User login

Enter your username and password here in order to log in on the website:

Forgot your password?

Please note: While some information will still be current in a year, other information may already be out of date in three months time. If you are in any doubt, please feel free to ask.

Cross infection Pseudomonas aeruginosa

I am afraid of my daughter catching a pseudomonas infection in our cystic fibrosis center. The policy at the clinic does not separate patients with pseudomonas from patients without pseudomonas.

Is this ok and what is recommended on other clinics?

A concerned parent
Dear questioner,

Thank you for your important question.

Pseudomonas aeruginosa is the most frequent and important pathogen responsible for chronic infection in people with cystic fibrosis (Cystic Fibrosis Foundation Patient Registry, 1996) and chronic infection with P. aeruginosa should be avoided as it can be associated with decline in pulmonary function and a worse prognosis.

P. aeruginosa is found in many natural environments and also in hospitals. It is likely that most P. aeruginosa infections are acquired outside hospital but it can be acquired in hospital. P. aeruginosa can be acquired from other people with cystic fibrosis.

The CF trust has developed consensus guidelines on this topic, written by expert clinicians and scientists in this area.
Currently medical opinion is divided as to whether patients with chronic P. aeruginosa infection should be segregated from those without this organism, and also whether patients with particular types of P. aeruginosa infection, such as transmissible strains, especially if multiresistant, should be segregated from others.

In some clinics, effective hygienic measures and patient segregation according to microbiological status, appear to have reduced the incidence of acquisition and cross-infection of P. aeruginosa, however it is still not clear which of the measures is most important, or whether all are necessary.

Regular attendance and follow-up at a Specialist CF Centre has been shown to be beneficial to both children and adults. Therefore avoiding clinic attendance because of fear of infection is likely to be harmful and seriously interfere with medical care and far outweighs any potential risk of acquiring new infection. Attendance at clinic will ensure regular monitoring of your daughters microbiology and prompt treatment if required. Please discuss your concerns about infection control measures with the clinic staff.

General hygienic recommendations to limit cross-infection are good practice (applicable whether or not a policy of segregating patients is in force), and these include;
•Hand washing and/or disinfection with alcohol rubs
•Covering your mouth and nose when coughing or sneezing.
• Wash or disinfect your hands before use of a spirometer or other handheld apparatus

Best regards,

Katherine O’Neill


• /aboutcf/publications/consensusdoc/C_Pseudomonas_aeruginosa_Nov_04.pdf

This topic comes out to be still a matter of debate, in the form of how mandatory segregation of patients is and who should be segregated in which way from the other patients.
Here some citations of the literature:
•CF Trust consensus document 2004 (see link in the answer):
"However, Specialist CF Centres and CF Clinics should consider implementing a policy of segregation according to lower respiratory tract bacteriology for all their patients with cystic fibrosis. The risk of cross-infection with P. aeruginosa is small, but it is quite definitely present; although it does not appear to be a problem in some clinics, in others, it can be a significant problem [B]. Segregation of patients is most important where the presence of transmissible strains of P. aeruginosa has been identified [B].....Where appropriate there would be separate clinics for patients chronically infected with P. aeruginosa and those who are not. In circumstances where separate clinics were not appropriate infrequent P. aeruginosa growers and those without P. aeruginosa infection may instead be seen at the beginning of the clinic or at a different time from those who are chronically infected [C].
Patients known to have transmissible strains should be seen in separate clinics. They should be separated from both Pseudomonas-positive and Pseudomonas-negative patients [C]…
•Kerem et al. in the Journal of Cystic Fibrosis 2005, 4:7-26:”Standards of care for patients with cystic fibrosis: A European consensus.”…”Under which circumstances should people with CF be separated from each other? People with CF who are infected with a pathogen which has been shown to be associated with cross-infection (e.g. B. cepacia complex, some strains of P.aeruginosa, MRSA) should be separated from others with CF both inside and outside the hospital [AII]. To what extent should people with CF be separated from each other in the outpatient clinic? Patients attending the clinic should be segregated according to their microbiological status – ideally attending on different days. [AIII]”
•Döring and Hoiby 2004 in the Journal of Cystic Fibrosis 3: 67-91 “Early intervention and prevention of lung disease in cystic fibrosis: a European consensus”: ” If guidelines for infection control are followed including separation of infected patients from uninfected, susceptible patients and the implementation of hygienic measures, prevention of cross-infection has been demonstrated. …smaller centers with low prevalence of infected patients and where the contact density is low may not have detectable cross-infection, whereas larger centers…may experience such cross-infection more often…Segregation of patients has been shown in several CF centers to prevent cross-infection with P.aeruginosa. …”

So in summary, especially for the epidemic/transmissible strains of P.a. segregation of patients is recommended, however, this topic needs further data and discussion on a European level to come to a uniform consensus recommendation.
D. d’Alquen