Two CF patients in the same school

Question

There are 2 patients with CF at our school These children do not attend the same class, but will soon be in the same building. Which precautions should be taken or should one of them leave school?

Answer

Dear questioner,
Thank you for this interesting question. I presume your question mainly relates to precautions to prevent cross-infection.
Very typically, children with CF have recurrent infections of the airways with bacteria such as Staphylococcus and Pseudomonas. These infections are usually acquired from the environment. Less frequently, patients with CF will cross-infect each other. This risk does exist and that is why it is current practice to segregate patients with CF in the hospital. Also outside of the hospital we do not encourage contact between patients. Your question is thus mainly relevant in terms of patient to patient contact.
Passing bacteria from patient to patient can occur several ways. Either via direct contact or via contact with the same objects. This type of infection is much decreased when hand hygiene guidelines are followed and when intimate contact is avoided such as kissing. Also by keeping material used for aerosols and chest physio separately.
Patients are more infectious when they are seriously ill or when they cough a lot. And certainly at these times, droplet infection should be avoided. When a patient coughs or sneezes, little drops containing bacteria can remain on surfaces. When another person touches this same surface and then touches his eyes or nose (less his mouth), he can become infected. Again it is very important to have good cough hygiene: elbow sleeve (better than hand) before your mouth when you cough and good hand hygiene. This means frequent washing of the hands (usual soap suffices), especially after coughing or sneezing, around toilet moments and meals. Droplet infections can be prevented by keeping a distance of at least 3 feet between people. This can be explained to children with CF but it is really impractical when children do become friends.
Some bacteria (especially certain species of Pseudomonas, methicilline resistant Staphylococcus aureus and mostly Burkholderia) are more contagious than others. Infection with these bacteria can also cause more serious infection. That is why these hygienic measures are even more important for patients carrying these bacteria. In addition it has been described that these bacteria can remain suspended in the air during several hours so that infection can also occur by breathing in this air. Luckily infection with these bacteria is uncommoin in Belgium and the Netherlands, so that the chance that one of these children is infected with these bacteria is limited.
To make a long story short: there is no wrong or right answer to this question. Two children with CF in the same school, but not in the same class, does not pose a big risk. But if one of the children is (or becomes) infected with Pseudomonas aeruginosa there is a very small risk that they might infect each other: they may e.g. attend the same social school events, they may use the same class room on the same day. Hand hygiene is very important for both children, especially when they are coughing more or when they are ill. It would be a problem if these children do become friends, since avoiding contact then becomes very difficult. The option of changing to another school is also fraught with difficulties: is this feasible, is there no child with CF in the other school now or in the future, would this make the child very unhappy.
We hope that this answers your question.
Best regards,
Prof. dr. K. De Boeck

08.08.2011