No segregation for Pseudomonas in hospital?

Question

Hello,
a friend of mine is at the moment in a large German University hospital (with its own CF center) due to an i.v. therapy. Unfortunately, he is sharing the room - even though he is private patient - with 3 other lung patients. One of those is colonized with Pseudomonas. My friend is at the moment free of Pseudomonas and has now extreme worries to get again Pseudomonas there in the hospital. The physician in charge said, that would not be dangerous. In spite of this, in the CF center and also at the physiotherapy, Pseudomonas patients are segregated from the others. How should he react now and what should he do?

Answer

Dear questioner,
you want to know, if in case of CF, patients with positive finding of Pseudomonas aeruginosa (PA) and patients with negative finding of PA should be segregated from each other and how you should behave, if in the hospital the manangement is different from the recommendations. We assume, that you mean Pseudomonas aeruginosa (in case of other Pseudomonas strains the below mentioned statements do not always pertain).
Pseudomonas aeruginosa is a factor, that markedly determines the prognosis in patients with CF. An eradication (full elemination of the germ) is in the chronic phase i.a. due to biofilm building not possible. Therefore the maintance of hygiene rules is of great importance. In the literature, there is very convincing epidemiological data from longitudinal observational studies, that segregation of PA-free patients from CF patients with PA have a positive effect on the course of the illness. These recommendations have been worked out from an expert panel together with the commission for hopsital hygiene and infection prevention at the Robert-Koch institute (KRINKO, German helath authority) in Berlin, and have been published as "hygiene requirements in case of medical care of patients with CF" in the year 2012. In these recommendations it is pointed out that an out- and in-patient segregation is necessary. The hygiene recommendations can be read under the following German link:
https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Kommission/Downloads/Mukoviszidose_AG.pdf?__blob=publicationFile

Now I come back to the second part of your question. You write, that the hospital has an own CF center. We recommend, that you turn with your request to the leader of the CF center. Our answer can for sure help you in here. We are of the opinion, that an exchange between the leader of the CF center and the physician in charge at the ward (possibly also with pointing at the hygiene recommendations) can lead to good denouement of the problem.
I hope to have helped you a bit with my answer and stay with my best regards,
Yours Dr. med. Christina Smaczny

23.09.2016