Download Carbapenemase Producing Enterobacteriaceae (CPE) Leeds

Carbapenemase Producing Enterobacteriaceae (CPE)
Leeds Community Healthcare NHS Trust Information Pack
Introduction:
The purpose is to provide information to support community health & social care professionals involved
with a patient colonised or infected with CPE; to safely manage the patient’s care and to reduce the risk
of transmission of CPE to other vulnerable/susceptible people.
What is CPE?
CRE stands for Carbapenemase Producing Enterobacteriaceae, also known of as KPC carbapenemase
producers. CPE is microorganism that resides in the bowel which have become increasingly resistant to
carbapenems, which include imipenem, meropenem, ertapenem and doripenem. These antibiotics are
invaluable for the treatment of infections due to multi-resistant Gram-negative bacteria, including
Extended Spectrum Beta Lactamase (ESBL) .
Although still rare, Carbapenemase Producing Enterobacteriaceae are beginning to emerge, and these
organisms are much more difficult to treat as they are often resistant to most other classes of antibiotic
as well. However carbapenem-resistant Gram-negative bacteria have emerged and are prevalent in most
areas outside of northern Europe, USA/Canada, and Australia.
The organisms of most concern include highly resistant strains of Klebsiella pneumoniae and Escherichia
coli. Transmission characteristics and pathogenesis resemble those of sensitive strains of the organisms
but the infections are much more difficult to manage as there are limited treatment options.
Contact Information:
For further advice please contact during normal working hours:
Infection Prevention and Control Advice – Leeds Community Healthcare NHS Trust on 0113 8434511
Medical Advice – Patient’s Registered GP
Microbiology & Antibiotic Prescribing Advice - Consultant Microbiologist on 0113 3923962
Public Health England South Yorkshire office on 0113 3860300
Out of hours/weekends/bank holidays:
Public Health England West Yorkshire office on 0113 3860300
Contents:
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Community Information Leaflet – Carbapenemase-Producing Enterobacteriaceae
(for Patients and Staff)
Carbapenemase-producing Enterobacteriaceae (CPE) Sheffield Community Guidance
Questions & Answers
Risk Assessment diagram for the use of PPE
Microbiology Laboratory report form example
This document has been adapted from a PHE South Yorkshire CPE Evidence Pack
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Carbapenemase-Producing Enterobacteriaceae (for Patients and Staff)
Community Information Leaflet
What are Carbapenemase-Producing Enterobacteriaceae (CPE)?
• Enterobacteriaceae live harmlessly in the gut of humans and animals and help us digest our food.
This is called colonisation. If the bacteria get into the wrong place, such as the bladder or
bloodstream, they can cause an infection.
• Some strains of Enterobacteriaceae have become very resistant to some antibiotics including
those called carbapenems. These are called Carbapenemase-Producing Enterobacteriaceae (CPE)
• Patients colonised by CPE would still not usually have any symptoms or illness caused by them as
they would continue to live harmlessly in the gut.
If infection develops due to CPE, these infections can be more difficult to treat with antibiotics. This is
why it is so important to prevent their spread from person to person.
How will I know if I am at risk of a CPE?
• You may be at risk of carrying CPE if you have been in a hospital abroad, or in a UK hospital which
has had patients carrying these bacteria, or you have been exposed to other carriers of these
bacteria.
• If you have these risk factors we will ask you to be screened and we will inform you of the
results.
• People in hospital are generally more at risk of infections because their body defences are
already weakened by illness, surgery, medication and the presence of invasive devices like ‘drips’
and urinary catheters.
How do you screen for CPE?
• The screening method requires a sample of faeces (poo) or rectal swab. The specimen will be
sent to the laboratory to see which germs grow.
• If you have a urinary catheter, we will need a sample of urine
• If you have a wound, we will also need this to be swabbed.
• The results of the tests will normally be available between 48-72 hours after taking the sample.
• We will let you know the results of all the specimens that are taken.
Does colonisation (carrier status) with CPE need to be treated?
• As CPE normally lives in the gut without causing problems they do not normally need to be
treated.
Treating an infection caused by CPE
• If this bacteria causes symptoms this may show an infection is present and treatment is required.
Your GP will discuss this with a consultant microbiologist (an expert in antibiotic treatment)
before prescribing antibiotics for you.
• If you are in hospital you may not have to stay in hospital until the infection has cleared up. You
will be able to go home when your general condition allows regardless of whether you are still
carrying the bacteria or not.
Will I get all the care I need if I am colonised with these bacteria?
• YES
• You will still be able to have rehabilitation and any other tests that you require.
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•
Sometimes you may have to have investigations or therapy at the end of the day or separate
from other patients.
What happens when I’m at home?
• The presence of the bacteria (which may disappear quite naturally) should not affect you or your
family at home.
• This type of bacteria (CPE) does not normally affect healthy individuals.
• Hand washing is essential for all those looking after you (this is if you have community healthcare
staff, such as District Nurse, Community Matron who is visiting you to stop transmission of germs
to other patients who they may be visiting later). You may wish to provide a separate hand towel
for friends or family visiting you.
• Staff caring for you may wear gloves & aprons depending on the care activity been undertaken
• It is especially important for you to wash your hands well with soap and water after going to the
toilet and before cooking or eating.
• Clothes, towels, crockery & cutlery etc, can all be washed as normal.
• You should avoid touching medical devices (if you have any) such as your urinary catheter tube
and your intravenous drip, particularly where it is inserted into your body.
• You should ensure your toilet is cleaned with bleach regularly and maintain a good standard of
bathroom cleanliness with your usual household cleaning products.
• There are no restrictions to daily social & work activities or visitors to your home.
What happens if you are attending or admitted to hospital?
• If you are going into hospital or attending outpatient appointments; please inform hospital staff
that you have or had previous CPE colonisation and/or infection.
• You will be moved to a side room whenever possible with its own toilet facilities.
• All staff will wear gloves and aprons or long sleeved gowns when caring for you. This is to
prevent the spread of bacteria (CPE) to other patients.
• Hand washing is essential for all those looking after you.
• It is especially important for you to wash your hands well with soap and water after going to the
toilet, before eating and before leaving your room.
• You should avoid touching medical devices (if you have any) such as your urinary catheter
tube/intravenous drip/ PEG / tracheostomy site, particularly where it is inserted into your body.
• All Visitors will be asked to wash their hands with soap and water when they come into your
room and also when leaving your room. If any of your visitors are helping you with ‘personal
care’ they may also be asked to wear gloves and an apron.
Where can I find more information?
If you would like any further information please speak to your GP or community team caring for you.
Public Health England website is another source of information:
http://www.hpa.org.uk/Topics/InfectousDiseases/InfectionsAZ/CarbapenemResistance/
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Carbapenemase-producing Enterobacteriaceae (CPE) Sheffield Community Guidance
Questions and Answers for Community Healthcare Workers
This information is not exhaustive and has been produced in response to previously asked questions.
Currently there is no national community guidance and we are awaiting these to be published. Please
refer to the patient information section and the acute toolkit (link below) for further information.
PHE (2013) Acute trust toolkit for the early detection, management and control of Carbapenemaseproducing Enterobacteriaceae
http://www.hpa.org.uk/Publications/InfectiousDiseases/AntimicrobialAndHealthcareAssociatedInfection
s/1312Toolkitforcarbapenementero/
1. Is there any increased risk to pregnant workers?
2. Is it OK to use the soap and cotton towels in the
patient’s home?
3. Is it necessary to wear long-sleeved disposable
gowns in the patient’s home?
4. Should I schedule to see CPE patient’s ‘last on
the list’ for a home visit?
5. How long would precautions need to be in
place?
6. What about documentation of infectious status
on patient records?
There is no additional risk to pregnant workers.
Standard infection control precautions (Standard
Precautions) must be deployed by all staff when
caring for patients with CPE.
All LCH services undertaking home visits should
already be ordering & taking with them their own
supplies of liquid hand soap, disposable paper
towels & alcohol handrub to carry in their kit bags.
Scrupulous attention to hand hygiene cannot be
over-emphasised. Please refer to the LCH Standard
Precautions Policy.
Disposable single-use gloves and plastic aprons are
required based on risk assessment of the task
about to be performed and the anticipated
exposure to blood or bodily fluids.
Disposable long sleeved gowns will be required for
bowel care/enemas if the practitioner/carer feels
there is a high risk of faecal soiling/splashing - as a
minimum use gloves and aprons and remember to
wash arms and hands after removing gloves.
Please refer to the LCH Standard Precautions
Policy.
Wherever practical schedule visits to patients ‘last
on the list.’ However this cannot always be the
case therefore all staff must adhere to standard
precautions at all times.
Standard precautions will need to be in place
continually. Please notify any hospital/care
home/healthcare provider or other community
teams if the patient is admitted to or transferred
anytime in the future; (for the life of the patient).
Please refer to the LCH Standard Precautions
Policy.
CPE status either previously infected or
colonisation need to be permanently recorded on
all patient records. This will ensure that
appropriate antibiotic choices can be made in
future if needed; and staff can take appropriate
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7. What cleaning products should we use for
reusable medical devices or equipment?
e.g. Sphygmomanometer / Tympanic Thermometer
/ Oxygen Saturation Monitor / Stethoscope
8. How do we dispose of healthcare waste
generated during the course of our home visit?
9. Are there any special laundry needs for
household linen or clothing?
standard precautions whilst providing care to limit
the spread of CPE to other vulnerable/susceptible
people.
LCH staff should use the disposable Tuffie 5 wipes
to clean and disinfect all equipment after use prior
to subsequent re-use on another patient.
• Keep minimal stocks of equipment in the
patient’s home
• Keep minimal supplies in your kit bag and
take your bag with you into the patient’s
home to avoid making numerous trip to
your car
• Use disposable equipment/items wherever
possible
Please refer to the LCH Local Decontamination of
Reusable Medical Equipment Policy.
• Waste produced from CPE colonised &
infected patients must be placed in an
infectious waste bag (orange). The waste
does not need to be double bagged.
• Outer packaging/wrappers (such as on a
dressing pack) can be placed in household
waste (black) if no visible contamination of
either blood or bodily fluids.
• Infectious waste generated in the
domiciliary setting will be removed by the
Local Authority and collection can be
arranged by contacting Leeds City Council
Waste Management Department on 0113
2224406.
• Prior to the delivery of a Local Authority
waste bin, the bagged waste must be
stored (with the householders consent) in
an area as secure as possible. This waste
must not be accessible to children, pets
and the general public.
• The infectious status of the health care
waste must be documented in the
patient’s notes and updated if any change
in status is determined. Please refer to LCH
Waste Management Policy.
If the patient is either colonised or infectious, no
special requirements are recommended. Clothing
or linen (bedding or towels) worn or used by the
patient should be washed separately to other
members of the household if possible. Don’t
overload the washing machine. Wash items on the
highest setting the fabrics will withstand. Continue
to use your normal washing liquids, powders and
fabric softeners. HCW should wear disposable
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gloves & aprons if loading the washing machine. As
most domestic washing machines are located in
the kitchen of most households; avoid loading the
machine whilst food is being prepared or cooked.
Always perform hand hygiene after dealing with
used linen. Dry & iron linen/clothing as normal.
Please refer to the LCH Linen and Laundry Policy.
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Microbiology Laboratory report form example
**Please put on form ‘’CPE Screen’’ – ROUTINE MC&S WILL NOT BE SUITABLE**
GP name,
practice &
‘B’ code
Patients full name in
capitals, DOB & NHS
Number
Sample type, stool,
rectum swab, wound,
sputum, urine etc…
Address, post-code &
telephone number
e.g. pyrexial, non healing
wound, exudate ++, cough,
UTI symptoms etc… Please
document previous known
CPE colonisation
Please list
antibiotics
Write ‘CPE
Screen’
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