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Delivery of multidisciplinary care by experienced teams in specialist units has conferred considerable benefits in care for individuals with cystic fibrosis (CF), with significant improvements in clinical outcome and survival figures. However, one particular concern of congregating patients at specialist CF centres is the potential for cross-infection. Over the past decade, the emergence and spread of clonal (transmissible) Pseudomonas aeruginosa strains among patients with CF has become an international problem.1–⇓3 Case series suggest that initial infection with clonal P. aeruginosa strains may be more difficult to eradicate,4 and in cohort studies chronic infection is associated with worse clinical outcomes.1 ,5 ,6The mechanism of spread of P. aeruginosa between patients with CF is unresolved. Potential routes include direct or indirect contact, droplet spread of relatively large infectious particles that travel short distances or airborne spread of smaller particles containing microorganisms that travel further and remain suspended for longer periods. It has been shown that patients with CF infected with clonal P. aeruginosa can contaminate their hands and their immediate environment for brief periods.7 In addition, clonal P. aeruginosa have been isolated from CF clinics by room air sampling.7 ,8
Knibbs and coworkers present the findings of their recent work using equipment they developed with an aerobiological sampling system to measure the viability of P. aeruginosa in cough-generated aerosols from patients with CF.9 Their studies demonstrate that after a 5 min period of intense coughing by a patient with CF, viable P. aeruginosa can frequently be isolated from room air at a distance of at least 4 m from the source and can persist …