Skip to main content
Top
Published in: BMC Pulmonary Medicine 1/2015

Open Access 01-12-2015 | Research article

Infection control knowledge, beliefs and behaviours amongst cystic fibrosis patients with epidemic Pseudomonas aeruginosa

Authors: R. Somayaji, B. Waddell, M. L. Workentine, M. G. Surette, N. P. Brager, H. R. Rabin, M. D. Parkins

Published in: BMC Pulmonary Medicine | Issue 1/2015

Login to get access

Abstract

Background

Epidemic P. aeruginosa (ePA) infections are common in cystic fibrosis (CF) and have been associated with accelerated clinical decline. Factors associated with ePA are unclear, and evidence based infection control interventions are lacking.

Methods

We prospectively collect all bacterial pathogens from adult CF patients. We performed PA strain typing on retrospectively collected enrolment samples and recent isolates to identify patients infected with ePA. All patients attending our clinic were approached to complete a survey on infection control knowledge, beliefs and exposures. We analyzed responses of those with ePA relative to the entire cohort without ePA as well as those infected with unique strains of P. aeruginosa to assess for risk factors for ePA and differences in infection control knowledge, beliefs or behaviours.

Results

Of 144 participants, 30 patients had ePA (two Liverpool epidemic strain, 28 Prairie epidemic strain), 83 % of which had established infection prior to transition to the adult clinic. Risk of concomitant infecting pathogens was no different between groups although, Staphylococcus aureus and non-tuberculous mycobacteria were less common in those with ePA. Patients with ePA were more likely to have attended CF-camp and have a history of CF fundraising. Patients with ePA did not differ with respect to beliefs regarding pathogens or transmission risk, except they believed indirect contact posed little risk. Furthermore, patients with ePA were more likely to continue to associate with others with CF despite extensive counselling. Use of peer-peer online networking was minimal in both groups.

Conclusion

Infections with ePA are closely linked to past exposures, now routinely discouraged. As socialization is the greatest risk factor for ePA, infection control strategies for ePA must focus on discouraging face-to-face interactions amongst CF patients. As peer support remains a desire amongst patients, investment in technologies and strategies that enable indirect communication and support are required.
Literature
1.
go back to reference Cheng K, Smyth RL, Govan JR, Doherty C, Winstanley C, Denning N, et al. Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic. Lancet. 1996;348(9028):639–42.CrossRefPubMed Cheng K, Smyth RL, Govan JR, Doherty C, Winstanley C, Denning N, et al. Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic. Lancet. 1996;348(9028):639–42.CrossRefPubMed
2.
go back to reference Aaron SD, Vandemheen KL, Ramotar K, Giesbrecht-Lewis T, Tullis E, Freitag A, et al. Infection with transmissible strains of Pseudomonas aeruginosa and clinical outcomes in adults with cystic fibrosis. JAMA. 2010;304(19):2145–53.CrossRefPubMed Aaron SD, Vandemheen KL, Ramotar K, Giesbrecht-Lewis T, Tullis E, Freitag A, et al. Infection with transmissible strains of Pseudomonas aeruginosa and clinical outcomes in adults with cystic fibrosis. JAMA. 2010;304(19):2145–53.CrossRefPubMed
3.
go back to reference Scott FW, Pitt TL. Identification and characterization of transmissible Pseudomonas aeruginosa strains in cystic fibrosis patients in England and Wales. J Med Microbiol. 2004;53(Pt 7):609–15.CrossRefPubMed Scott FW, Pitt TL. Identification and characterization of transmissible Pseudomonas aeruginosa strains in cystic fibrosis patients in England and Wales. J Med Microbiol. 2004;53(Pt 7):609–15.CrossRefPubMed
4.
go back to reference Martin K, Baddal B, Mustafa N, Perry C, Underwood A, Constantidou C, et al. Clusters of genetically similar isolates of Pseudomonas aeruginosa from multiple hospitals in the UK. J Med Microbiol. 2013;62(Pt 7):988–1000.CrossRefPubMed Martin K, Baddal B, Mustafa N, Perry C, Underwood A, Constantidou C, et al. Clusters of genetically similar isolates of Pseudomonas aeruginosa from multiple hospitals in the UK. J Med Microbiol. 2013;62(Pt 7):988–1000.CrossRefPubMed
5.
go back to reference Ashish A, Shaw M, Winstanley C, Ledson MJ, Walshaw MJ. Increasing resistance of the Liverpool Epidemic Strain (LES) of Pseudomonas aeruginosa (Psa) to antibiotics in cystic fibrosis (CF)--a cause for concern? J Cyst Fibros. 2012;11(3):173–9.CrossRefPubMed Ashish A, Shaw M, Winstanley C, Ledson MJ, Walshaw MJ. Increasing resistance of the Liverpool Epidemic Strain (LES) of Pseudomonas aeruginosa (Psa) to antibiotics in cystic fibrosis (CF)--a cause for concern? J Cyst Fibros. 2012;11(3):173–9.CrossRefPubMed
6.
go back to reference Armstrong DS, Nixon GM, Carzino R, Bigham A, Carlin JB, Robins-Browne RM, et al. Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic. Am J Respir Crit Care Med. 2002;166(7):983–7.CrossRefPubMed Armstrong DS, Nixon GM, Carzino R, Bigham A, Carlin JB, Robins-Browne RM, et al. Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic. Am J Respir Crit Care Med. 2002;166(7):983–7.CrossRefPubMed
7.
go back to reference Parkins MD, Glezerson BA, Sibley CD, Sibley KA, Duong J, Purighalla S, et al. Twenty-five-year outbreak of Pseudomonas aeruginosa infecting individuals with cystic fibrosis: identification of the prairie epidemic strain. J Clin Microbiol. 2014;52(4):1127–35.PubMedCentralCrossRefPubMed Parkins MD, Glezerson BA, Sibley CD, Sibley KA, Duong J, Purighalla S, et al. Twenty-five-year outbreak of Pseudomonas aeruginosa infecting individuals with cystic fibrosis: identification of the prairie epidemic strain. J Clin Microbiol. 2014;52(4):1127–35.PubMedCentralCrossRefPubMed
8.
go back to reference O’Carroll MR, Syrmis MW, Wainwright CE, Greer RM, Mitchell P, Coulter C, et al. Clonal strains of Pseudomonas aeruginosa in paediatric and adult cystic fibrosis units. Eur Respir J. 2004;24(1):101–6.CrossRefPubMed O’Carroll MR, Syrmis MW, Wainwright CE, Greer RM, Mitchell P, Coulter C, et al. Clonal strains of Pseudomonas aeruginosa in paediatric and adult cystic fibrosis units. Eur Respir J. 2004;24(1):101–6.CrossRefPubMed
9.
go back to reference Fothergill JL, Walshaw MJ, Winstanley C. Transmissible strains of Pseudomonas aeruginosa in cystic fibrosis lung infections. Eur Respir J. 2012;40(1):227–38.CrossRefPubMed Fothergill JL, Walshaw MJ, Winstanley C. Transmissible strains of Pseudomonas aeruginosa in cystic fibrosis lung infections. Eur Respir J. 2012;40(1):227–38.CrossRefPubMed
10.
go back to reference Al-Aloul M, Crawley J, Winstanley C, Hart CA, Ledson MJ, Walshaw MJ. Increased morbidity associated with chronic infection by an epidemic Pseudomonas aeruginosa strain in CF patients. Thorax. 2004;59(4):334–6.PubMedCentralCrossRefPubMed Al-Aloul M, Crawley J, Winstanley C, Hart CA, Ledson MJ, Walshaw MJ. Increased morbidity associated with chronic infection by an epidemic Pseudomonas aeruginosa strain in CF patients. Thorax. 2004;59(4):334–6.PubMedCentralCrossRefPubMed
11.
go back to reference Jones AM, Dodd ME, Morris J, Doherty C, Govan JR, Webb AK. Clinical outcome for cystic fibrosis patients infected with transmissible pseudomonas aeruginosa: an 8-year prospective study. Chest. 2010;137(6):1405–9.CrossRefPubMed Jones AM, Dodd ME, Morris J, Doherty C, Govan JR, Webb AK. Clinical outcome for cystic fibrosis patients infected with transmissible pseudomonas aeruginosa: an 8-year prospective study. Chest. 2010;137(6):1405–9.CrossRefPubMed
12.
go back to reference Poonja A, Workentine, M, Waddell, B, Surette, MG, Duong, J, DG Storey, Gregson, D, Rabin, HR and MD Parkins. Development and validation of a PCR assay to detect the Prairie Epidemic Strain (PES) of Pseudomonas aeruginosa. In. Ped Pulmonol: 2015; Phoenix, AZ; 2015. Poonja A, Workentine, M, Waddell, B, Surette, MG, Duong, J, DG Storey, Gregson, D, Rabin, HR and MD Parkins. Development and validation of a PCR assay to detect the Prairie Epidemic Strain (PES) of Pseudomonas aeruginosa. In. Ped Pulmonol: 2015; Phoenix, AZ; 2015.
13.
go back to reference Somayaji RLJ, Surette M, Waddell B, Purighalla S, Sibley C, Rabin H, et al. Clinical outcomes of chronic ‘Prairie Epidemic Strain’ Pseudomonas aeruginosa infection in adults with cystic fibrosis. In: 38th Annual European Cystic Fibrosis Conference. Brussels: Journal of Cystic Fibrosis; 2015. 2015. Somayaji RLJ, Surette M, Waddell B, Purighalla S, Sibley C, Rabin H, et al. Clinical outcomes of chronic ‘Prairie Epidemic Strain’ Pseudomonas aeruginosa infection in adults with cystic fibrosis. In: 38th Annual European Cystic Fibrosis Conference. Brussels: Journal of Cystic Fibrosis; 2015. 2015.
14.
go back to reference Masterson TL, Wildman BG, Newberry BH, Omlor GJ. Impact of age and gender on adherence to infection control guidelines and medical regimens in cystic fibrosis. Pediatr Pulmonol. 2011;46(3):295–301.CrossRefPubMed Masterson TL, Wildman BG, Newberry BH, Omlor GJ. Impact of age and gender on adherence to infection control guidelines and medical regimens in cystic fibrosis. Pediatr Pulmonol. 2011;46(3):295–301.CrossRefPubMed
15.
go back to reference Sibley CD, Sibley KA, Leong TA, Grinwis ME, Parkins MD, Rabin HR, et al. The Streptococcus milleri population of a cystic fibrosis clinic reveals patient specificity and intraspecies diversity. J Clin Microbiol. 2010;48(7):2592–4.PubMedCentralCrossRefPubMed Sibley CD, Sibley KA, Leong TA, Grinwis ME, Parkins MD, Rabin HR, et al. The Streptococcus milleri population of a cystic fibrosis clinic reveals patient specificity and intraspecies diversity. J Clin Microbiol. 2010;48(7):2592–4.PubMedCentralCrossRefPubMed
16.
go back to reference Lee TW, Brownlee KG, Conway SP, Denton M, Littlewood JM. Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. J Cyst Fibros. 2003;2(1):29–34.CrossRefPubMed Lee TW, Brownlee KG, Conway SP, Denton M, Littlewood JM. Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. J Cyst Fibros. 2003;2(1):29–34.CrossRefPubMed
17.
go back to reference Walter S, Gudowius P, Bosshammer J, Romling U, Weissbrodt H, Schurmann W, et al. Epidemiology of chronic Pseudomonas aeruginosa infections in the airways of lung transplant recipients with cystic fibrosis. Thorax. 1997;52(4):318–21.PubMedCentralCrossRefPubMed Walter S, Gudowius P, Bosshammer J, Romling U, Weissbrodt H, Schurmann W, et al. Epidemiology of chronic Pseudomonas aeruginosa infections in the airways of lung transplant recipients with cystic fibrosis. Thorax. 1997;52(4):318–21.PubMedCentralCrossRefPubMed
18.
go back to reference Varekojis SM, Douce FH, Flucke RL, Filbrun DA, Tice JS, McCoy KS, et al. A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients. Respir Care. 2003;48(1):24–8.PubMed Varekojis SM, Douce FH, Flucke RL, Filbrun DA, Tice JS, McCoy KS, et al. A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients. Respir Care. 2003;48(1):24–8.PubMed
19.
go back to reference Saint S, Greene MT, Olmsted RN, Chopra V, Meddings J, Safdar N, et al. Perceived strength of evidence supporting practices to prevent health care-associated infection: results from a national survey of infection prevention personnel. Am J Infect Control. 2013;41(2):100–6.PubMedCentralCrossRefPubMed Saint S, Greene MT, Olmsted RN, Chopra V, Meddings J, Safdar N, et al. Perceived strength of evidence supporting practices to prevent health care-associated infection: results from a national survey of infection prevention personnel. Am J Infect Control. 2013;41(2):100–6.PubMedCentralCrossRefPubMed
20.
go back to reference Tummler B, Koopmann U, Grothues D, Weissbrodt H, Steinkamp G, von der Hardt H. Nosocomial acquisition of Pseudomonas aeruginosa by cystic fibrosis patients. J Clin Microbiol. 1991;29(6):1265–7.PubMedCentralPubMed Tummler B, Koopmann U, Grothues D, Weissbrodt H, Steinkamp G, von der Hardt H. Nosocomial acquisition of Pseudomonas aeruginosa by cystic fibrosis patients. J Clin Microbiol. 1991;29(6):1265–7.PubMedCentralPubMed
21.
go back to reference Ojeniyi B, Frederiksen B, Hoiby N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp. Pediatr Pulmonol. 2000;29(3):177–81.CrossRefPubMed Ojeniyi B, Frederiksen B, Hoiby N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp. Pediatr Pulmonol. 2000;29(3):177–81.CrossRefPubMed
22.
go back to reference Walsh NM, Casano AA, Manangan LP, Sinkowitz-Cochran RL, Jarvis WR. Risk factors for Burkholderia cepacia complex colonization and infection among patients with cystic fibrosis. J Pediatr. 2002;141(4):512–7.CrossRefPubMed Walsh NM, Casano AA, Manangan LP, Sinkowitz-Cochran RL, Jarvis WR. Risk factors for Burkholderia cepacia complex colonization and infection among patients with cystic fibrosis. J Pediatr. 2002;141(4):512–7.CrossRefPubMed
23.
go back to reference Razvi S, Quittell L, DiMango E, Andersen J, Sewell W, Garber E, et al. Abstract 348: CF patients and families’ perspectives of infection control recommendations. Pediatr Pulmonol. 2006;S29(S29):329–30. Razvi S, Quittell L, DiMango E, Andersen J, Sewell W, Garber E, et al. Abstract 348: CF patients and families’ perspectives of infection control recommendations. Pediatr Pulmonol. 2006;S29(S29):329–30.
24.
go back to reference Miroballi Y, Garber E, Jia H, Zhou JJ, Alba L, Quittell LM, et al. Infection control knowledge, attitudes, and practices among cystic fibrosis patients and their families. Pediatr Pulmonol. 2012;47(2):144–52.CrossRefPubMed Miroballi Y, Garber E, Jia H, Zhou JJ, Alba L, Quittell LM, et al. Infection control knowledge, attitudes, and practices among cystic fibrosis patients and their families. Pediatr Pulmonol. 2012;47(2):144–52.CrossRefPubMed
25.
go back to reference Clifton IJ, Peckham DG. Defining routes of airborne transmission of Pseudomonas aeruginosa in people with cystic fibrosis. Expert Rev Respir Med. 2010;4(4):519–29.CrossRefPubMed Clifton IJ, Peckham DG. Defining routes of airborne transmission of Pseudomonas aeruginosa in people with cystic fibrosis. Expert Rev Respir Med. 2010;4(4):519–29.CrossRefPubMed
26.
go back to reference Zimakoff J, Hoiby N, Rosendal K, Guilbert JP. Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in a cystic fibrosis clinic. J Hosp Infect. 1983;4(1):31–40.CrossRefPubMed Zimakoff J, Hoiby N, Rosendal K, Guilbert JP. Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in a cystic fibrosis clinic. J Hosp Infect. 1983;4(1):31–40.CrossRefPubMed
27.
go back to reference Wainwright CE, France MW, O’Rourke P, Anuj S, Kidd TJ, Nissen MD, et al. Cough-generated aerosols of Pseudomonas aeruginosa and other Gram-negative bacteria from patients with cystic fibrosis. Thorax. 2009;64(11):926–31.PubMedCentralCrossRefPubMed Wainwright CE, France MW, O’Rourke P, Anuj S, Kidd TJ, Nissen MD, et al. Cough-generated aerosols of Pseudomonas aeruginosa and other Gram-negative bacteria from patients with cystic fibrosis. Thorax. 2009;64(11):926–31.PubMedCentralCrossRefPubMed
28.
go back to reference Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, et al. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infect Control Hosp Epidemiol. 2014;35 Suppl 1:S1–S67.CrossRefPubMed Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, et al. Infection prevention and control guideline for cystic fibrosis: 2013 update. Infect Control Hosp Epidemiol. 2014;35 Suppl 1:S1–S67.CrossRefPubMed
29.
go back to reference Zuckerman JB, Clock SA, Prato BS, McDevitt JJ, Zhou JJ, Leclair LW, et al. Air contamination with bacteria in cystic fibrosis clinics: implications for prevention strategies. Am J Respir Crit Care Med. 2015;191(5):598–601.CrossRefPubMed Zuckerman JB, Clock SA, Prato BS, McDevitt JJ, Zhou JJ, Leclair LW, et al. Air contamination with bacteria in cystic fibrosis clinics: implications for prevention strategies. Am J Respir Crit Care Med. 2015;191(5):598–601.CrossRefPubMed
30.
go back to reference Ashish A, Shaw M, Winstanley C, Humphreys L, Walshaw MJ. Halting the spread of epidemic pseudomonas aeruginosa in an adult cystic fibrosis centre: a prospective cohort study. JRSM Short Rep. 2013;4(1):1.PubMedCentralCrossRefPubMed Ashish A, Shaw M, Winstanley C, Humphreys L, Walshaw MJ. Halting the spread of epidemic pseudomonas aeruginosa in an adult cystic fibrosis centre: a prospective cohort study. JRSM Short Rep. 2013;4(1):1.PubMedCentralCrossRefPubMed
31.
go back to reference Griffiths AL, Jamsen K, Carlin JB, Grimwood K, Carzino R, Robinson PJ, et al. Effects of segregation on an epidemic Pseudomonas aeruginosa strain in a cystic fibrosis clinic. Am J Respir Crit Care Med. 2005;171(9):1020–5.CrossRefPubMed Griffiths AL, Jamsen K, Carlin JB, Grimwood K, Carzino R, Robinson PJ, et al. Effects of segregation on an epidemic Pseudomonas aeruginosa strain in a cystic fibrosis clinic. Am J Respir Crit Care Med. 2005;171(9):1020–5.CrossRefPubMed
32.
go back to reference Matt B, Mitteregger D, Renner S, Presterl E, Assadian O, Diab-Elschahawi M. Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital. GMS hygiene and infection control. 2014;9(3):Doc20.PubMedCentralPubMed Matt B, Mitteregger D, Renner S, Presterl E, Assadian O, Diab-Elschahawi M. Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital. GMS hygiene and infection control. 2014;9(3):Doc20.PubMedCentralPubMed
33.
go back to reference Saiman L, Garber E. Infection control in cystic fibrosis: barriers to implementation and ideas for improvement. Curr Opin Pulm Med. 2009;15(6):626–31.CrossRefPubMed Saiman L, Garber E. Infection control in cystic fibrosis: barriers to implementation and ideas for improvement. Curr Opin Pulm Med. 2009;15(6):626–31.CrossRefPubMed
34.
go back to reference Jones AM, Dodd ME, Govan JR, Doherty CJ, Smith CM, Isalska BJ, et al. Prospective surveillance for Pseudomonas aeruginosa cross-infection at a cystic fibrosis center. Am J Respir Crit Care Med. 2005;171(3):257–60.CrossRefPubMed Jones AM, Dodd ME, Govan JR, Doherty CJ, Smith CM, Isalska BJ, et al. Prospective surveillance for Pseudomonas aeruginosa cross-infection at a cystic fibrosis center. Am J Respir Crit Care Med. 2005;171(3):257–60.CrossRefPubMed
35.
go back to reference McCallum SJ, Corkill J, Gallagher M, Ledson MJ, Hart CA, Walshaw MJ. Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P aeruginosa. Lancet. 2001;358(9281):558–60.CrossRefPubMed McCallum SJ, Corkill J, Gallagher M, Ledson MJ, Hart CA, Walshaw MJ. Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P aeruginosa. Lancet. 2001;358(9281):558–60.CrossRefPubMed
36.
go back to reference Garber E, Desai M, Zhou J, Alba L, Angst D, Cabana M, et al. Barriers to adherence to cystic fibrosis infection control guidelines. Pediatr Pulmonol. 2008;43(9):900–7.CrossRefPubMed Garber E, Desai M, Zhou J, Alba L, Angst D, Cabana M, et al. Barriers to adherence to cystic fibrosis infection control guidelines. Pediatr Pulmonol. 2008;43(9):900–7.CrossRefPubMed
38.
go back to reference Kirk S, Milnes L. An exploration of how young people and parents use online support in the context of living with cystic fibrosis. Health Expectations. 2015. doi:10.1111/hex.12352. [Epub ahead of print]. Kirk S, Milnes L. An exploration of how young people and parents use online support in the context of living with cystic fibrosis. Health Expectations. 2015. doi:10.​1111/​hex.​12352. [Epub ahead of print].
Metadata
Title
Infection control knowledge, beliefs and behaviours amongst cystic fibrosis patients with epidemic Pseudomonas aeruginosa
Authors
R. Somayaji
B. Waddell
M. L. Workentine
M. G. Surette
N. P. Brager
H. R. Rabin
M. D. Parkins
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2015
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-015-0116-x

Other articles of this Issue 1/2015

BMC Pulmonary Medicine 1/2015 Go to the issue