherapy, were significantly higher than that after the bedroom had been cleaned. For P. aeruginosa, 33% of isolates were multiresistant to antibiotics; 50% of the colonised patients had the same P. aeruginosa strain in their sputum as in air taken from their bedroom. P. aeruginosa was detected in 23% of samples taken from the surfaces in the showers after patient washing. Very low levels of pathogenic bacteria were found in samples from the other locations. Overall, activities with the highest risk of contamination in the CF ward are physiotherapy and washing in the communal shower room. We therefore recommend to open windows after physiotherapy and to implement a strong decontamination after showers.

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

“…Infectious droplets in the air may represent another source of transmission for CF pathogens. P. aeruginosa was recovered from the air in hospital rooms 45 minutes to 2 hours after people with CF left, 126,127 and the LES of P. aeruginosa was recovered from the corridors of CF clinics as long as 3 hours after individuals had left the area. 127 In the United Kingdom, after individuals with CF performed PFTs or nebulization, the Manchester epidemic strain of P. aeruginosa as well as nonepidemic P. aeruginosa were recovered from the air.…”

“…341 In France, the concentration of P. aeruginosa was highest after the person with CF awoke or performed chest physiotherapy. 126 Several CF pathogens (ie, P. aeruginosa, MSSA, and MRSA) were recovered from air collected 3 feet from CF subjects in exam rooms; these strains were the same as those infecting the subjects as assessed by PFGE. 128 Similarly, CF pathogens were recovered from the air 6 feet from CF subjects performing PFTs.…”

“…As described above (Section II), experimental and clinical data have demonstrated the generation of infectious droplets by people with CF; these studies confirm the potential for transmission of CF pathogens to others with CF by the droplet route. 1,[120][121][122][125][126][127] Thus, to prevent transmission by the droplet route people with CF should routinely don a facemask of appropriate size when entering healthcare settings where they are likely to encounter others with CF. Such settings include the common areas of the CF clinic, when leaving their hospital room, or when leaving the clinic exam room.…”

“…[322][323][324][325]416,417 The importance of the principles of environmental contamination and cleaning and disinfection can be extrapolated to the CF clinic where surface contamination has been studied extensively. [126][127][128]317 As all people with CF may harbor transmissible pathogens or are at risk of acquiring such pathogens, environmental cleaning and disinfection practices should be implemented when caring for all people with CF.…”

Phase 1 evaluation of tubing PEP as an improvised positive expiratory pressure device: pressures generated through oxygen tubing across a range of flow rates and lengths

“…At its simplest, it comprises of a container that is partially filled with water and a tube, whose distal tip is submerged into the water, into which the patient exhales. However there are safety concerns regarding potential water-borne bacterial contamination, inadvertent aspiration of water [17] and, in the case of non-commercial bubble PEP devices, the inconsistency of assembly of bubble PEP [11,18]. To obtain a valid pressure-regulated system, bubble PEP tubing must be at least 20 cm long and have an inner diameter and apparatus air-escape aperture of ≥ 8 mm [18].…”