Infection and Cross-Infection: What It Means

Over the last few decades, according to several studies, lung infections such as B. Cepacia and highly transmissible strains of Pseudomonas have been spreading between cf populations. Even though hospitals were being kept clean, patients were getting the same infections. They believed this to be due to patient-to-patient contact.[1] Today, cf centers put recommendations in place that they believe will limit the number of infections being spread between patients and caregivers. This includes common sense practices such as hand washing and covering your mouth when you cough or sneeze, as well as cf patients staying six feet apart from each other, avoiding close physical contact, and sharing personal items.[2] At many cf events, only one person with Cystic Fibrosis is permitted to attend due to cross-infection risks. Cepacia patients are often treated by different staff at other areas and times to prevent cross-infection, and due to cross-infection many cf camps no longer exist. Back in the day, it was common for patients with cf to share everything, even becoming hospital roommates. Today when patients go to clinic they often wear masks and use hand sanitizer to avoid cross-infection.

Mask Efficacy:

Most disposable isolation masks work by limiting contact with fluids and larger particles that make people sick. Heavier, durable masks like an N95 mask are more likely to help filter out smaller particles that cause the spread of viruses and other illnesses but they are more difficult to breathe in.[3] Certain masks do a great job filtering what you breathe in, but some masks do not filter what you breathe out and of course, the efficacy of the mask is determined not only by type but by proper usage.

Once widely used reusable masks such as the “Vogmask” - the mask I am pictured with, have been determined to be useful for protection from environmental problems like dust, pollen, and air pollution. However, the CF Foundation does not support the use of these masks in a clinical setting as a way of protecting yourself and others from pathogens and reducing the risk of cross-infection. It is recommended instead to use a disposable surgical mask, with N95 masks offering the highest level of protection.

Research:
Since the bacteria that causes most lung infections can be found in water and soil I wondered how cross-infection was discovered. Infection strains can be studied and we can see how they've mutated using genotyping. Genotyping can help discover whether or not infections are being transmitted from person to person based on how the characteristics of each infection are similar or different. Similar characteristics found in genotyping suggest that the infections are due to cross-infection or infections spreading in the same area, while different characteristics are more likely to be due to picking up infections in different areas or due to a reason other than cross-infection. The instances of cross-infection have decreased since isolation practices and guidelines have been put in place.

Education:
The isolation of patients with Cystic Fibrosis is a debatable subject. Strict guidelines and miseducation makes some parents fear their children playing in dirt or sand, or even going out at all. While isolation does help prevent infection and cross-infection, it's important for people with cf to have social support and skills that help them live fairly normal lives. Our bodies still need to build up immunity early on in life so while hand washing and wearing a mask can help prevent illnesses, it's important to realize that regardless of what you do or don't do, children and adults with cf will get sick at some point and that is a normal part of life.

Infection and Cross-Infection Prevention:
While sickness is a normal part of life, how can it be prevented? For people with Cystic Fibrosis, a cold can mean a 14+ day hospital stay and the flu can mean death due to bacteria getting stuck in our lungs. Herd immunity and vaccinations help because if you don't get sick, it's harder for us to get sick. If you are a family member or friend of someone with cf you should know that being around them when you're sick (even if it's "just a little cough or cold") puts their health and life at risk.

Video chatting and messaging are great options for social support and a safer alternative than meeting up. Personally, I used to care less about cross infection but with my lung function suffering and after doing research, I care more about safeguarding myself and protecting my health now. I'm not saying everyone should start living in a bubble or fear being around other people but after having our baby, I've realized even more just how important it is to protect my health not only for myself but so I can enjoy more memories and be around for my family so we can get to see our son grow up together. The incidences of cross-infection seem to vary widely. Some siblings don't end up having issues with cross-infection after years of living, playing, doing treatments, and eating together. Ultimately, it appears that it's important for our mental and physical health to balance "regular life" with proper education and awareness.


Sources:

1. D.L. Smith, L.B Gumery, E.G. Smith, D.E. Stableforth, M.E. Kaufmann, T.L. Pitt 
Epidemic of Pseudomonas cepacia in an adult cystic fibrosis unit: evidence of person-to-person transmission

J Clin Microbiol, 31 (11) (1993)

2. CFF 
How Can You Reduce the Risk of Cross-infection?

https://www.cff.org/Life-With-CF/Daily-Life/Germs-and-Staying-Healthy/How-Can-You-Avoid-Germs/How-Can-You-Reduce-the-Risk-of-Cross-infection/ 
(2017)

3. FDA 
About Facemasks and N95 Respirators

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm055977.htm 
(2017)