Q & A with Dr. Larry Lands
Despite significant progress in treating cystic fibrosis (CF), lung infections caused by germs, such as bacteria, viruses, yeasts and molds, remain a serious problem for those with CF and can lead to worsening of the disease. The Infection Prevention and Control Guidelines contain recommendations to reduce the risk of CF patients receiving or spreading potential pathogens in the CF clinic or hospital setting. Negative pressure rooms in CF clinics further reduce the patient’s risk of cross-contamination of harmful bacteria.
Dr. Larry Lands is the CF Clinic Director at Montreal Children’s Hospital. A long-serving volunteer and clinical advisor to the Canadian CF community, Dr. Lands has assumed several leadership roles for Cystic Fibrosis Canada including a Chair position on a past Clinical Advisory Committee. Dr. Lands has also served as a medical leader on numerous Accreditation Site Visits as part of Cystic Fibrosis Canada’s program to ensure consistent high quality CF care across the country. Dr. Lands is recognized nationally and internationally for his renowned research in cystic fibrosis.
What is the purpose of negative pressure rooms, and how do they work?
We now have a better understanding of how germs, like Pseudomonas aeruginosa bacteria, or viruses, are spread. Most of these are spread by droplets which are produced when someone sneezes or coughs, or performs pulmonary function tests. It used to be thought that these could not travel beyond a range of three feet, but we now know that they can be projected up to six feet.
A standard room has the same pressure as the corridors outside. A negative pressure room causes air to flow from outside and into the room, like taking a breath in. This limits how far a droplet produced in the room can travel. The air that is brought into the room is then either sent outside the building, or cleaned through a high-efficiency particulate arrestance (HEPA) filter before being re-circulated.
How will negative pressure rooms help with infection control?
By limiting the movement and spread of droplets, negative pressure rooms, particularly in the pulmonary function laboratory where people often cough, can keep the droplets from moving around.
Will care for CF patients be affected by negative pressure rooms?
The patients will not notice any difference. In fact, having negative pressure in the pulmonary function laboratory and clinic rooms allows patients to move through more quickly. In pulmonary function laboratories and clinic rooms without negative pressure or HEPA filters, a wait time between patients is recommended.
Is cross-infection reduced for CF patients with these new rooms?
This is the desired result. Of course, negative pressure rooms are just part of an overall strategy to reduce the risk of cross-infection. Patients should wear masks when in common areas of the hospital and clinic (but not in the clinic visit room), and staff are encouraged to wear gowns and gloves. Generally the patient will remain in the clinic room while the members of the CF team come by for the visit. In addition, surfaces in clinic rooms and stethoscopes are wiped between patients. If patients must wait in the waiting room, then they should sit at least six feet apart.