Segregation is good for patients with cystic fibrosis.

It is bewildering, in the face of so much evidence for the potential for cross-infection between patients – cross-infection that may have devastating consequences – that we continue to debate the advantages (numerous and important) and disadvantages (few and largely irrelevant) of keeping patients separated. Amazingly, to my mind, there has been no resolution of the conflicting points of view since Professor Geddes and I first argued this issue in a cystic fibrosis (CF) conference in 2001. Some CF centres have a strict patient segregation policy, some centres have no policy at all, and many centres follow management protocols that fall at varied points between these two extremes. In this paper I will provide evidence which I believe supports a strict segregation policy as practised in the Leeds CF centres. An interesting and quizzical starting point might be to ask this question: Why does the international CF community readily accept separation of patients with Burkholderia cepacia complex (Bcc) infection from all other patients but does not universally accept separation of all patients from each other? It is instructive to consider this. We treat patients with Bcc infection separately because we know that Bcc is a potentially virulent pathogen, that it can cause an accelerated or catastrophic clinical deterioration, that it is difficult to treat and almost impossible to eradicate, that it may preclude acceptance onto a lung transplant programme, but most of all because Bcc infection is transmitted from patient to patient. We have known all these facts for some time. In 1987, Tablan et al. reported that patients with Bcc infection and moderate or advanced CF were hospitalized for longer and died sooner than controls with similar levels of disease severity. These early data suggested a possible nosocomial source of Bcc infection, consistent with a report as far back as 1986 that an introduction of infection control measures resulted in a sharp decline in the incidence of Bcc infection. In 1995, Whiteford et al. reported a Bcc outbreak in children with CF and, importantly, a concurrent ‘dramatic decrease in the number of newly colonized patients’ after the introduction of segregation measures. In 1998, Ledson et al. reported cross infection with different Bcc strains between patients with Bcc infection who were already separated from other patients but not from each other, advising that further subsegregation of patients within the Bcc infected group might be necessary. By 1999, the UK CF Trust confidently stated that