<html>
<head>
<meta charset="UTF-8"/>
<meta name="tikaGenerated" content="true"/>
<meta name="date" content="2017-09-27T00:39:01Z"/>
<meta name="xmp:CreatorTool" content="Acrobat PDFMaker 15 for Word"/>
<meta name="Company" content="TOSHIBA"/>
<meta name="Keywords" content="template, SA Health, report"/>
<meta name="Category" content="For Official Use Only,I4,A1 I2, A2"/>
<meta name="DocLeg" content="DocLeg"/>
<meta name="subject" content="Document template"/>
<meta name="dc:creator" content="Brown, Colin"/>
<meta name="dcterms:created" content="2017-09-25T03:49:02Z"/>
<meta name="Last-Modified" content="2017-09-27T00:39:01Z"/>
<meta name="dcterms:modified" content="2017-09-27T00:39:01Z"/>
<meta name="title" content="SA Health Fact Sheet Template - Green on White - Helix Position A"/>
<meta name="Last-Save-Date" content="2017-09-27T00:39:01Z"/>
<meta name="meta:save-date" content="2017-09-27T00:39:01Z"/>
<meta name="dc:title" content="SA Health Fact Sheet Template - Green on White - Helix Position A"/>
<meta name="modified" content="2017-09-27T00:39:01Z"/>
<meta name="cp:subject" content="Document template"/>
<meta name="Content-Type" content="application/pdf"/>
<meta name="creator" content="Brown, Colin"/>
<meta name="meta:author" content="Brown, Colin"/>
<meta name="dc:subject" content="template, SA Health, report"/>
<meta name="meta:creation-date" content="2017-09-25T03:49:02Z"/>
<meta name="created" content="Mon Sep 25 13:19:02 ACST 2017"/>
<meta name="Comments" content="This template provides the correct style, logo, fonts and layout to produce a report in the SA Health branding."/>
<meta name="DocSenIA" content="-I2-A2"/>
<meta name="xmpTPg:NPages" content="16"/>
<meta name="Creation-Date" content="2017-09-25T03:49:02Z"/>
<meta name="DocSenCav" content=" "/>
<meta name="_DocHome" content="-1707252612"/>
<meta name="DocSen" content="Public"/>
<meta name="SourceModified" content="D:20170925031711"/>
<meta name="meta:keyword" content="template, SA Health, report"/>
<meta name="DocConf" content="DocConf"/>
<meta name="Author" content="Brown, Colin"/>
<meta name="producer" content="Adobe PDF Library 15.0"/>
</head>
<body>
<pre>
 
 

Policy Classification: Public   I2   A1 
Policy No.: CG261 

 

 
 
 

 

Cystic fibrosis: 
Infection prevention and control 

Clinical Guideline 
 

Version No:   1.0 
Approval date:   1 August 2017 

 
  



 
 

Contents  
1. Policy Statement .................................................................................................................. 3 
2. Roles and Responsibility .................................................................................................... 3 
3. Policy Requirements ........................................................................................................... 3 
3.1. Background ......................................................................................................................... 3 

3.2. Infection control principles for CF patient care in inpatient settings ...................................... 4 

3.2.1. Patient placement ............................................................................................................... 4 

3.2.2. Patient movement within the healthcare facility ................................................................... 5 

3.2.3. Transport and patient movement between healthcare facilities ........................................... 5 

3.2.4. Transmission-based precautions ......................................................................................... 5 

3.2.5. Respiratory protection ......................................................................................................... 6 

3.2.6. Infection control signage ..................................................................................................... 6 

3.2.7. Dedicated patient equipment ............................................................................................... 6 

3.2.8. Respiratory therapy equipment: nebulisers and diagnostic equipment ................................ 6 

3.2.9. Environmental cleaning ....................................................................................................... 7 

3.2.10. Staffing ................................................................................................................................ 7 

3.2.11. Visitors ................................................................................................................................ 7 

3.3. Management of CF patients in out-patient clinics and pulmonary function 

laboratories ......................................................................................................................... 7 

3.3.2. Pulmonary Function Laboratory (PFL) ................................................................................. 8 

3.4. Management of CF patients in community settings ............................................................. 8 

3.5. Patient education and support ............................................................................................. 8 

3.6. Drug treatment and antimicrobial stewardship ..................................................................... 9 

3.7. Surveillance and screening for carriage of potential pathogens ........................................... 9 

3.7.1. Screening for non-tuberculous mycobacteria (NTM) ............................................................ 9 

3.7.2. Screening for Burkholderia cepacia complex ....................................................................... 9 

3.7.3. Screening for multi-resistant organisms ............................................................................... 10 

3.7.4. Collection of specimens ...................................................................................................... 10 

3.7.5. Alerting patient records ....................................................................................................... 10 

3.7.6. Staff with cystic fibrosis ....................................................................................................... 10 

4. Implementation and Monitoring.......................................................................................... 10 
5. National Safety and Quality Health Service Standards ..................................................... 10 
6. Definitions ............................................................................................................................ 11 
7. Associated Directives / Guidelines &amp; Resources .............................................................. 12 
8. Document Ownership &amp; History ......................................................................................... 13 

  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 2 of 16 
Public   I2   A1 

 



 
 

Cystic fibrosis: infection prevention and control 
Clinical Guideline 

 
 
1. Policy Statement  
 
This guideline describes recommended best practice infection prevention and control procedures 
for the management of patients (adult and paediatric) with cystic fibrosis (CF) in both inpatient and 
non-inpatient health care settings. Inpatient health care settings include any hospital settings 
where a patient is admitted for a least an overnight stay. Non-inpatient health care settings include 
outpatient clinics (including lung function and CF clinics), emergency departments, radiology, 
dental, perioperative settings, dialysis centres, ambulance and aeromedical transport services, 
community health care and residential care facilities (e.g. rehabilitation facilities, nursing homes, 
mental health facilities) and other settings in which people with CF may receive medical care.  

The guideline presents a risk-based approach to the management of patients with CF to minimise 
the acquisition and transmission of multidrug-resistant organisms (MRO) and/or other 
microorganisms of clinical significance. 

Individual facilities may require specific procedures and protocols relevant to their patient 
population and clinical setting.  
 
 
2. Roles and Responsibility 
 
This policy applies to all staff involved in the direct care of patients with CF. 

Staff caring for patients with CF are responsible for ensuring that the patient, their relatives/visitors 
and all persons involved in their care are informed and understand the purpose of the infection 
control precautions implemented. 
 
 
3. Policy Requirements 
 
3.1. Background 

It is known that chronic infection with certain microorganisms in people with CF is associated 
with increased respiratory symptoms and poorer outcomes.  All people with CF can harbour 
microorganisms in their respiratory secretions that can potentially be transmitted to others with 
CF.  These pathogens include (but are not limited to): Burkholderia cepacia complex, 
methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, human respiratory 
syncytial virus, human parainfluenza viruses, and influenza viruses.  

There is no reliable way to completely eliminate the risk of cross-infection, however, the 
implementation of standard and transmission-based precautions is recommended to minimise 
this risk.  Standard and contact precautions are recommended for the routine care of all CF 
patients. 

The origin of most pathogens in CF remains unknown, but there are several potential sources; 
these include the natural environment (e.g. soil, water), the healthcare or hospital environment 
(e.g. sinks and surfaces), contaminated equipment (e.g. nebuliser, pulmonary function 
equipment) and other people with CF who harbour potentially transmissible pathogens.  During 

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 3 of 16 
Public   I2   A1 

 



 
 
the past decade, new evidence has led to a renewed emphasis on source containment of 
potential pathogens and the role played by the contaminated healthcare environment in the 
transmission of infectious agents.  People without CF, including household and family members, 
are not generally responsible for transmission of respiratory bacterial pathogens to people with 
CF; however, they can transmit viruses to someone who has CF, which can be equally 
important.  

As those with CF survive longer and have increasing exposure to antibiotics, other problematic 
colonising microorganisms are being found in sputum of CF patients.  These have been termed 
 late emerging pathogens  and include Stenotrophomonas maltophilia, Achromobacter 
xylosoxidans, Ralstonia picketti, Pandoraea apista, Inquilinus limosus, Aspergillus species, and 
non-tuberculous mycobacteria (NTM).  These microorganisms are environmental bacteria 
commonly found in water, soil, and on plants, including fruit and vegetables.  Whether all of 
these organisms have a primary pathogenic role in CF lung disease and are capable of 
transmission between people with CF remains unclear.  

3.2. Infection control principles for CF patient care in inpatient settings 
The general infection control principles for the care of CF patients includes adhering to hand 
hygiene, source containment of respiratory secretions, appropriate use of personal protective 
equipment, environmental cleaning, and disinfection of reusable medical equipment.  

CF patients should be managed with standard and transmission-based precautions (contact 
precautions and, when indicated, droplet or airborne precautions) in both inpatient and non-
inpatient settings.   

All healthcare personnel should wear gowns and gloves when caring for all people with CF 
patients regardless of respiratory tract culture results.  The rationale for the universal use of 
gowns and gloves by healthcare personnel caring for people with CF is that direct and indirect 
contact with respiratory secretions that may contain transmissible pathogens is likely to occur, 
including through contact with contaminated environmental surfaces.  

All healthcare facilities should develop a comprehensive risk-based, institution-specific, infection 
management plan to detect, prevent and control infection and/or colonisation risks for CF 
patients.  Measures implemented to eliminate or minimise transmission should not interrupt the 
normal course of treatment required for the patient s recovery. 

3.2.1. Patient placement 

Patient placement should be based on a risk management approach and will depend upon the 
setting of the health care facility.  It is recommended that CF patients are not placed alongside 
those with impaired immunity because of the high likelihood of transmission of opportunistic 
pathogens to this vulnerable patient group. 

To decrease the risk of transmission of MRO organisms from one CF patient to another patient 
(CF or non-CF patient) within the wards, it is important to include the following in planning 
patient placement:  

&gt; A single room with ensuite facilities or dedicated bathroom is preferred.  Cohorting of patients 
with CF should not occur.  

&gt; CF patients with Mycobacterium abscessus colonisation should be placed in a single room, 
preferably with negative air pressure, to prevent  seeding  of the ward environment with the 
organisms. 

&gt; CF patients with significant organisms such as Burkholderia cepacea should be placed in 
different wards and away from immunocompromised patients. 

  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 4 of 16 
Public   I2   A1 

 



 
 
&gt; Ensure that appropriate additional precautions signage is clearly visible at the entrance to the 

room. 

3.2.2. Patient movement within the healthcare facility  

The MRO status of a CF patient must not compromise patient management.  Avoid 
unnecessary patient movement between wards, ensuring that the normal course of treatment is 
not interrupted.  

Patients may go outside of their isolation room provided the following precautions are followed:  

&gt; the patient wears a single-use face mask 
&gt; hand hygiene is performed before leaving their room 
&gt; all lesions/wounds are covered and exudate contained 
&gt; the patient is requested not to visit other patients during their hospital admission.   
Staff accompanying patients during transport or movement through the facility do not need to 
wear gowns and gloves if direct patient care is not anticipated, however staff must perform hand 
hygiene after completing the transport task. 

3.2.3. Transport and patient movement between healthcare facilities  

Patients with CF should not be refused admission or transfer to any health care facility on the 
basis of having CF or due to their MRO status. Patient management should not be 
compromised and transfer may be necessary from acute care hospitals to other facilities for 
convalescence, rehabilitation or long term care.   

If transfer is required to another clinical area or health care facility, the receiving staff, and (if 
applicable) the ambulance service, must be informed of the precautions required for ongoing 
patient management. 

The following are recommended: 

&gt; The medical/nursing documents accompanying the patient must clearly state details relating 
to the patient's MRO status and if they have any risk factors for transmission. 

&gt; If the transfer is being conducted by the SA Ambulance Service they should be informed of 
the patient s MRO status when the booking for transport is made, and that contact 
precautions are required. 

&gt; Transport via taxi requires standard precautions only.  

3.2.4. Transmission-based precautions  

Contact precautions are recommended as the baseline precautions to be implemented for all 
CF patients.   

Whereas some microorganisms are spread predominantly by direct or indirect contact (e.g. 
B. cepacia, MRSA and P. aeruginosa) or by the droplet route (pertussis, influenza viruses), it is 
likely that most respiratory pathogens can be transmitted by a combination of pathways (i.e. 
both by contact and droplet). 

For information on application of infection control precautions to specific diseases see the 
SA Health Infection Control Management of Infectious Diseases Summary Table.  

See Appendix 2 for a summary of the personal protective equipment requirements.  

Clearly document the precautions required in the patient s medical record. Additional 
precautions should only be ceased by the clinical care team.  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 5 of 16 
Public   I2   A1 

 



 
 
The importance of respiratory hygiene and cough etiquette should be explained to patients who 
are placed on droplet precautions. 

3.2.5. Respiratory protection 

All staff who are required to be present during aerosol-generating procedures* (AGP) must wear 
a properly fit-tested P2/N95 respirator in accordance with the SA Health Respiratory Protection 
against Airborne Infectious Diseases Clinical Guideline, Dec 2013. 

Healthcare personnel who cannot wear or be adequately fitted with a disposable P2/N95 
respirator may be required to use a powered air purifying respirator (PAPR) with a disposable 
hood.  Training in the use of PAPR, including the safe removal of the equipment, must be 
undertaken prior to use.  

*Note: AGPs include but are not limited to open airway suctioning, intubation, bronchoscopy 
and use of a nebuliser.  

3.2.6. Infection control signage 

Place signage indicating the need for additional transmission-based precautions and the use of 
appropriate PPE outside of the patient room.  Appropriate signage can be accessed from: 
http://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/national-infection-
control-guidelines/. 

3.2.7. Dedicated patient equipment  

Only take minimum amounts of equipment and supplies into the patient s room.  Dedicate the 
use of non-critical items (e.g. stethoscope, sphygmomanometer etc.) to a single patient with CF 
where possible.  If this is not possible, clean and disinfect shared patient equipment prior to use 
on another patient. 

Patients should not use communal phones; however, if this is unavoidable ensure the phone is 
decontaminated using a large alcohol wipe prior to use and before returning to general use. 

3.2.8. Respiratory therapy equipment: nebulisers and diagnostic equipment 

Devices used for respiratory therapy (e.g., nebulisers) or for diagnostic evaluation (e.g., 
bronchoscopes and spirometers) are potential reservoirs for infectious organisms. Therefore, 
processes for proper cleaning and sterilization or disinfection of reusable equipment are 
essential components of a program to prevent infections of people with CF, both in the hospital 
and non-hospital setting.  

Although a patient s own respiratory flora usually contaminate nebulisers, it is prudent not to 
introduce those microorganisms into the lower respiratory tract during aerosol treatments.  
Single-dose medication vials are always preferred, due to the risk of contamination; if multi-dose 
medication vials must be used, then the manufacturer s directions for handling, dispensing, and 
storing must be followed precisely to prevent contamination and the transmission of potential 
pathogens). 

Proper training of personnel responsible for reprocessing equipment is important, including 
demonstration of competency initially and then at least annually, as is consistent adherence to 
reprocessing guidelines.  

For details refer to: Appendix 3:  Nebuliser cleaning and disinfecting recommendations. 
  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 6 of 16 
Public   I2   A1 

 





 
 
3.2.9. Environmental cleaning 

Thorough cleaning of the environment is an important strategy to minimise the risk of MRO 
transmission amongst CF patients.  Routine cleaning should be intensified by the use of a 
detergent/disinfection solution as per the SA Health Cleaning Standard for Healthcare Facilities 
Policy Directive, Oct2014.   

Key points are: 

&gt; Use a Therapeutic Goods Authority (TGA) approved hospital grade disinfectant (preferably 
with label claims against MROs) or a chlorine-based product at 1000 ppm available chlorine.  

&gt; Pay particular attention to all frequently touched surfaces, such as bedrails, door handles, 
commodes, toilet, hand basins and taps. 

&gt; Clean all patient equipment with detergent and water and disinfect prior to use on or by 
another patient.  A large detergent/disinfectant or alcohol wipe may be used to 
decontaminate small items of patient care equipment which are not visibly soiled.  A new 
wipe should be used for each item of equipment. 

&gt; On discharge, change non-disposable patient bedside curtains.  Change disposable 
antimicrobial curtains if visibly soiled, damaged or the use-by date has expired.  The room 
may be safely re-used once all steps are completed and all surfaces are dry. 

&gt; Ensure that all cleaning equipment and solutions are changed before moving to the next 
patient area/room. 

3.2.10. Staffing  

To decrease the risk of transmission of infectious organisms to other patients within the wards, 
staff should be educated and demonstrate competency in the application of both standard and 
transmission-based precautions. 

All healthcare personnel should be vaccinated against vaccine-preventable diseases, including 
annual vaccination against influenza.  (Refer to the SA Health Immunisation Guidelines for 
Health Care Workers in South Australia 2014). 

3.2.11. Visitors 

Under normal circumstances, there is no requirement for visitors to wear personal protective 
equipment (PPE).  However, there may be certain situations where PPE may be required (e.g., 
when a visitor is providing direct care and intends to visit another patient in the same facility).   

&gt; All visitors should be instructed to perform hand hygiene prior to leaving the patient s room.   
&gt; Patient s clothing may be taken home in a plastic bag for washing using a normal wash 

cycle.  

3.3. Management of CF patients in out-patient clinics and pulmonary function 
laboratories  

3.3.1. CF Outpatient Clinics 

Colonisation or infection with MROs or transmissible pathogens in CF patients should not 
prevent their treatment in outpatient clinics or other ambulatory care settings.  

Recommended infection control precautions for CF outpatient clinics include the following: 

&gt; Schedule CF patients in ways that minimises time in common waiting areas.   
&gt; Place people with CF, regardless of their respiratory culture results, in a consultation room 

immediately on arrival at the clinic. 
  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 7 of 16 
Public   I2   A1 

 



 
 
&gt; Consider use of a pager system or personal mobile phone to alert people with CF that a 

consultation room is available.  
&gt; Keep the person with CF in one consultation room while the CF care team rotate through the 

consultation rooms.  
&gt; Infants under 2 years of age should be separated from other people with CF in CF clinics 

until adequate infection control education has been provided to care givers. 
&gt; Separate newly diagnosed people with CF from other people in CF clinics until adequate 

infection control education has been provided and understood by newly diagnosed 
individuals. 

&gt; Clean and disinfect consultation rooms between patients using a TGA registered hospital 
grade detergent/disinfectant in accordance with local policy and procedures.  Allow 15   20 
minutes between patients for airborne contaminants to settle before cleaning frequently 
touched surfaces. 

3.3.2. Pulmonary Function Laboratory (PFL)  

In these settings, strict adherence to standard precautions (i.e. hand hygiene, cleaning shared 
patient equipment and environmental cleaning) for ALL patients will assist in minimising cross-
transmission risks. 

&gt; Provide hand hygiene products in Pulmonary Function Laboratories (PFLs).  
&gt; All staff must don gown and gloves prior to performing pulmonary function testing. Use one 

of the following options (where current facilities permit): 
1. Perform in examination room at start of clinic visit 
2. Perform in PFL, allowing 30 minutes to elapse before next CF patient enters lab 
3. Perform in a negative pressure room 
4. Perform in a room with HEPA filtered air supply. 
Note: All new facilities should be designed to comply with this requirement. 

&gt; Use a disposable mouthpiece for each patient.  
&gt; Patients should not touch PFL machines or computers. 
&gt; Clean the surface of PFL machines and other frequently-touched surfaces (e.g., computer 

keyboard, door handles) after each patient using detergent/disinfectant wipes. 

3.4. Management of CF patients in community settings 
Contact precautions (gloves and gowns) should be used for all close contact with all patients 
with CF in out of hospital settings e.g. homes, schools, to minimise contact of clothes with 
respiratory secretions.  Hand hygiene must be performed before and after patient contact and 
procedures.   

Ensure that any shared patient equipment is cleaned and disinfected prior to use on another 
patient. 

3.5. Patient education and support  
It is important to effectively partner with the CF community to share information on best 
practices, including written policies, quality improvement initiatives, educational materials, and 
strategies for avoiding face-to-face interactions among individuals with CF, as well as 
information from studies related to infection prevention and control practices.  

Inform the patient and their family/carer (as appropriate) of their MRO status as soon as 
possible and provide information that clearly explains the importance of infection control and 

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 8 of 16 
Public   I2   A1 

 



 
 
MROs, how to prevent transmission whilst in hospital and how it is managed once discharged.  

It is recommended that patients are informed of the importance of hand and respiratory hygiene, 
and immunisation against vaccine-preventable diseases. 

3.6. Drug treatment and antimicrobial stewardship 
It is recommended that policies and procedures are in place to promote judicious antibiotic use, 
particularly of broad spectrum antibiotics, in order to limit the increased development of 
antibiotic resistant microorganisms.  Refer to the SA Health Antimicrobial Prescribing Clinical 
Guideline.   

3.7. Surveillance and screening for carriage of potential pathogens 
Routine real-time surveillance for epidemiologically significant microorganisms is recommended 
in the acute care setting to understand endemic rates of carriage and to identify outbreaks as 
soon as possible.  

3.7.1. Screening for non-tuberculous mycobacteria (NTM)  

Traditionally NTM have been regarded as environmental opportunistic pathogens and person-
to-person transmission was thought to be unlikely.  Most infections were thought to arise in 
susceptible individuals, including those with cystic fibrosis, from environmental sources such as 
water, soil and biofilms.  However, in recent years the data appear to be conflicting, with some 
studies suggesting that person-to-person transmission is unlikely or rare, and others describing 
M. abscessus cross-infection associated with health facilities and hospitals.  

The US Cystic Fibrosis Foundation and European Cystic Fibrosis society released guidelines 
regarding management of NTM in late 2015.  These included the issue of cross-infection.  Their 
recommendation is that, in the absence of definitive evidence, it should be assumed that cross-
infection is an important mechanism for acquisition of M. abscessus.  

The following actions are recommended:   

&gt; Perform sputum cultures for NTM annually in spontaneously expectorating individuals with a 
stable clinical course.  

&gt; Oropharyngeal swabs are not suitable for NTM screening.  
&gt; In the absence of clinical features of NTM pulmonary disease, individuals who are not 

capable of spontaneously producing sputum do not require screening cultures for NTM.  
&gt; All NTM isolates from individuals with CF should undergo molecular identification. 

3.7.2. Screening for Burkholderia cepacia complex 

There is insufficient evidence at the time of writing to recommend criteria by which to consider a 
person with CF who previously had Burkholderia species isolated from respiratory tract cultures 
to be  Burkholderia free .  

It is recommended that that CF centres obtain and review quarterly surveillance reports (e.g. 
data from the local clinical microbiology laboratory) on the incidence and prevalence of 
respiratory tract pathogens at their centres.  This review should be conducted in collaboration 
with institutional infection prevention teams and a clinical microbiologist from the laboratory. 

The CF Foundation Guideline recommends that molecular typing of B. cepacia complex isolates 
and other significant microorganisms (e.g., P. aeruginosa and NTM) is performed when 
epidemiologically indicated (e.g., in suspected patient-to-patient transmission).  

  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 9 of 16 
Public   I2   A1 

 



 
 
3.7.3. Screening for multi-resistant organisms  

CF patients are noted to have ongoing or re-emergence of MROs due to frequent antibiotic 
therapy.  

In the acute health care setting, screening for clearance of MROs for the discontinuation of 
contact precautions is not recommended.  All healthcare personnel must implement contact 
precautions at all times (i.e., wear a gown and gloves) when caring for all people with CF 
regardless of respiratory tract culture results, in both inpatient and non-inpatient settings. 

3.7.4. Collection of specimens 

Obtain specimens in accordance with local procedures with the additional steps of using a 
consultation room at the start of a clinic visit or in the patient s room away from other CF 
patients. 

3.7.5. Alerting patient records  

Infection control alerts should be placed in the patient s medical records in accordance with the 
practices of the health care facility.  This can include alerts for MROs and other significant 
organisms (such as Burkholderia spp. and M. abscessus). Infection control alerts can be set 
electronically through either the facility s patient administration system, Oacis-ICIMS or EPAS. 

3.7.6. Staff with cystic fibrosis 

Staff who have CF and are colonised or infected with MROs should be managed in accordance 
with the Cystic Fibrosis Australia guidelines.  

 
 
4. Implementation and Monitoring  
 
It is the responsibility of LHNs to implement the measures contained in this guideline and to 
monitor the clinical outcomes. 

This may be achieved by: 
&gt; regular audit of infection control practice in CF clinics and pulmonary function laboratory 
&gt; regular review of the incidence of colonisation with key multi-resistant organisms and other 

organisms of clinical significance in this patient group to determine whether there is any 
indication of cross-transmission occurring within the healthcare environment. 

 
 
5. National Safety and Quality Health Service Standards  

 
The following National Safety and Quality Health Service Standards (NSQHSS) standards apply: 

Standard 1 - Governance for Safety and Quality in Health Service Organisations 

 
 

National 
Standard 1 

 
Governance 

for Safety 
and Quality 

in Health 
Care 

 

 
 

National 
Standard 2 

 
Partnering 

with 
Consumers 
 
 
 

 
 

National 
Standard 3 

 
Preventing 

&amp; 
Controlling 
Healthcare 
associated 
infections 

 
 

National 
Standard 4 

 
Medication 

Safety 
 
 
 
 

 
 

National 
Standard 5 

 
Patient 

Identification 
&amp; Procedure 

Matching 
 
 

 
 

National 
Standard 6  

 
Clinical 

Handover 
 
 
 

 

 
 

National 
Standard 7 

 
Blood and 

Blood 
Products 

 
 

 

 
 

National 
Standard 8 

 
Preventing 

 &amp; 
Managing 
Pressure 
Injuries 

 

 
 

National 
Standard 9 

 
Recognising &amp; 
Responding to 

Clinical 
Deterioration 

 
 

 
 

National 
Standard 10 

 
Preventing 

Falls &amp; 
Harm from 

Falls 
 
 

? ? ? ? ? ? ? ? ? ? 

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 10 of 16 
Public   I2   A1 

 







































































 
 
Standard 2 - Partnering with Consumers.  

&gt; Criterion 2.2.2.   Consumers and/or carers are actively involved in decision making about safety 
and quality.  

Standard 3 - Preventing and Controlling Healthcare Associated Infections, in particular Managing 
patients with infection or colonisations: 

&gt; Criterion 3.11 - Implementing systems for using standard precautions and transmission-based 
precautions. 

&gt; Criterion 3.12 - Assessing the need for patient placement based on the risk of infection 
transmission. 

&gt; Criterion 3.13 - Developing and implementing protocols relating to the admission, receipt and 
transfer of patients with an infection 

 
 
6. Definitions  
 
In the context of this document: 
 
AGP refers to: aerosol-generating procedures, such as intubation, bronchoscopy, 

sputum induction including airway clearance techniques, nebulised drug 
administration. 

Colonisation means: the presence, growth and multiplication of microorganisms without 
observable signs or symptoms of infection. 

Infection means: invasion of microorganisms into host tissues with replication of the 
organism accompanied by signs or symptoms of illness. 

MRO refers to: multidrug-resistant organism. 

NTM refers to: non-tuberculous mycobacteria. 

Pathogen means: a microorganism that is capable of establishing infection and 
causing disease. 

Respirator means: a tight-fitting, disposable high filtration mask (N95 or P2) that is 
designed to protect the wearer from airborne contaminants, including 
respiratory pathogens. 

 
 
  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 11 of 16 
Public   I2   A1 

 



 
 
7. Associated Directives / Guidelines &amp; Resources  

7.1. SA Health policies and guidelines 
 

SA Health Antimicrobial Prescribing Clinical Guideline.  Available at: 
http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+res
ources/clinical+topics/medicines+and+drugs/antimicrobial+guidelines/antimicrobial+guidelines?
contentIDR=26299e004f9fd09c8f34dfc4163822ed&amp;useDefaultText=0&amp;useDefaultDesc=1  
SA Health Cleaning Standard for Healthcare Facilities Policy Directive, Oct 2014. Available at: 
https://www.sahealth.sa.gov.au/infectionprevention 

SA Health Hand Hygiene Policy Directive, Jan 2016. Available at: 
https://www.sahealth.sa.gov.au/HandHygiene 

SA Health Immunisation Guidelines for Health Care Workers in South Australia 2014 Policy 
Guideline. Available at: http://inside.sahealth.sa.gov.au/wps/wcm/connect/non-
public+content/sa+health+intranet/business+units/health+system+development/office+of+the+c
hief+executive/policies/guidelines/immunisation+guidelines+for+health+care+workers+in+south
+australia+2014+policy+guideline 

7.2. Resources 
Australian Guidelines for the Prevention and Control of Infection in Healthcare, 2010. Available 
at:  https://www.nhmrc.gov.au/guidelines-publications/cd33 

Cystic Fibrosis Australia. Infection Control Guidelines for cystic fibrosis patients and carers. 2nd 
ed., 2012. Available at: http://www.cysticfibrosis.org.au/cfa/infection-control 

Cystic Fibrosis Australia. Infection Control Policy, 2015. Available at: 
http://www.cysticfibrosis.org.au/cfa/infection-control  

Cystic Fibrosis Australia patient fact sheets: http://www.cysticfibrosis.org.au/all/fact_sheets 

Cystic Fibrosis Australia Standards of Care: http://www.cysticfibrosis.org.au/cfa/standards-of-
care  

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update.  
Saiman L et al, Infection Control and Hospital Epidemiology, Vol. 35, S1, pp S1-S67. The 
Society for Healthcare Epidemiology of America (SHEA). 

SA Health Management of Infectious Diseases Summary Table. Available at: 
https://www.sahealth.sa.gov.au/infectionprevention 

7.3. References: 
1. Kidd TJ, Ramsay KA, Hu H, Marks GB, Wainwright CE, Bye PT, et al. Shared 

Pseudomonas aeruginosa genotypes are common in Australian cystic fibrosis centres.  
Eur Respir J. 2013;41(5):1091-100. 

2. Griffiths AL, Wurzel DF, Robinson PJ, Carzino R, Massie J. Australian epidemic strain 
Pseudomonas (AES-1) declines further in a cohort segregated cystic fibrosis clinic.  
J Cyst Fibros. 2012;11(1):49-52. 

3. Knibbs LD, Johnson GR, Kidd TJ, Cheney J, Grimwood K, Kattenbelt JA, et al. Viability of 
Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis. 
Thorax. 2014;69(8):740-5. 

4. Kerem E, Conway S, Elborn S, Heijerman H, Consensus C. Standards of care for patients 
with cystic fibrosis: a European consensus. J Cyst Fibros. 2005;4(1):7-26. 

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 12 of 16 
Public   I2   A1 

 



















 
 
5. Kapnadak SG, Hisert KB, Pottinger PS, Limaye AP, Aitken ML. Infection control strategies 

that successfully controlled an outbreak of Mycobacterium abscessus at a cystic fibrosis 
center.  Am J Infect Control. 2016;44(2):154-9. 

6. Harris KA, Underwood A, Kenna DT, Brooks A, Kavaliunaite E, Kapatai G, et al. Whole-
genome sequencing and epidemiological analysis do not provide evidence for cross-
transmission of Mycobacterium abscessus in a cohort of pediatric cystic fibrosis patients. 
Clin Infect Dis. 2015;60(7):1007-16. 

7. Harris KA, Kenna DT. Mycobacterium abscessus infection in cystic fibrosis: molecular 
typing and clinical outcomes.  J Med Microbiol. 2014;63(Pt 10):1241-6. 

8. Floto RA, Olivier KN, Saiman L, Daley CL, Herrmann JL, Nick JA, et al. US Cystic Fibrosis 
Foundation and European Cystic Fibrosis Society consensus recommendations for the 
management of non-tuberculous mycobacteria in individuals with cystic fibrosis.  
Thorax. 2016;71 Suppl 1:i1-22. 

7.4. Appendices 
Appendix 1: Recommended precautions and personal protective equipment (PPE) 

summary 

Appendix 2: Nebuliser and airway clearance device cleaning and disinfecting 
recommendations  

Appendix 3: Summary of strategies to minimise the risk of transmission of potential 
pathogens  

 
 
8. Document Ownership &amp; History 
 

Approval 
Date Version 

Who approved New/Revised 
Version Reason for Change 

01/08/17 v1.0 SA Health Policy Committee Original. 

    

    
 
 

  

Document developed by:  Communicable Disease Control Branch, System Performance &amp; 
Service Delivery  

File / Objective No.: 2017-02259  |  eA979720 
Next review due:   1/08/2022  
Policy history: Is this a new policy (V1)?  Y  
 Does this policy amend or update and existing policy?   N 
 If so, which version? 
 Does this policy replace another policy with a different title?  N 
 If so, which policy (title)? 
 

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 13 of 16 
Public   I2   A1 

 



 
 
Appendix 1: Recommended precautions and personal protective equipment 

(PPE)  

PPE 
Recommendations for healthcare staff, patient or visitors 

Healthcare staff People with CF Family members &amp; visitors 
GLOVES &gt; Wear when caring 

for all people with 
CF. 

&gt; Not recommended 
routinely. 

&gt; Perform hand 
hygiene. 

&gt; Not recommended 
routinely.  

&gt; Use as defined in 
local health care 
facility policy when 
visiting hospitalised 
patients. 

 

GOWN or 
APRON 

&gt; Wear when caring 
for all people with 
CF. 

&gt; Not recommended 
routinely. 

SINGLE-USE 
FACE MASK 

&gt; Wear when caring 
for all people with 
CF as indicated for 
Contact / Droplet 
Precautions. 

&gt; Patient 
recommended to 
wear a mask on 
leaving their room or 
when in common 
areas including out-
patient clinics. 

P2 / N95 
RESPIRATOR 

&gt; Wear when caring 
for all people with 
CF under airborne 
precautions and 
when performing 
any aerosol-
generating 
procedures. 

&gt; Not required. 

GOGGLES / 
FACE 
PROTECTION 

&gt; Wear when caring 
for all people with 
CF, as per 
Standard 
Precautions and  
as indicated for 
Droplet / Airborne 
Precautions. 

&gt; Not recommended 
routinely. 

 
Adapted from: Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update. Saiman L et al, Infection 
Control and Hospital Epidemiology, Vol. 35, No.S1, Cystic Fibrosis Foundation Guideline (August 2014), pp S1-S67. The 
Society for Healthcare Epidemiology of America (SHEA).  
  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 14 of 16 
Public   I2   A1 

 



 
 
Appendix 2: Nebuliser and airway clearance device cleaning and 

disinfecting recommendations  
Proper processes for cleaning and sterilisation or disinfection of reusable equipment are essential 
components of a program to prevent infections in people with CF.  Training of personnel 
responsible for reprocessing reusable equipment is important, including demonstration of 
competency. Specific manufacturers  instructions for reprocessing should be followed. 

Disposable and reusable nebulisers are for single patient use only. 
Airway clearance devices must be sterilised by a hospital sterilising department between patients 
according to manufacturer recommendations. 

Disposable nebulisers 
Key principles for the care of disposable nebulisers in the healthcare setting are: 

&gt; Disposable nebulisers and associated equipment should be replaced as per manufacturer s 
instructions. 

&gt; When handling the nebuliser and dispensing medications, aseptic technique should be followed. 
&gt; Nebulisers should be handled away from sinks to prevent contamination. 
&gt; Only sterile water should be used for rinsing nebulisers, and filling of humidifier reservoirs. 
&gt; Use sterile saline for nasal rinses. 
&gt; After each use, residual volume should be rinsed out with sterile water, and masks/mouthpieces 

wiped with an alcohol wipe. 
&gt; Air-dry the nebuliser away from sinks to prevent contamination. The safety of storing moist 

nebulisers in plastic bags is unknown.  
&gt; Nebuliser contamination between uses can be avoided by not placing them in line with a 

ventilator circuit, which may expose the nebuliser to tubing condensation. 

Reusable nebulisers and airway clearance devices e.g. Pari nebulisers, PariPEPs 
&gt; After use, dismantle the nebuliser or airway clearance device, and manually clean all parts 

using a hospital approved detergent in a clean bowl or jug.  
Note: Do not use room hand basin for cleaning. 
&gt; Rinse nebuliser or airway clearance device parts in bottled sterile water.  After rinsing, shake off 

excess water and leave to air dry. 
&gt; After drying store in a manner that will prevent contamination.  For example wrap the nebuliser 

in a single use lint-free cloth and place in a kidney dish or bowl which could then be placed into 
a single use brown paper bag or bedside drawer.  

 
Note:   If patients or their carers are able to do so, they should be encouraged to clean their own 

nebuliser whilst in hospital as per the above instructions. 
Patients should be educated regarding the importance of continuing the above cleaning 
process when discharged home.   

 

  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 15 of 16 
Public   I2   A1 

 



 
 
Appendix 3: Summary of strategies to minimise the risk of transmission of 

potential pathogens in CF clinics  

Item Specific Strategies  
Scheduling &gt; Stagger clinic schedule. 

&gt; Place patient in consultation room immediately. 

Reception area &gt; Provide hand hygiene supplies, tissues and single use face masks. 
&gt; Encourage all people entering the facility to perform hand hygiene.  
&gt; CF patients to put on single use face masks on entry into the clinic. 
&gt; Maintain a distance of at least 2 metres between all people with CF.  

Waiting room &gt; Continue strategies used in reception area. 
&gt; Advise people with CF, if necessary, to wait in another identified location 

where no others with CF will be present. 
&gt; Call patients  mobile phones when examination room available. 
&gt; No common use toys or computers. Patients should bring their own toys, 

books, iPods, iPads, etc. 

Common areas &gt; CF patients to wear a single use face mask in all public areas of the 
hospital. 

Consultation 
room activities 

&gt; All patients and staff to perform hand hygiene on entry into and exiting 
from the consultation room. 

&gt; Obtain heights and weights in consultation rooms. 
&gt; All staff members to don gowns and gloves either before or on entry into 

consultation room. 
&gt; Shared patient equipment should be decontaminated with 

detergent/disinfectant wipes between patient use. 
&gt; People with CF do not need to wear a face mask whilst in the room. 

Pulmonary 
Function Testing 
(PFT)  

&gt; All patients and staff to perform hand hygiene prior to procedure. 
&gt; Decontaminate surface of PFT machines and other high-touch surfaces 

(e.g., computer keyboard, door handles) after each patient. 
&gt; Use disposable mouthpiece for each patient. 
&gt; Patients should not touch PFT machines or computers. 

Restrooms &gt; CF patient to keep face mask on when entering and using public 
restrooms. 

&gt; Perform hand hygiene before and after using toilet. 

Respiratory 
specimens 

&gt; Obtain specimens in consultation room at start of clinic visit. 

Clinic cleaning &gt; All frequently touched surfaces in the consultation room must be 
decontaminated using a TGA registered hospital-grade 
disinfectant/detergent after each patient. 

&gt; Schedule daily cleaning by hotel services of consultation rooms and 
common areas, including reception area, waiting room, PFT laboratory, 
sinks, and bathrooms.   

&gt; Perform regular audits of cleaning. 

Adapted from: Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update. Saiman L et al, Infection 
Control and Hospital Epidemiology, Vol. 35, Suppl.1, pp S1-S67. The Society for Healthcare Epidemiology of America 
(SHEA).  

INFORMAL COPY WHEN PRINTED Cystic Fibrosis Infection Prevention &amp; Control Clinical Guideline v1.0 Page 16 of 16 
Public   I2   A1 

 


	1. Policy Statement
	2. Roles and Responsibility
	3. Policy Requirements
	3.1. Background

	4. Implementation and Monitoring
	5. National Safety and Quality Health Service Standards
	6. Definitions
	7. Associated Directives / Guidelines &amp; Resources
	7.1. SA Health policies and guidelines
	7.2. Resources
	8. Floto RA, Olivier KN, Saiman L, Daley CL, Herrmann JL, Nick JA, et al. US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibros...
	7.4. Appendices

	8. Document Ownership &amp; History

</pre>
</body>
</html>