Improved patient safety through reduced airway infection rates in a paediatric cystic fibrosis programme after a quality improvement effort to enhance infection prevention and control measures

Savant, Adrienne P.; O'Malley, Catherine; Bichl, S.; McColley, Susanna A.

doi:10.1136/bmjqs-2013-002315

Cited by 16 publications

(16 citation statements)

References 37 publications

(47 reference statements)

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“…30 Support for acquisition of MRSA in health-care settings is provided by a report that found that more stringent infection prevention and control strategies, which included universal contact precautions, significantly reduced MRSA in a pediatric CF clinic. 31 Studies to find effective therapeutic approaches to eradication are ongoing. 32,33 We found that the prevalence of S maltophilia increased.…”

Section: Discussionmentioning

confidence: 99%

Changing Epidemiology of the Respiratory Bacteriology of Patients With Cystic Fibrosis

Salsgiver

Fink

Knapp

et al. 2016

Chest

199

166

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Section: Discussionmentioning

confidence: 99%

Changing Epidemiology of the Respiratory Bacteriology of Patients With Cystic Fibrosis

Salsgiver

Fink

Knapp

et al. 2016

Chest

199

166

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“…In addition to the lack of knowledge of the recommendations, they identified other barriers, such as disagreement with the recommendations, organizational constraints to following the recommendations, and ambiguity in the guidelines. Although there is more than one barrier to the implementation of infection-control guidelines in any healthcare setting, 7 lack of awareness is a significant one. Change begins with awareness.…”

Section: Awareness Of Guidelinesmentioning

confidence: 99%

Device Cleaning and Infection Control in Aerosol Therapy

O'Malley

2015

Respir Care

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Aerosol delivery equipment used to administer inhaled medications includes the nebulizer, positive expiratory pressure devices added to the nebulizer, and valved holding chambers (spacers). These devices are semi-critical medical devices, and as such, infection prevention and control (IPC) guidelines recommend that they be cleaned, disinfected, rinsed with sterile water, and air-dried. There is confusion surrounding the care of aerosol devices because of inconsistencies in the various published IPC guidelines, lack of a standard of practice among institutions and respiratory therapists (RTs), and manufacturer's instructions for use of these devices are not always compatible with guidelines or practice. Challenges lie in awareness of IPC guidelines and establishing a standard for the care of aerosol delivery devices among all stakeholders/manufacturers, governments, vendors, and users. The latest IPC guideline from the Cystic Fibrosis Foundation, reviewed and endorsed by the Society for Healthcare Epidemiology of America and the Association for Professionals in Infection Control, has a recommendation for disposable nebulizers and a recommendation for reusable nebulizers. Reusable nebulizers should be cleaned, disinfected, rinsed with sterile water (if using a cold disinfectant), and air-dried between uses. The mouthpiece/mask of disposable nebulizers should be wiped with an alcohol pad, the residual volume should be rinsed out with sterile water after use, and the nebulizer should be replaced every 24 h. The RT plays a significant and responsible role in providing and teaching aerosol therapy to patients. The RT and all stakeholders need to work together to provide a standard of care for the safe use of aerosol delivery devices.

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“…Infection with MRSA remains an important problem in cystic fibrosis where primary prevention through infection control is the best strategy . Phenotypic methicillin resistance is classically encoded by the mec A gene, but non‐genetic resistance mechanisms are also found.…”

Section: Resultsmentioning

confidence: 99%

“…Such factors are multi‐factorial and include climate, that is, higher rates in warmer climate, social and healthcare factors. For example, extensive versus more restrictive use of antibiotics and hospital infection control policies in CF and non‐CF . Specifically, antimicrobial stewardship programs with reduced use of antibiotics are associated with reduced rates of MRSA …”

Section: Epidemiologymentioning

confidence: 99%

Biology and management of methicillin resistantStaphylococcus aureusin cystic fibrosis

Akil

Muhlebach

2018

Pediatric Pulmonology

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Staphylococcus aureus is one of the earliest bacteria isolated from the respiratory tract in people with cystic fibrosis (CF). Its methicillin resistant form, MRSA, has gained attention due to the rapid increase in the last decades and worse outcomes with chronic infection. In the United States, prevalence of MRSA in CF is around 27%, but is much lower (3-18%) in most other countries. Methicillin is typically genetically encoded by the mecA gene, which encodes for an alternative penicillin binding protein (PRBa). This PRBa has low affinity to β-lactams, thereby enabling growth of S. aureus in the presence of penicillinase resistant penicillins and most other β-lactams. Non-mecA positive strains of MRSA, so-called borderline resistant (BORSA) have also been described. In addition to production of toxins, the virulence of S. aureus is conferred by its adaptability allowing persistence in face of antibiotic therapies and host defense. These adaptive growth mechanisms include small colony variants, biofilms, and growth under anaerobic conditions. Several reports have described successful eradication of MRSA, yet only two randomized trials of eradication during early infection have been conducted. A list of MRSA specific antibiotics with dosing relevant to CF patients is presented here. Many of these require special dosing in people with CF. Novel antibiotics are in trials for skin and soft tissue infections and it is unclear if and when those might be available for lung infections. Thus the best strategies for MRSA would be primary prevention.

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Improved patient safety through reduced airway infection rates in a paediatric cystic fibrosis programme after a quality improvement effort to enhance infection prevention and control measures

Cited by 16 publications

References 37 publications

Changing Epidemiology of the Respiratory Bacteriology of Patients With Cystic Fibrosis

Changing Epidemiology of the Respiratory Bacteriology of Patients With Cystic Fibrosis

Device Cleaning and Infection Control in Aerosol Therapy

Biology and management of methicillin resistantStaphylococcus aureusin cystic fibrosis

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