P368: SEGREGATED CYSTIC FIBROSIS CLINICS : FIRST YEAR'S EXPERIENCE
EF Burrows, JJ Cottrell,
Royal Liverpool Children's Hospital, Alder Hey

There is growing awareness and concern regarding cross infection between CF patients in outpatient clinics. There is evidence that cross infection between CF patients can occur (Lancet 1996;348:639-642), that Pseudmonas aeruginosa (PA) can be eradicated if treated early (Ped Pulmonol 1997;23:330-335)and that colonisation with PA may be associated with decline in health status (Paediatric Pulmonol 1995;19:10-15). Our CF team is keen to minimise the risk of cross infection in our clinic.

Our aim was to provide segregated outpatient services for our 115 CF patients and to ensure that the quality of our service was not compromised with the change. We were responding to the growing concerns of our parents and patients, and we were attempting to provide a service in compliance with the CF Trust control of Infection Group recommendations. Given our resources and funding constraints we were unable to provide 2 clinics per week. We did not have the required outpatient department space , nor could we provide physiotherapy or dietetic input for a second weekly clinic. To proceed would mean that one group would receive sub-standard care. As approximately 30% of our patients are not colonised with PA we decided that every third clinic would be a Non-PA clinic. The clinic time and venue has not changed so confusion for families is minimised, and all members of the CF team are able to attend all clinics as usual.

Patients with 'first growth' of PA continue to attend the Non-PA clinic but are seen at the end of the clinic. If they continue to grow PA despite eradication treatment - nebulised colomycin and oral ciprofloxacin and/or IV therapy- they move to the PA clinic and attend at the start of the clinic. In practice there is some movement between the clinics. The segregation is extended to other departments in the hospital, the patients no longer mix at their annual assessment visit, in x-ray, ultrasound, audiology or the medical day case unit., as all appointments are grouped according to microbiology.

Effective communication is essential when implementing change in our CF clinic. All families were given written information and this was discussed in clinic so that they were well informed. Parents are knowledgeable about the microbiology of their child's sputum, and quickly became familiar with the clinic system. There have been very few mistakes. As the new changes were reviewed we have implemented further inpatient segregation to provide separate facilities for 4 distinct groups ; those who are Non-PA, those with a sensitive PA, a resistant PA and those with B.cepacia or MRSA. All CF patients are nursed in single rooms. This clinic segregation policy is well accepted by the CF team and families.

We intend to review it and formally seek the opinion of families. For the future, areas of interest are acquisition of PA, further segregation for shared-care clinics and MRSA.