Implementation of the Cystic Fibrosis Foundation infection control guidelines at a university healthcare system: A multidisciplinary approach requiring continuous quality improvement

ISSUE: This university healthcare system provides comprehensive care for over 400 adult and pediatric cystic fibrosis (CF) patients, including lung transplantation for patients with highly antibiotic-resistant B. cepacia. Implementation of the CF Foundation guidelines was an important element of our comprehensive infection control program and used a framework of continuous quality improvement. PROJECT: Multiple activities were conducted and included: 1) evaluation of staff and institutional resources to support this intervention, 2) policy planning and development with a multidisciplinary CF advisory group, 3) focus group discussion with patients and family members of the lung transplant support group, 4) educational sessions for clinical staff, including nurses/physicians, physical therapy, respiratory care, and recreation therapy, 5) development of an electronic patient medical record notification system operated by epidemiology that alerts clinical staff and bed management of a CF patientʹs isolation status, 6) education for patients and families including a trifold color brochure explaining CF and contact isolation for both inpatient and outpatient settings, 7) support from legal services to establish our obligations and response to the noncompliant patient or family member, and 8) point prevalence surveys to assess compliance with isolation policies with staff feedback. RESULTS: The infection control policy was initially approved in August 2003, with revisions in December 2003. Point prevalence surveys assessing compliance with gown/glove usage for all isolation categories including CF patients on contact isolation were conducted in March and October 2004. Results are reported as percentage of observed compliance for each survey. LESSONS LEARNED: Institution of a new infection control policy requires the basic components of program development: needs and resource assessment, planning and policy development, implementation, and evaluation. To succeed, the policy must be structured using a continuous quality improvement framework with ongoing assessments and modifications. Staff ownership of the policy and input and support from the CF population were keys to this policyʹs effectiveness and acceptance.