Basics of Controlling Infection
"Bugs" (germs/bacteria) find a good place to live in the lungs of people with CF. They come from lots of places in the world you live in, including warm, damp dirt, around and in water, to name a few, and through close contact with other people.
You can’t control everything or go live in a bubble, but you should try to control some important things, like:
- Keeping germs away from your nose and mouth by washing your hands OFTEN and avoid touching your hands to your mouth and nose as much as possible.
- Avoiding close contact with others with CF.
- Regularly and carefully cleaning the nebulizer equipment you use to put medications into your lungs.
You probably also want to know how to best handle some, shall we say, delicate situations like being out on a date. A couple of quickies to remember:
- You CAN’T get these "bugs" from kissing someone who doesn’t have CF.
- If you kiss someone who has CF, you CAN give your bugs to them and you can get their bugs.
So be careful who you kiss … or share food and drink with ... or get close to.
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You may also want to know how to handle some common situations. Let’s say you have an office mate who has a cold and is coughing.
You can get a chart from the Centers for Disease Control and Prevention (CDC) website on how to cover your cough and stop the spread of germs. Try posting the CDC chart on protecting your cough in the restroom that you and your co-workers use.
Put hand sanitizer and tissues on prominent display on your desk.
If you feel comfortable, let your office mate know that respiratory viruses are harder for you to handle than the “average Joe” and ask him/her to help you by limiting personal contact and using email or texting with you for at least three days when he or she has a cold.
Beyond the Basics
Why is it easier for me to get germs?
As discussed elsewhere in this guide, a gene mutation causes a problem with the CFTR protein. This protein helps your body move fluids in an out of the cells. This helps regulate the fluids for digestion, sweat and mucus.
When CFTR is not working right, the mucus in your lungs does not have enough fluid for it to flow and move out of your body. In CF, this is what causes the mucus to become thick and sticky (think paste vs. slime).
The thick mucus then interrupts one of the normal ways the lungs stay clean. The thick sticky mucus pushes down on cilia, which are hair-like projections on cells in your nose and lungs that normally trap and sweep away debris out of the lungs.
So the mucus, combined with the interruption of the cilia’s job of cleaning, creates a perfect environment for germs to thrive and thus for infections to grow.
The infections that grow in this environment are chronic (or long-lasting). As the germs multiply, your body tries to fight the infection by sending white blood cells to the lung. This creates inflammation, which leads to swelling and increased secretions and mucus.
Inflammation and chronic infections lead to scarring and changes in the lungs — the medical term for this is bronchiectasis.
This process repeats itself in CF and is called the “vicious cycle” of infection and inflammation.
Unfortunately, bacterial infections are the major cause of lung health getting worse in people with CF. At this time, the best therapy is prevention or infection control.
How do I come in contact with these germs in the first place?
There are three ways that germs get picked up: contact, droplet and airborne transmission. The two we are most concerned with in CF are contact and droplet.
- Contact transmission is the most frequent type of transmission of germs and it includes both direct contact and indirect contact. Common bugs or germs that are spread through contact transmission include Pseudomonas aeruginosa and Burkholderia cepacia complex.
- Droplet transmission is when germs are passed short distances by coughing, sneezing or talking. An example of a germ spread by droplet is seasonal influenza (the flu).
- Airborne transmission is when germs are carried through the air on dust particles and are inhaled. Tuberculosis and Aspergillus are spread this way.
For more details on how germs spread, see the CF Foundation fact sheet “Lung Health: What You Should Know About Germs.”
Which germs should I be worried about?
Respiratory germs that can cause respiratory infections in CF include three categories:
- Bacteria are microorganisms that are all around us (in soil, water, on our skin, on surfaces, etc). Most bacteria are regarded as harmless and not a threat to your lungs.
Some bacteria are common in cystic fibrosis and can cause chronic problems. These include Pseudomonas aeruginosa, Staphylococcus aureus and Burkholderia cepacia complex (see table below).
- Respiratory viruses are microorganisms that multiply inside our living cells. Examples are influenza (the flu) and rhinovirus (the common cold). Viruses are often seasonal in nature and are spread between people.
- Fungi or molds are sometimes also called yeast. One example of fungus seen in CF lung disease is Aspergillus fumigatus.
|Influenza (flu) - A virus that any person can catch. It makes people with CF sicker than it does people without CF. A yearly flu shot can prevent this. People with CF who are 6 months and older and their families and friends should get the yearly shot.
||In any person who has the flu.
|Common cold viruses - Many types of viruses cause colds. They often affect the nose and throat. People with CF aren't more likely to get colds than people without CF, but they may get sicker.
||In people with colds or on items they've touched.
|Respiratory synchytial virus (RSV) - A virus that can cause sever lung illness. It most affects young children and older people.
||In people who have RSV. RSV can cause common cold symptoms in older children and adults. The virus can live on a surface for six hours.
|Staphylococcus aureus - (STAFF-lh-cock-us-OR-ee-us) (S. aureus) and methicillin-resistant S. aureus (MRSA) - Often the first bacteria found in the lungs of people with CF. MRSA is more resistant to antibiotics than other bacteria and is harder to treat.
||In people who have S. aureus or MRSA on the skin or in the nose or lungs.
|Pseudomonas aeruginosa - (Soo-duh-MOAN-us uh-roo-gin-OH-suh) (Pseudomonas) - Bacteria that causes many lung problems in people with CF. About 35% of children with CF have it in their lungs. About 73% of adults with CF have it. It can be resistant to antibiotics.
||Often unknown and in other people with CF and on respiratory equipment that has not been cleaned the right way. It may live in nature or on other objects. It can live on a surface for hours.
|Burkholderia cepacia complex - (Bur-cold-AIR-ee-uh suh-PAY-shuh) (B. cepacia) - A group of bacteria spread between people with CF. It can lower lung function quickly. In the United States, less than 3% of people with CF have this.
||In other people with CF and on respiratory equipment that has not been cleaned the right way.
|Nontuberculous mycobacteria (NTM) - A group of bacteria that can cause lung problems in people with CF. Researchers are studying how common it is and its effect on people with CF.
||In nature and on respiratory equipment that has not been cleaned the right way.
|Aspergillus fumigatus - A fungus found in the lungs of people with CF. It can cause allergic bronchopulmonary aspergillosos (ABPA) in some.
||In nature. It gets into the air through building materials and activities, gardening, lawn mowing and water leaks.
|Stenotrophomonas maltophillia - (S. maltophillia) - Bacteria that can cause lung problems in people with CF. It may resist antibiotics. Researchers are studying how common it is and its effect on people with CF.
||Maybe contact. More research is needed.
||Much is unknown. It may live in other people with CF, in nature or on respiratory equipment and other objects that have not been cleaned the right way.
|Achromobacter xylosoxidans - (A. xylosoxidans) - Bacteria that can cause lung problems in people with CF. Researchers are studying how common it is and its effect on people with CF.
Maybe contact. More research is needed.
|Much is unknown. It may live in other people with CF, in nature or on respiratory equipment and other objects that have not been cleaned the right way.
I was told I have a multiple-drug-resistant organism. What does that mean?
Multiple-drug-resistant organisms (MDRO) in CF are bacteria that have become resistant to either a certain antibiotic or to multiple types of antibiotics. Resistance means that the antibiotic does not work to kill or weaken the bacteria. Some bacteria are naturally resistant to antibiotics.
For others, resistance happens when the bacteria is exposed to antibiotics over time. With each exposure the bacteria can make changes to outsmart the antibiotics.
You can also get this type of germ by coming into contact with a person infected with the resistant bacteria or equipment that has been contaminated (has the germ on it).
Drug-resistant bacteria can be a problem in CF, as they can make treating your lung infections and exacerbations more difficult. You can read more about resistance by reading “Bacterial and Antibiotic Resistance in People with Cystic Fibrosis.”
This brings us to a very important point. The misuse of antibiotics is one of the leading causes of antibiotic resistance. So when you are prescribed antibiotics, you need to take the prescription as it was ordered and finish it unless you are told otherwise by your health care provider.
Sometimes we may forget, or we start to feel better and decide we’ll save the antibiotic for “when we really need it.” But that is never a good idea! It can lead to the antibiotic not working any more to fight infections.
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