Prospective Surveillance for Pseudomonas aeruginosa Cross-Infection at a Cystic Fibrosis Center

We have performed a 4-year prospective surveillance for Pseudomonas aeruginosa cross-infection at a large regional adult cystic fibrosis center Despite purpose-built facilities in a of the present day building and the practice of strict hygiene, P aeruginosa cross-infection has continued. In contrast, individuals segregated from the cohort of patients with chronic P aeruginosa infection nevertheless who attend the same center have not acquired infection with transmissible P aeruginosa strains. Simple infection bridle measures alone do not interrupt the spread of transmissible P aeruginosa strains between individuals with cystic fibrosis. However, in our clinic patient segregation effectively controll spread of so strains.

Keywords: incidence; infection control; prevalence

Cystic fibrosis (CF) is the most numerous common lethal inherited disease among whites (1) Morbidity and mortality is primarily from chronic suppurative lung disease (2) The major pathogen for this cluster of patients is Pseudomonas aeruginosa (3) The epidemiology and management of P aeruginosa cross-infection in CF is controversial and has been highlighted in three new editorial articles (4-6). Recent studies have reported evidence for P aeruginosa cross-infection at CF center in the United Kingdom and Australia (7-12) although Speert and colleagues did not find epidemiological evidence of P aeruginosa cross-infection at a large Canadian CF center (13) To date, there are no published large prospective studies of cross-infection with P aeruginosa in CF centers

An initial cross-sectional studious mood at the Manchester Adult CF Center discovered convincing evidence of P aeruginosa cross-infection (7) The CF Center is located in a novel purpose-built dedicated facility. Close attention is paid to hygienic principles in keeping with the recommendations of the UK Cystic Fibrosis Trust Infection repress Subcommittee (14). In brief, all inpatients have their be in possession of bedroom, although only two of the eleven spaces have en-suite facilities. Rooms are cleaned between patients. Treatment including nebulization and airway clearance is performed in the patient's have a title to room with the door clos Compressor and nebulizer regularitys airway clearance devices, and oxygen therapy delivery a whole s are not shared between patients. Staff are educated to practice hand washing or disinfection with alcohol wipes before and after physical contact with patients; false fingernails are prohibited. cloaked sputum pots are provided for patients. Single use disposable mouthpieces with one-way valves are used with the spirometers. An extensive microbiological screening of the CF Center failed to point out to an environmental reservoir for or contamination with transmissible strains of P aeruginosa (15) Similarly, the same studious mood showed no evidence of carriage of P aeruginosa upon the hands of the health care workers. Spirometry was previously done in a small field on the ward. Since 2002 following our findings from air sampling meditation at the center (15), spirometry is performed in each patient's be in possession of room with the door clos The patients did have access to a kitchen area and dayroom upon the ward and were allowed to socialize outside their acknowledge rooms.

As our initial consideration had documented cases of of recent origin P. aeruginosa infection with a transmissible strain in patients previously exempt of P. aeruginosa infection, we instituted a policy of segregation for patients with CF with and without chronic P aeruginosa infection. Patients without P aeruginosa infection attended outpatient clinic appointments in succession a different day than other patients with CF As inpatients they were housed forward the same CF ward as patients with chronic P aeruginosa infection, nevertheless in rooms with en-suite facilities, and were advised not to socialize with other patients forward the ward. We have continued prospective microbiological surveillance for P aeruginosa cross-infection and now report the incidence and prevalence of transmissible P aeruginosa at our center for the past 4 years (2000-2003) a certain of the results of these studies have been previously reported in the form of an abstract (16)

METHODS

Patients

Over a 4-year period (2000-2003) we have prospectively typ P aeruginosa isolates from patients with CF who attend the Manchester Adult Center to assess clonality of strains. This has been part of clinical practice at the center instituted after the finding from an initial inquiry (7) that patients at the center shared the same clonal P aeruginosa strain, indicative of cross-infection. We ensur that all patients with CF with chronic P aeruginosa infection had an isolate(s) retyp since the original cross-sectional typing consideration (7). For the purpose of this inquiry we have defined chronic P aeruginosa infection as the regular tillage of the organism from the sputum or respiratory secretions, in succession two or more occasions extending through 6 months (14). P. aeruginosa isolates from patients were retyp more not seldom if they displayed unusual phenotypic features, including a change in antibiotic resistance pattern. In addition, patients with multiple inpatient admissions or patients institute to have been exposed to potential risk of cross-infection, similar as through social contact with other patients with CF had isolates retyp more not seldom We also targeted all fresh acquisitions of P. aeruginosa infection in any previously "Pseudomonas-free" patients.