Stopping the Spread of Germs
Living with cystic fibrosis (CF), or raising a child with CF, can put heavy demands on your daily routine. Medicines and treatments take a lot of time, but will help you or your child stay healthy. There are some other simple things that people with CF can do to decrease the risk of catching germs (bacteria or viruses) that cause infections. This pamphlet lists ways that people with CF can stop the spread of germs to stay in the best possible health. As with any healthcare information, be sure to talk with your CF care team to decide what is best for you or your child.
Clean Hands Are Important!
One of the best ways to keep from catching or spreading germs is hand cleaning or hand hygiene. Clean your hands often (see "When to Clean Your Hands"), and after touching anything that has been in contact with mucous membranes, sputum or phlegm. There are two ways to clean hands: One is to wash with soap and water. Antibacterial soap is the best to use (see "Handwashing Steps"). The second way is to use an alcohol-based hand gel. These hand gels are often called antiseptic handrubs or hand sanitizers. They can work better than soap and water to kill germs. To decide which method to use, follow this rule: if you see dirt on your hands, wash with soap and water; if you do not see dirt, use hand gel. It is a good idea to carry hand gel with you to use before eating and after blowing your nose, coughing, sneezing or shaking hands.
*Words that appear in bold italic are defined at the end of this pamphlet.
Cleaning Your Respiratory Equipment
Germs can get on respiratory equipment and cause lung infections. Clean and disinfect all equipment used for inhaled medicines or airway clearance using the manufacturer's instructions. It is vital to clean and disinfect equipment that has been in contact with mucous membranes, sputum or phlegm, like nebulizers!
To clean and disinfect your nebulizer, follow these steps:
- Clean your hands.
- Clean the nebulizer parts. The parts cannot be disinfected until they are cleaned. With a new paper towel, wash the inside and outside of the nebulizer parts with liquid dish soap and hot water. Be careful not to damage any of the parts. Throw the paper towel away, then rinse the nebulizer parts with water. Clean the nebulizer right after it is used to keep the medicine and debris from drying. Once debris dries, it is difficult to wash off. You also can clean the nebulizer parts in an automatic dishwasher, if the nebulizer's manufacturer's instructions allow.
- Disinfect the nebulizer parts. DO NOT USE VINEGAR. Vinegar is not strong enough to kill the germs a person with CF might get. Instead, if the manufacturer's instructions allow, disinfect the nebulizer parts using one of these options:
- Boiling for 5 minutes
- Microwaving (in water) for 5 minutes
- Dishwasher, if the water is hotter than 158° F for 30 minutes
- Soaking in a solution of 1 part household bleach and 50 parts water for 3 minutes
- Soaking in 70% isopropyl alcohol for 5 minutes
- Soaking in 3% hydrogen peroxide for 30 minutes
- Rinse the nebulizer parts. If you disinfect using bleach, isopropyl alcohol or hydrogen peroxide, rinse all parts well. Use sterile water for the final rinse. DO NOT USE WATER FROM THE FAUCET, BOTTLED, OR DISTILLED WATER. You can make water sterile by boiling it for 5 minutes. Use this water once, then throw it out. If you disinfect by boiling, you do not need to rinse the nebulizer.
- Air-dry the nebulizer parts. After the final rinse, drain the parts on a clean surface covered with new paper towels. Replace wet paper towels with dry ones and fully air-dry all parts. Remember, germs will grow on anything that stays wet, so store the dry nebulizer in a clean, dry bag in a clean, dry place. Follow the manufacturer's care and cleaning instructions for all equipment used for inhaled medicines or airway clearance. Some respiratory equipment may need to be cleaned but not disinfected. These items can be cleaned often with liquid soap and hot water. Ask the physical or respiratory therapist, or the physician or nurse at your CF care center, how often to clean your equipment and the best way to do so. Do not share nebulizers, PEP devices, spacers or anything that has been in contact with mucous membranes, sputum or phlegm.
Ask your care center team what might work best for you.
Read the manufacturer's instructions to see what option is best for your nebulizer. Do not use a nebulizer that cannot be disinfected using one of these options.
When People With CF Live Together
People with CF who live together can "share" the same CF germs. To decrease the spread of germs, they should limit contact with each other's mucous membranes, sputum or phlegm. People with CF should not share respiratory equipment, airway clearance devices, toothbrushes, eating utensils or drinking cups or anything that has been in contact with mucous membranes, sputum or phlegm. When coughing, germs can spread up to three feet (about an arm's length). Performing airway clearance at different times and in different rooms can help decrease the spread of germs. People with CF who do not live together should also avoid activities that spread germs, such as hand shaking, hugging or kissing. They should also try to keep at least three feet (an arm's length) between each other.
People with CF should clean their hands often, especially after coughing, sneezing, or blowing their nose. When coughing, sneezing or coughing up sputum, use a tissue and throw it away in a trashcan. Then, clean your hands!
Get Vaccinated (Shots)
EVERYONE should get the vaccinations or shots recommended by the Centers for Disease Control and Prevention. These vaccines help prevent illness. People with CF have the same risk of a viral infection as people without CF. However, when people with CF catch a respiratory virus, they can get much sicker. Influenza or "the flu" is a viral illness that can cause pneumonia in people with CF. Flu outbreaks often occur between December and March. People with CF older than six months should get a flu shot every year. Make a clinic appointment in the fall to get your or your child's flu shot, or to find out where to get one. The relatives, day care and health care staff, and close friends of those with CF also should get regular shots to prevent the flu and other infections. If you or your child did not get a flu shot and are exposed to someone with the flu, call your CF care center to see about starting medicine that may keep you or your child from getting sick.
Another germ that anyone can get is called "RSV" or respiratory syncytial virus. RSV can make babies, young children and the elderly very sick. There is a special shot to prevent RSV in children, but there areno current guidelinesfor giving it to children with CF. Good hand cleaning reduces your or your child's risk of getting RSV and other germs.
Germs in Public
There are many different types of germs out there. You may have heard a lot about Pseudomonas aeruginosa (sue-da-moan-us a-ridge-a-no-sa) (Pseudomonas) and Burkholderia cepacia complex (bur-cold-air ee-ah sa-pay-sha) (B. cepacia). Pseudomonas and B. cepacia are both types of bacteria that people with CF can catch. There is medical evidence that B. cepacia can be passed between people with CF. It is important for those with CF to keep their hands clean, stay at least three feet away from each other, and limit contact with each other's mucous membranes, sputum and phlegm. Hand cleaning is the best way to keep from catching and spreading most germs (see"Preventing Germs in Public"). Remember: clean your hands often and after touching things that have been in contact with mucous membranes, sputum or phlegm.
School: Health information is private, unless you tell someone, or ask your CF care center to provide others with your health information or your child's health information. If your child has CF, consider letting the school nurse know. Work with your CF care team to decide what information to tell the school. Members of the CF care team can talk to the school about CF.
More than one child with CF may attend the same school. When possible, they should not share the same classroom. To lower exposure to germs, they should try to stay at least three feet apart. Ask the school to schedule common activities, such as gym, at different times. Again, hand cleaning can help prevent the spread of germs that cause infections.
Camps: There is medical evidence that CF germs have been passed between people with CF at CF-specific camps. People with CF should not attend CF-specific camps. The risks outweigh the benefits. Because it is vital to exercise, make friends, and build support systems, people with CF are encouraged to join in camps, social groups and sports activities that are not specifically for people with CF.
Spas, hot tubs and pools: Pseudomonas has been found in spas and hot tubs with low chlorine levels. People with CF should avoid spas and hot tubs without enough chlorine to kill Pseudomonas! Pseudomonas has not been found in swimming pools with proper chlorine levels. Your city or county public health department can tell you what chlorine levels kill germs and meet public health standards. Ask the pool maintenance crew how often the chlorine level is checked and if the pool meets public health standards.
CF Education Days: There have been no reports of CF germs being passed from one person with CF to another at CF Education Days. If you have questions, talk with your CF care team. Again, hand cleaning is the best way to keep from catching and spreading germs (see "Preventing Germs in Public"). Once again, clean your hands after touching things that have contacted mucous membranes, sputum or phlegm!
There Is Support for You and Your Family!
Your CF care center is a great place to look for support to help you and your family deal with the challenges of CF. Educate yourself and your family about why these actions are vital to the health of someone with CF. Share your questions or concerns with your CF care team. Some centers have parent support groups. In these groups, parents can help each other. Ask your CF care center team where you can find support in your area. If there is not a parent support group in place, ask how you can start one.
Living with CF or raising a child with CF is challenging. But just as the daily medicine and treatment demands can be time consuming, knowing and using these guidelines to stop the spread of infections can help everyone stay healthier. The benefits of close contact must be weighed against the risk of infections. Think of these guidelines as a key to help you and your family stay healthier. Remember, your CF care team is a good resource for questions about changes in your home and school routine that can help you lower the risk of catching and spreading germs.
GLOSSARY
Antibacterial: Something that kills or stops bacteria growth
Antiseptic handrub: A substance that, when put on the hands, kills germs
Bacteria: A tiny organism that can cause infections; antibiotics can kill bacteria
Burkholderia cepacia complex (bur-cold-air-ee-ah sapay-sha): A group of bacteria that can be spread between people with CF; it can cause a serious lung infection
Debris: Remains of something; for inhaled medicine, this could be medication or sputum
Disinfect: To kill most of the germs
Germs: Organisms, like bacteria and viruses, that can cause infections
GREAT STRIDES: The CF Foundation's annual walk-athon, which raises money to fund CF research and care
Hand cleaning: Includes using soap and water or alcohol-based hand gels (see hand hygiene)
Hand gel: A substance that has alcohol to kill germs as it dries
Hand hygiene: A general term for cleaning hands; this includes the use of soap and water or an alcohol-based hand gel (see hand cleaning)
Hand sanitizer: See hand gel
Mucous membranes: Places in the body that produce mucus; these are found in the nose, mouth, lungs, esophagus, stomach and intestine
PEP — Positive Expiratory Pressure: an airway clearance technique
Phlegm: Lung mucus or sputum
Pseudomonas aeruginosa (sue-da-moan-us a-ridge-a-no-sa): Bacteria often found in the lungs of people with CF; it is a cause of many lung infections
Sputum: Lung mucus or phlegm
Sterile: The complete absence of all germs
Vaccination: Giving a vaccine (shot)
Vaccine: A solution to put into the body to build a defense against a disease
Viral: An illness caused by a virus
Virus: A tiny organism that can cause infections
The information in this pamphlet is based on "Infection Control Recommendations for Patients With Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patientto-Patient Transmission" by Lisa Saiman, M.D., M.P.H.; Jane Siegel, M.D.; and the participants of the CF Foundation's Consensus Conference on Infection Control. This document is available as a supplement to Infection Control and Hospital Epidemiology (ICHE), May 2003, Volume 24, Number 5 (http://www.ichejournal.com) and as a supplement to American Journal of Infection Control (AJIC), May 2003, Volume 31, Number 3 (http://www.apic.org).
This article has been adapted by Novartis from content provided by the Cystic Fibrosis Foundation and is providing the article for general information purposes only. Please visit www.CFF.org for the complete and most current version of this article.
