Controlling the Spread of Germs

Germs are everywhere, and for people with CF, some germs can cause major respiratory or lung infections. It's important to know about germs, how they spread, and how to protect yourself and your family members.

Germs (commonly known as viruses or bacteria) spread from one person to another in many ways, most commonly the three major routes of transmission: contact, droplets or airborne. These germs thrive in the thick mucus that forms in the lungs of people with CF, so they can get more frequent and more serious cases of these diseases.

Contact transmission can be direct - when there is actual body contact, such as hugging, kissing or handshaking - or indirect - when one person touches something that has germs on it from another person, such as sharing a cup or a straw or touching a doorknob, and then transfers the germs to themselves by rubbing their nose or eyes. Contact transmission is how common colds, many viruses, and CF-specific germs like Pseudomona and B. cepacia get passed around. Learn more about different types of germs and how to stop them from spreading.

Whenever someone laughs, sings, coughs or sneezes, invisible droplets are made, and may contain germs. When those droplets land in another person's eyes, nose or mouth (from as far as three feet away), that person can get sick. The flu and whooping cough are spread through droplet transmission.

Sometimes, those same droplets include germs that can float in the air for a long time, and for long distances. Infection from airborne germs such as tuberculosis, measles, chickenpox and Aspergillus can occur when someone breathes in these germs that are floating in the air.

Protect Yourself - Prevent Infections:

• Do hand hygiene
• Keep vaccines up-to-date
• Use and throw away tissues
• Clean and disinfect nebulizers
• Avoid sick people
• Do not share eating utensils or cups
• Work with your CF care team to inform your child's school about CF and necessary precautions
• Send children to a non-CF-specific camp to reduce the risks of CF germ transfer
• Avoid spas and hot tubs without enough chlorine to kill Pseudomonas

Hand Hygiene

• Wash your hands with anti-bacterial soap whenever possible
• Wet hands with warm water
• Apply soap
• Rub hands together to lather
• Scrub hands back and front, up to wrist, between fingers and under nails - this should take about 15 seconds
• Rinse in warm running water
• Use a clean towel to dry - paper towels are the best
• Use the paper towel to turn off the faucet
• Use hand gels properly:
• Put a nickel-sized amount in the palm of one hand
• Rub hands together to spread the get over your entire hand, fingers and nails
• Rub briskly for about 15 seconds, until dry
• Do not rinse or dry hands with a towel
• Clean your hands regularly:
• At the doctor's office, in a waiting room, or in a lab
• After coughing, sneezing and nose-blowing
• After using automatic teller machines (ATM), handrails, elevator buttons, public telephones, countertop pens and grocery carts
• At shared play areas and gymnasiums

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Keep Your Vaccines Up-to-Date

• Diphtheria, Tetanus, Pertussis (DPT)
• Haemophilus B (Hib)
• Hepatitis B
• Influenza
• Measles, Mumps, Rubella (MMR)
• Pneumococcal
• Polio
• Varicella (Chicken Pox)

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Clean and Disinfect Your Respiratory Equipment

• Clean your hands
• Clean the nebulizer parts
• Wash immediately after use, to keep medicine and debris from drying
• Wash inside and out of parts with a new paper towel, liquid dish soap and hot water
• Throw away the paper towel
• Rinse nebulizer parts with water
• Check manufacturer's instructions - some nebulizer parts may be cleaned in an automatic dishwasher
• Disinfect the nebulizer parts
• Do not use vinegar - it is not strong enough to kill all the germs
• Follow manufacturer's instructions for these options:
• Boil parts for 5 minutes
• Microwave in water for 5 minutes
• Dishwasher, if water is hotter than 158° F for 30 minutes
• Soak in a solution of 1 part household bleach and 50 parts water for 3 minutes
• Soak in 70% isopropyl alcohol for 5 minutes
• Soak in 3% hydrogen peroxide for 30 minutes
• Rinse the nebulizer parts with sterile water (not faucet, bottled or distilled) if you've used bleach, isopropyl alcohol or hydrogen peroxide to disinfect
• Sterilize water by boiling it for 5 minutes
• Throw out water after each use
• Boiling your nebulizer parts (if an approved manufacturer's method) will disinfect and rinse in one step
• Air-dry nebulizer parts on a clean surface covered with new paper towels
• Store the dry nebulizer parts in a clean, dry bag in a clean, dry place

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How Germs are Spread

Germ	Type of Transmission	Where They Live
Influenza (Flu)	Droplet Transmission	Anyone who has the flu
Common Cold Viruses	Contact Transmission	People who have colds or items they've handled
Respiratory syncytial virus (RSV)	Contact Transmission	Anyone with RSV. RSV can cause the common cold in children and adults, and can live on surfaces for 6 hours
Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA)	Contact Transmission	People with S. aureus or MRSA
Pseudomona aeruginosa (Pseudomonas)	Contact Transmission	Often unknown, can be other people with CF, the environment, contaminated respiratory equipment or other objects
Burkholderia cepacia complex (B. cepacia)	Contact Transmission	Other people with CF or contaminated respiratory equipment
Stenotrophomona maltophilia (S. maltophilia)	Maybe Contact Transmission, more research is needed	Could be the environment, contaminated respiratory equipment and other objects, or in people with CF
Achromobacter xylosoxidans (A. xylosoxidans)	Maybe Contact Transmission, more research is needed	Could be the environment, contaminated respiratory equipment and other objects, or in people with CF
Nontuberculous mycobacteria (NTM)	Airborne Transmission	In the environment or contaminated respiratory equipment
Aspergillus fumigatus	Airborne Transmission	Found in nature, gets into the air through building renovation, gardening, lawn cutting, or water leaks that are not dried within 3 days

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Protect Yourself - When people with CF live together

• Do not share:
• respiratory equipment
• airway clearance devices
• toothbrushes
• eating utensils
• drinking cups
• Perform your airway clearance in separate rooms
• Avoid hand shaking, hugging or kissing
• Try to keep at least three feet between each other
• Clean hands often

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At the Hospital - Contact Precautions

If you have to stay at the hospital for any length of time, depending on your condition you may be placed in a room with a "Contact Precautions" sign on the door. This will let the staff know to take extra precautions when treating you to stop the spread of germs between you and other patients.

What it means:

• The hospital staff will wash their hands before and after every contact with you
• Wear gloves and gowns when they come into your room
• Make sure you get all the care you need

What you can do:

• Remind the staff to wear gowns and gloves
• Limit visitors
• Remind visitors to wash their hands

What your visitors should do:

• Wash their hands when coming in or leaving your room
• Avoid contact with your dressings, urine bag, IV or drainage tubes, or any other medical items in your room
• Ask the nurses and hospital care team any questions

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