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- Introduction
- Segregation is not good for patients with cystic fibrosis
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When someone with CF makes a booking for a clinic the sputum result refers to some day in the past. It may be within the last week but more often is 2—3 months previously and by the time the clinic happens it may be even longer. While in the chronic stable state the organisms may be the same, and so it may be reasonable to use out-of-date information for a routine visit, the microbiology may change at the time of a clinical deterioration.
The next problem is what should be sent to the laboratory. Many people with CF do not cough sputum and so throat or cough swabs are used. These may or may not be a good reflection of what is or will later be present in the lungs. Perhaps the biggest problem is that we do not know what really matters.
The history of CF has been one of blaming different bacteria. Staphylococcus aureus was the first, there was then a brief period of concern about Haemophilus influenzae , followed by a long period in which P. Recently, new bacteria have been isolated and the importance of each is still being worked out. In the future there will be more.
Finally different strains of the same species behave differently. For Bcc some genomovars are linked to clinical decline while others are not, and the same is probably true of P. This means that segregation by species may simply miss the point. By putting them together in a segregated clinic we may therefore be exposing the most vulnerable to a greater risk.
The Manchester clinic reported cross-infection with a new multi-resistant P. These data can be used to reach the opposite conclusion, namely that the segregated P. All these concerns and uncertainties argue that cohort segregation by bacterial species is an illusion. We do not know what bacteria a patient carries, we do not know what matters, we cannot define a few simple groups based on bacteriology which will either limit cross-infection or its consequences, and cohort segregation does not prevent cross-infection within the cohort.
It therefore seems more logical to assume that every patient is a potential risk to every other patient and that minimal contact and optimal general infection control measures are the best approach.
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It can be argued that even with all these uncertainties and difficulties segregation may help a bit and anyway does no harm. Again, sadly, this is not the case. This means that when it is first isolated from someone with CF this is taken as a disaster and leads at best to concern and at worst to terror.
In reality, the rate of decline in lung function in CF patients with P. There have been reports of parents preventing their children playing outside because of the fear of P. Let's look at some examples of what may happen if we over-stress segregation:. Two brothers stopped seeing each other because one acquired Bcc. The request was refused and they never met again.
Should the girl have been segregated from these two relatives?
Introduction
The rest of the story, which may provide the answer, is given at the end of the text. The message is clear. Segregation can do harm. If it also does good then clearly a balance must be struck. However, the burden of proof rests with the segregationists. The patient's two relatives were her parents. She remains well with normal lung function at the age of In this case, strict separation of family members would have done more harm than good.
National Center for Biotechnology Information , U. J R Soc Med. Duncan Geddes , Professor of Respiratory Medicine. Author information Copyright and License information Disclaimer.
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This article has been cited by other articles in PMC. Introduction This is an intentionally polarized opinion presented as part of a debate. Is cross-infection a problem is CF?
Segregation is not good for patients with cystic fibrosis
Cross-infection — how and why If we accept that the same organism spreads from one person with CF to another, this could happen by direct contact between patients or indirect transmission via the environment or hospital staff. The majority of Pseudomonas strains in CF are acquired from the environment. Pseudomonads are perhaps the most abundant life form on the planet and have evolved many ways of surviving and moving from host to host other than by direct contact.
The hospital environment is heavily colonized by bacteria such as Pseudomonas and hospital hygiene has not always been ideal. Hospital staff have been lax about infection control over the period that the cross-infection outbreaks have occurred and contact between staff and patient is at least as close and frequent as between patient and patient. Hospital cross-infection is a much wider problem than a CF clinic: CF microbiology Segregation by organism might be sensible if there were only a few bacteria involved and they remained constant.
Practicalities of segregation For segregation to be logical and feasible we should know what bacteria, fungi and viruses matter and which one two, three or 60 each person is carrying. Does cohort segregation do harm It can be argued that even with all these uncertainties and difficulties segregation may help a bit and anyway does no harm.
A real 'Fault in Our Stars' couple
Let's look at some examples of what may happen if we over-stress segregation: So go hike up those hills. Take your oxygen tank if you require it. If I let fear of the unknown get to me I never would have been able to do it. Fear of traveling, fear of his rejection from seeing me coughing lots of mucus and fear of doing treatments in public places where strangers could stare. We want to hear your story.
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Become a Mighty contributor here. Find this story helpful? Share it with someone you care about. Please click here if you are not redirected within a few seconds. You can also browse from over health conditions. Join Us Log In. What is cystic fibrosis? Thriving with cystic fibrosis Resources. I am 26 years old, born and raised in Richmond, Virginia, where I currently reside. I was diagnosed with Cystic Fibrosis at 18 months old. I am of Hungarian descent and speak the Hungarian language.
I currently work part time as a lab manager in an environmental microbiology laboratory at the university. Want the best Mighty stories emailed to you? There was a problem with the address entered.