Barriers to adherence to cystic fibrosis infection control guidelines

Elizabeth Garber, Manisha Desai, Juyan Zhou, Luis Alba, Denise Angst, Michael Cabana, Lisa Saiman, Robert A. Kaslovsky, Scott A. Schroeder, Raj Padman, Amy Szymanski, John McNamara, Mary Sachs, David A. Hicks, Ofelia Vargas-Shiraishi, Thomas Scanlin, Howard B. Panitch, Barbara T. Jansma, William M. Gershan, Mary Ellen FreemanLynne M. Quittell, Samiya Razvi, Karen McCoy, Beth D'Antonio, Nancy N. Dambro, Janet Garbarz, Thomas Murphy, Barbara McLurkin, Kimberly Jones, Antoinette Gardner, Amanda Dove, Kathleen Buckley, Joel H. Schmidt, Andrew J. Lipton, Monica Leupold, Henry A. Wojtczak, Jerri Gray, Laurie Varlotta, Deborah Conklin, Daniel B. Rosenbluth, Jane Quante, Ran D. Anbar, Donna Lindner, Thomas Lahiri, Jackie Swartz, Paula J. Anderson, Larry Gann, Bettina Hilman, Rodolfo Amaro, Monya Rucker, Scott H. Davis, Joanna Reboul, Mary H. Wagner, Terry Spencer, Cindy Capen, Catherine Kier, Teresa Carney, Michael J. Rock, Cynthia Moodie, Dana G. Kissner, Yvette LeFlore

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Background: In 2003, the American Cystic Fibrosis (CF) Foundation published revised, evidence-based guidelines for infection control. We sought to assess potential barriers to adherence to these guidelines experienced by health care professionals (HCPs) caring for CF patients. Methods: From April 2004 to December 2005, a knowledge, attitude, and practice survey was administered to HCPs at randomly selected CF centers in the United States to explore potential barriers to adherence to selected guidelines; (1) obtaining quarterly cultures from CF patients, (2) discouraging socialization among CF patients during hospitalization, (3) educating patients and families about hand hygiene, (4) educating patients and families to clean and disinfect home nebulizers, and (5) cleaning the clinic exam rooms between CF patients. Results: The survey was completed by 528 HCPs from 25 sites (5-50 respondents per site). Only 60% of respondents were aware of the guidelines, but despite awareness, 31-47% were unfamiliar with the specific guidelines. Self-reported adherence was low; only 23-63% of respondents reported practicing the selected guidelines >75% of the time/opportunities. Lack of self-efficacy, that is, confidence in adequately performing the guidelines, was commonly experienced by respondents. Access to a copy of the guidelines was associated with increased agreement with the recommendations and increased self-efficacy. Conclusions: Strategies to reduce barriers to adherence to CF infection control guidelines are needed. Strategies could include quality improvement initiatives with enhanced education and skills workshops, sharing successful interventions among CF centers, and linking adherence to improved patient outcomes.

Original languageEnglish
Pages (from-to)900-907
Number of pages8
JournalPediatric Pulmonology
Issue number9
StatePublished - Sep 2008


  • Hand hygiene
  • Health care professionals
  • Nebulizers
  • Outcome expectancy
  • Self-efficacy


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