1 / 25

Gruppo Infermieri del GIFC

Strategies for infection control adopted in the Italian CF Centers. Silvana Ballarin, RN Filippo Festini, RN BA Carmen Loganes, RN on behalf of the Italian Cystic Fibrosis Nurses’ Group. www.infermieri-fc.net Infermieri-fc@iol.it. Gruppo Infermieri del GIFC.

faye
Download Presentation

Gruppo Infermieri del GIFC

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Strategies for infection control adopted in the Italian CF Centers Silvana Ballarin, RN Filippo Festini, RN BA Carmen Loganes, RN on behalf of the Italian Cystic Fibrosis Nurses’ Group www.infermieri-fc.net Infermieri-fc@iol.it Gruppo Infermieri del GIFC

  2. Although the way CF patients get in contact with respiratory pathogens such as PA or BC, has not been completely explained, healthcare settings seem to play a role in determining the risk for patients of contracting infection. Segregation, reduction of overcrowding, behavioral rules for caregivers and patients and other measures have showed to be effective in reducing the risk, in some cases. • aims of the survey • to evaluate the measures adopted by the Italian CF Centers to prevent and control infections sustained by respiratory pathogens in CF patients • to provide data for a future possible Italian consensus on this issue

  3. materials and methods Standardized questionnaire, sent to all 21 Regional centers (15 mixed, 3 adult, 3 pediatric) and 7 local CF Services. 24 questions results Answers from 16 Regional Centers (11 mixed, 3 adult, 2 pediatric) and 5 local services. =3363 patients (88.9% of Italian CF population) Results will be presented both as number of Centers and as % of patients followed

  4. 7 Centers (51.7% pts): non-shared healthcare setting 14 Centers (48.3% pts): healthcare settings in common with other services and diseases • Airways culture is usually performed every 3 months in 18 Centers. (1 Center less frequently, 2 Centers more frequently). • In 15 Centers (84.7% pts) all caregivers are aware of pathogens present in last culture of patients they are taking care of. • 10 Centers (50.6%) have a written protocol about the infection control issue.

  5. Respiratory pathogens found in the last sputum or throat swab culture of patients: Percentages are not reciprocally exclusive. (*) missing data from 5 Centers

  6. SEGREGATION POLICIES Segregation with regard to B. Cepacia is implemented in all Italian Centers Types of segregation policies adopted

  7. WHAT KIND OF SEGREGATION MEASURES ? Ambulatory settings: fixing visits in different days according to airways colonization is a segregation measure adopted in all Italian Centers kind of segregation measures adopted Inpatient settings: single room and bathroom in all CF Centers, except one

  8. STAFF HYGIENIC PRACTICES Frequent hands washing: all Centers Hands disinfection: 13 Centers (73.5% of pts) Use of disposable gowns and gloves: (only for assisting some types of pts i.e. with BC or MRSA) 13 Centers (74.2% pts)

  9. REDUCTION OF ENVIRONMENTAL CONTAMINATION • Measures to reduce the presence of pts • in the waiting room: 16 Centers (63.1%) • Ventilation of visiting room: daily 19 Centers • after each examination 17 Centers (52.8%) • Disinfection of visiting rooms’ surfaces: daily18 Centers (93.2%) • after each examination 4 Centers (19.8%) • Daily disinfection of waiting rooms’ surfaces: 18 Centers (90%) • Disinfection of wash-basin siphons: 11 Centers (69%) • Nebulisation of disinfectants in visiting rooms:3 Centers (7.9%) • No aerosolised therapy in the outpatient clinic:12 Centers (51.4%) • No toys, books etc. in the waiting room:15 Centers (71.9%)

  10. DISINFECTANTS n. of Centers using each type of disinfectant for each kind of substrate

  11. SPIROMETRY TESTING Measures adopted are wide-ranging, as they depend on the type of device used Use of disposable mouthpieces: 19 Centers (89.2% of pts) Use of antibacterial filters: 18 Centers (84.5% of pts) 1 Center: disinfection of mouthpiece, not disposable (missing data from 1 Center)

  12. RESPIRATORY PHYSIOTHERAPY EQUIPMENT No shared physio equipment, only personal ones 14 Centers (50.2% of pts) Use of common physio equipment after sterilisation 5 Centers Use of common physio equipment after disinfection 2 Centers Suggested disinfection at home: Possible more than one at the same time Amukine: 12 Centers (54.1% of pts) Acetic Acid: 13 Centers (53.8% of pts) Boiling (or steam): 5 Centers (27.6% of pts) Vinegar: 2 Centers

  13. AEROSOL THERAPY EQUIPMENT No shared A.T. equipment, only personal ones 14 Centers (56.7% of pts) Use of common A.T. equipment after sterilisation 3 Centers Use of common A.T. equipment after disinfection 4 Centers Suggested disinfection at home: Possible more than one at the same time Amukine: 12 Centers (54.1% of pts) Acetic Acid: 13 Centers (53.8% of pts) Boiling (or steam): 6 Centers (35.1% of pts)

  14. ENVIRONMENTAL MICROBIOLOGIC SURVEILLANCE Periodical cultures of specimens from the environment of healthcare setting are performed in 7 Centers (45.7% of pts). Occasional or periodical cultures on staff members (hands etc.) are performed in 5 Centers (43.1%)

  15. BEHAVIOURAL RULES FOR PATIENTS Informational material on infection control issue for patients available in 10 Centers (57.4% of pts) Beahioural rules for pts strongly suggested or mandatory in CF Centers (n. of Centers and % of pts)

  16. DATA ANALISYS (1) P.aeruginosa in last culture OR 2.75 (CI95% 2.37-3.19) χ2 p<0.001 B.cepacia in last culture OR 1.46 (CI95% 1.09-1.94) χ2 p=0.007 Segregation with regard toPA seems effective in determining a lower prevalence of PA colonization. Is it effective in reducing prevalence of BC colonisation too ?

  17. DATA ANALISYS (2) Multiresistant P.aeruginosa in last culture OR 2.82 (CI95% 2.1-3.79) χ2 p<0.001 Data from 5 Centers missing ! Segregation with regard toMR PA seems effective in determining a lower prevalence of MR PA colonization.

  18. DATA ANALISYS (3) Meticillin resistant S.Aureus in last culture OR 1.48 (CI95% 1.06-2.07) χ2 p=0.015 Segregation with regard toMRSA seems effective in determining a lower prevalence of MRSA colonization.

  19. DATA ANALISYS (4) No correlation between the prevalence of each single pathogen in each CF Center and : - Number of patient followed by each Center - Number of yearly visits performed in the outpatient Clinic

  20. DATA ANALISYS (5) Use of structures (premises, rooms, staff, equipment etc) in common with other Services which take care of different diseases: Multiresistant P.aeruginosa in last culture OR 1.96 (CI95% 1.47-2.62) χ2 p<0.001 Data from 5 Centers missing ! Is the use of non-shared structures effective in reducing the prevalence of MR PA? No significant differences in prevalences of PA, BC and MRSA

  21. DATA ANALISYS (6) Comparison with 2001 CFF Registry data: Higher prevalence of P.aeruginosa in USA than in Italy (58.8% vs. 54.1%, χ2 p<0.001) Higher prevalence of B.cepacia in Italy than in USA (6.4% vs.3.1%, χ2 p<0.001)

  22. DISCUSSION (1) • In general, policies and measures adopted by Italian Centers seem effective in controlling infections from respiratory pathogens in CF patients. • Nonetheless in a few Centers some measures are still being used whose inefficacy has been proved (e.g. environmental nebulisation of disinfectant) or which put patients at serious risk of contamination (e.g. use of shared AT devices after simple disinfection).

  23. DISCUSSION (2) • Many factors are involved in and concur to the prevention and control of infection from respiratory pathogens in CF: • Characteristics of the CF Center’s structure • Type of segregation policy adopted • Measures of segregation adopted • Protocolos of disinfection used • Staff members’ hygienic practices • Behavioural rules suggested to patients • A local policy for infection control should consider as many factors as possible among the above mentioned, considering available resources. • Many CF Centers staffs have complained of the shortage of structural, logistic and human resources available, which seems to be an important barrier to an effective infection control.

  24. SUGGESTIONS • Adopt a written protocol for prevention and control of infections from respiratory pathogens, which takes into account the resources available locally. • Provide that all staff members are aware of the airways microbiological status of the CF patients they are assisting. • Consider the implementation of regular environmental microbiological controls. • Program a Consensus on national guidelines about prevention and control of infections

  25. Italian Cystic Fibrosis Nurses’ Group Gruppo Infermieri del GIFC www.infermieri-fc.net infermieri-fc@iol.it

More Related