Download CPE - Liverpool Community Health NHS Trust

Liverpool Community Health NHS Trust
Guidelines for Carbapenemase Producing
Enterobacteriaceae – (CPE)
1
Version Number:
1
Ratified by:
Clinical Policies Group
Date of Approval:
February 2015
Name of originator/author:
Infection Prevention & Control Team
Approving Body / Committee:
Clinical Policies Group
Date issued (Current version):
May 2015
Review date (Current Version): May 2016
Target Audience:
LCH Staff & Clinical staff within
Nursing & Residential Homes HMP
Liverpool
Name of Lead Director / Amanda Pye- Director of Infection
Managing Director:
Prevention and Control
Changes / Alterations Made To
Previous Version:
New Policy May 2015
2
Contents
Section
Page
Number
5
1
Introduction
2
Purpose / Scope
5
3
Definitions
6
4
Duties
6
5
Equality Analysis
7
6
Implementation, Monitoring and Review
7
7
Risk Factors
7
8
8
10
10
Guidance for Staff Caring for a Patient within
Domestic Settings
Role of the Infection Prevention and Control
nurse
Intermediate Care Arrangement
11
Protecting Patients from Infection
12
12
Hand Hygiene
13
Cleaning & Decontamination of equipment &
14
9
13
10
environment
14
Treatment & Therapies
14
15
Removing Patients from Isolation
15
16
References
15
Annex
Annex 1
Patient Pathway Management
Annex 2
GP Information Letter for discharge of CPE positive patient
Annex 3
Information leaflet for patients in North West England
Annex 4
Patient Hand held Card
3
1. Introduction
Enterobacteriaceae are bacteria that usually live harmlessly in the gut of
humans. This is called ‘colonisation’ (a person is said to be a ‘carrier’).
However, if the bacteria get into the wrong place, such as the bladder or
bloodstream they can cause infection. Examples of these bacteria are
E.coli, Klebsiella and Enterobacter. They may also be referred to as
gram negative bacteria.
Carbapenemase are enzymes (chemicals), made by some strains of
these bacteria, which allow them to destroy Carbapenemase antibiotics
e.g. Meropenem, imipenem, ertapenem etc. the bacteria are therefore
resistant to this group of antibiotics.
Until now, Carbapenemase antibiotics have been used to successfully
treat certain ‘difficult’ infections when other antibiotics have failed to do
so. In a hospital, where there are many vulnerable patients, spread of
resistant bacteria can cause problems with potentially a significant
mortality rate.
If a person is a carrier of Carbapenemase-producing Enterobacteriaceae
(sometimes called CPE), they do not need to be treated. However, if the
bacteria have caused an infection then antibiotics will be required and
few, if any, are available.
The bacteria spread from person to person with transfer facilitated by
contaminated hands, equipment and surfaces adjacent to the
colonised/infected person.
2 Purpose / Scope
This is a clinical policy document for use in Liverpool Community Health
NHS Trust (LCH). The purpose of this policy is to identify
Carbapenemase Producing Enterobacteriaceae (CPE); from individual
colonised cases and to prevent the risk of transmission
This policy applies to healthcare personnel working within LCH. It also
applies to private contractors working on Trust premises including,
locum, agency staff and volunteers.
4
This guidance provides detail for the management and care of patients
within the inpatient ward areas in Intermediate care and for LCH staff
caring for patients with CPE in the domestic / shared care setting.
LCH has developed this guideline to fulfil the requirements of patients /
service users receiving care from staff within LCH. LCH is committed to
ensuring that all staff are trained and equipped to perform their role
effectively.
LCH staff will identify CPE infection in colonised and symptomatic
patients and will provide quality and consistency in the delivery of clinical
care when caring for an individual with known or suspected CPE.
All staff working for or on behalf of LCH will provide care, management
and control CPE within the healthcare setting and community in
accordance with the latest research based evidence. This guidance was
developed in accordance with partner organisations CPE procedures
and guidance contained within acute trust toolkit for the early detection,
management and control of CPE. Public Health England (2013)
3 Definitions
Cephalosporin’s-Broad spectrum antibiotics used in the treatment of
septicaemia, pneumonia, meningitis, biliary tract infections, peritonitis
and urinary tract infections. Examples include-Cefalexin, Cefotaxime
Ceftriaxone, Ceftazidine and Cefuroxime.
Enterobacter –organisms that colonise the intestines of humans and
animals e.g.
ESBL-Extended Spectrum Beta Lactamase. Gram negative bacteria e.g.
Escherichia coli that produce an enzyme that breaks down commonly
used antibiotics e.g. penicillin’s and render them ineffective.
E Coli- Gram negative bacteria that colonise the bowel.
IP&CT-Infection Prevention and Control Team
MDR- Multi Drug Resistance.
Quinolones e.g Ciprofloxacin-Broad spectrum, synthetic antibacterial
agents particularly for use against gram negative bacteria.
5
4 Duties All LCH staff are responsible for co-operating with the
development and implementation of clinical policies as part of their
normal duties and responsibilities.
All other personnel will be expected to comply with the requirements of
all relevant LCH policies applicable to their area of operation.
All potential adverse incidents should be reported in line with LCH
Incident reporting policy.
5. Equality Analysis-an impact assessment has been undertaken and
kept by the author
6. Implementation, Monitoring and Review
6.1 The implementation of this policy will be undertaken by users. The
policy should be disseminated via communication cascades including
staff and team meetings. It is the responsibility of all managers to ensure
staff distribution of LCH wide and local policies in their areas.
6.2 This policy will be made available on the staff intranet once approved
and published on the internal and external LCH Websites
6.3 Monitoring of staff compliance to policy and guidance remains a line
management responsibility. Managers with line management
responsibility are responsible for implementation of policies and
guidance and reporting non-compliance.
6.4 These guidelines have been developed and peer reviewed by the
following professional groups:
The Infection Prevention and Control team
Clinical Policies working group
7. Risk Factors for CPE-:
CPE occurs in all ages, but is more likely to be seen more in the elderly
as they are more likely to be hospitalised/screened, but young people
are also at risk.
6
Risk factors for CPE include the following:
Travel abroad- particularly within the last twelve months where CPE is
prevalent.
Healthcare abroad- hospitals/countries where CPE is prevalent.
Direct inter-Healthcare transfers either locally or nationally.
Past admission to a hospital in the UK known to have a CPE problem
Any previous hospital admission
Previous contact with a CPE case; family member, or hospital contact
with a case.
Colonisation with another MDR organism especially ESBL-due to the
use of selective antibiotics.
Presence of invasive devices.
Antibiotics-Broad spectrum e.g. cephalosporin’s, quinolones, and
clindamycin which are harmful to gut flora.
Serious underlying disease/illness.
Immune compromised conditions.
8. Guidance for Staff caring for a patient within domestic settings
Strict adherence to standard Infection Prevention and Control
precautions is essential in preventing the spread of infection-please refer
to Standard Precautions Policy.
 Where possible make the patient the last visit of the day.
 Compliance with Hand Hygiene is essential. Hands should be
washed with liquid soap and disposable paper towels before and after
patient contact. Alcohol gel can be used for hand hygiene if hands are
visibly clean (unless diarrhoea is evident). Liverpool Community
Health staff can acquire individual liquid soap and hand gel bottles
together with paper towels from procurement. Encourage good hand
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






hygiene practice with the patient, especially if they develop loose
stools or diarrhoea.
Personal Protective Equipment (PPE) must be worn – Non sterile
Vinyl disposable single use only gloves. Disposable plastic aprons to
be used for close contact/clinical procedures. Remove gloves first as
these will be the most contaminated followed by aprons and dispose
of in clinical waste bags Hand hygiene must always be performed
prior to donning and removal of PPE.
Decontamination of all patient equipment must be performed after
every use with detergent based wipes as per decontamination of
medical devices policy. Any equipment that cannot be effectively
cleaned should be condemned.
If patient is generating clinical waste, this could include waste from
continence products by those patients known to be colonised and
having loose stools/diarrhoea, please arrange for a clinical waste pick
up. For patients within the Liverpool area please ask district nurse
team leader to complete clinical waste referral form and fax to
Liverpool waste contractor 01132700347 (telephone 03332404400).
For Sefton residents please contact LCH infection prevention and
control team on 0151 295 3036.
For Knowsley patients with a Liverpool GP please contact infection
Prevention and Control on 0151 295 3036
Until the clinical waste is set up and running, ensure that any waste is
double bagged if entering the domestic waste stream.
Scrupulous Infection prevention and Control Practices are particularly
important when caring for indwelling devices/equipment. For e.g.
Urinary catheters, enteral feeding equipment, central venous catheter
lines, colostomy or ileostomy, wound dressings as these provide a
direct route of entry into the patient’s body. Consider if such devices
are necessary and remove if not. Strict adherence to aseptic
technique is crucial in preventing the spread of infection.
Loose stools or diarrhoea increase the risk of spread of gut bacteria;
therefore advise the patient of the need for scrupulous general
hygiene including hand washing and cleaning of the environment to
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reduce the risk of transmission of infection. Any unexplained
diarrhoea should be reported to patients GP.
 N.B it should be noted that if the patient is colonised or infected , then
no antibiotic or decolonisation treatment is required for the following
reasons;
Skin decolonisation-not advised as these bacteria generally colonise the
gut rather than the skin.
Gut decolonisation (by prescribing antibiotics) this is not advised as
antibiotic therapy could contribute to increasing resistance in the longer
term. If the patient becomes infected then antibiotic therapy will depend
upon sensitivity results. GP’s should take advice from local microbiology
departments.
For further advice contact Infection Prevention and Control at;
[email protected]
Telephone: 0151 295 3036
9. Role of the Infection prevention and control team (IP&CT)
When patients are found to be CPE positive within community settings,
the IPCT will
 Inform GP and advice caution with antibiotic prescribing Please see
annex 2
 Establish and assess risks including, indwelling devices, wounds,
twelve month history of travel and community healthcare interaction.
 Assess risk and give advice re indwelling devices. If no longer
required to remove at first opportunity.
 Identify if patient attends outpatients appointments and to inform
relevant department.
 Has the patient been in hospital in the last the last 12 months?
Inform relevant organisation.
Current Care-identify current providers of health and social care. Ensure
that they have been informed of CPE status and that appropriate
Infection Prevention and Control advice is given.
9
Send patient CPE Card and information leaflet.
10. Intermediate Care Arrangements
Identification of Carbapenemase Producing Enterobacteriaceae (CPE)
Patients:
For patients transferred to another healthcare provider, it is the
responsibility of the transferring hospital / ward to inform the receiving
ward if the patient has been tested positive for CPE see Annex 3
GP Admissions:
GP’s are now notified when any patients are tested positive. They are
advised to inform any healthcare provider if a patient has been
previously tested positive for CPE.
Patients will also be given a CPE card and are asked to present this, if
admitted to hospital.
CPE Patient Pathway:
Implement CPE patient pathway see Appendix 1 for all CPE patients to
ensure correct management across the patient journey and across
organisations.
Contact screening:
Where this is required it will be requested by a member of the infection
prevention and control team.
Where a whole ward has to be screened the screening swabs are rectal
swab, catheter specimen of urine and wound swab. If not possible, a
stool sample can be submitted.
The Infection Prevention and Control team will compile a list of patients
to be screened for Intermediate Care.
Flagging of case notes and ICE:
All confirmed positive patients will be flagged on the alert on ICE/SIGMA
as being colonised with a Multidrug resistant micro-organism (MDR).
Case notes and SIGMA will also be flagged with an infection control
alert.
10
Contacts requiring screening on readmission are flagged on the infection
control data base and a member of the infection prevention control team
will alert the ward.
Patient Information Leaflets:
Please ensure all CPE patients are given CPE leaflets (Public Health
England CPE tool kit). Copies should be made available for visitors on
request. Please see Annex 3
Isolation Precautions:
All patients known or suspected to be CPE positive must be isolated and
IP & CT informed.
Patients must have their own equipment e.g. blood pressure monitoring
machines and hoists should not be shared with other patients.
Unless advised otherwise by a member of the infection Prevention and
control team disposable gowns and gloves must be worn.
There is a specific isolation door notice to be used now available from
reprographics.
Enhanced Contact Precautions:
Health care Works (HCW’s) when nursing a patient with diarrhoea need
to utilise gowns to provide greater protection.
11. Protecting patients from infection:
The lack of antibiotics available to treat patients who develop infections
caused by strains of these resistant bacteria means any lapses in
practice are likely to have serious consequences for colonised patients
ant the risk of cross infection to other patients.
The bacteria are carried in the bowel but may be found on the patients’
skin and hands and immediate environment. It is essential these are not
introduced into the patients’ blood stream or other vulnerable site where
they can cause an infection.
Adherence to asepsis is essential and all invasive devices must be
removed as soon as no longer required.
11
All patients who have a long term urinary catheter or a urinary catheter
which was not removed prior to transfer must be provided with a
completed urinary catheter passport. If identified as CPE positive there
is a section to record this in the catheter passport.
The patient’s GP and any healthcare teams who will be caring for a
positive patient following discharge or transfer must be informed about
patients who are CPE positive. e.g. District nurses, nursing homes, other
level 2 beds within community care facilities and clinical teams in
receiving hospitals. (please refer to Appendix 3).
The infection prevention & control team (IPCT) must be informed and
will assist by providing any additional advice required. If CPE is
identified within Intermediate Care the IPCT will inform the GP and they
will also ensure that the patient is given a CPE card.
12. Hand hygiene:
Alcohol hand gel correctly used on visibly clean hands is effective for
hand decontamination for both patients and staff.
Hand hygiene after using the toilet is particularly important for patients.
As CPE are carried in the bowel there may be colonised patients who
we are unaware of therefore
 Faulty hand wash basins and toilet facilities must be promptly
reported and escalated
 Overloading and inappropriate disposal of items in macerators
must stop. A Datix report is required if this occurs.
 Commodes must be cleaned and disinfected between each
patient.
 Patients should not have urinary catheters unless there is a clear
indication for this. Patients with long term catheters or discharged
with a urinary catheter must have an up to date catheter passport.
Extract from Health Protection England Advice
12
ENSURE THAT:
1. All staff fully understand
2. Scrupulous IP&C practices are
isolation procedures and adhere
emphasised as being
to standard precautions as a
particularly important when
norm including:
using and caring for devices /
equipment such as:






Hand hygiene
Personal protective equipment
Aseptic technique
Laundry management
Safe use of sharps
Waste disposal (especially
faeces)








Intravenous / peripheral line
Central venous catheter line
Urinary catheter
Ventilators
Renal dialysis equipment
Enteral feeding equipment
Colostomy or ileostomy
Any re-useable diagnostic
equipment (Annex 3)
NOTE: Loose stools or diarrhoea (for any reason) increase the risk of spread of the bacteria
from the gut therefore:


Observe strict IP&C measures
Provide assistance to patients where effective hand hygiene is in doubt
13. Cleaning
environment:
and
decontamination
of
equipment
and
the
Whilst these bacteria can be carried on hands and gloves and
equipment and contaminate surfaces they are not as resistant to
cleaning and disinfection as Clostridium difficile.
The disinfectants which we have available e.g. Acticlor plus, disinfectant
based wipes, e.g. Chlorclean,Terminal Cleaning and disinfection should
also be followed by Hydrogen Peroxide Vapour (HPV)
Visible soiling of surfaces or equipment must be removed first using a
neutral detergent solution or detergent wipe as appropriate before a
disinfectant is used.
Dedicated single patient or single use equipment is preferable, and
should always be considered when treating a CPE positive patient.
For other contact patient equipment which cannot be decontaminated for
example endoscopes, attached cameras and other equipment which
13
cannot be steam cleaned, should be protected using a single use
covering (sleeve) and thoroughly disinfected between patients once the
covering has been removed.
Mattresses are of particular importance and conventional mattress
covers should be cleaned and disinfected.
Dynamic mattresses should be disassembled cleaned and disinfected
and then sorted within the appropriate bagging which is supplied, whilst
awaiting collection from the specialist mattress provider.
Privacy curtains should be removed and laundered or should be single
use.
Unused wrapped single use items in the patient’s immediate vicinity (that
may have become contaminated by hand contact) should be discarded.
14. Treatment & Therapies:
Those patients, who do not have diarrhoea, can leave their isolation
room to receive treatment or therapies. Following treatment or therapy
session, used equipment must be cleaned as stated in section 9. Gloves
and aprons must be worn by staff and hand hygiene performed following
15. Removing patients from isolation:
Patients may be removed from isolation, following three consecutive
negative screens 48 hours (two days apart). Please refer to (Annex 1 )
of the pathway to record results and ensure results are documented
within patient’s case notes. Patients should be closely monitored as
individuals following negative screenings can revert to a positive state,
especially after a course of antibiotics.
Decontamination is most crucial following a patient leaving a specific
area – for example from an isolation room or a bed space. This will need
co-ordination between the domestic, healthcare assistants, nurses and
other specialities as appropriate.
16. References
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Carbapenemase-producing Enterobacteriaceae: early detection,
management and control toolkit for acute trusts.1ST Published 19th June
2014 Public Health England.
BNF 65(British National Formulary) March-September 2013-bnf.org
Communicable Disease Control and Health Protection handbook-third
edition 2012.Hawker J, Begg N- Wiley Blackwell
15
Carbapenemase-producing Enterobacteriaceae
(CPE) Patient Pathway Management
ANNEX 1
Place patient sticker
Place patient sticker
To be used for both suspected and confirmed cases of CPE.
here
Immediate actions to be taken:
 Isolate the patient immediately with enhanced precautions in place
 Ensure that en-suite facilities or dedicated commode are available
 Notify the Infection Control Nurses on 295-3036
 If sepsis is suspected ward bleed GP to contact Medical Microbiology for antibiotic prescribing
advice
Checklist for patient confirmed or suspected of being CPE positive
Date
1
Isolate patient in a side room
2
En-suite toilet facilities provided
3
If no en-suite toilet facilities are available a dedicated toilet
facility for the patient has been identified
4
Enhanced precaution signage displayed
5
Explain CPE to patient and provide information leaflet.
6
Explain how infection is spread and precautions to
relatives.
7
All staff in contact with the patient to be informed of
precautions required.
8
Dedicated single patient or single use equipment has been
provided to include-:



BP cuff
Stethoscope
Thermometer
9
All appropriate PPE available outside the patient’s room to
include gloves, aprons, and long sleeved gowns.
10
Bristol Stool Chart in place for early detection of diarrhoea
11
Enhanced environmental cleans in place & discussed with
cleaning contractors the use of chloride based detergent
1000 ppm.
Sign
Comments
If the patient has a previously screened positive for CPE




Obtain a rectal swab within 24 hours of admission
Request specimens through ICE /SIGMA
Document specimens as collected/sent in Section 2
Please ensure CPE is clearly documented on request form
CPE Specimen results from this admission (all specimens obtained):
Date
Collected
Site
Result
Signature
NB: Please ensure that enhanced precautions remain in place even if negative results are obtained.
Section 3a: Transfer department for investigations:
Date
Investigation
Department
informed of
patients CPE
status? Y/N
Patient placed at end
of investigation list if
practicable Y/N
Therapies
Section 3b: Transfer to another ward (to be completed by receiving ward):
Date
1
Isolate patient in a side room
2
En-suite toilet facilities provided
3
If no en-suite toilet facilities are available a
dedicated toilet facility for the patient has been
identified
4
Enhanced precaution signage displayed
5
All staff in contact with the patient to be informed
of precautions required
6
Dedicated single patient or single use equipment
has been provided to include -:



BP cuff
Stethoscope
Thermometer
7
All appropriate PPE available outside the patients
room to include gloves, aprons, and long sleeved
gowns
8
Bristol Stool Chart in place for early detection of
diarrhoea
9
Enhanced environmental cleans in place
Signature
Comment
Signature
Section 4: Discharge or Transfer to another health care setting:
Date
Signature
Date
Signature
Inform receiving hospital, hospice, nursing home etc. (if appropriate)
Ensure all written communication includes the patients infection risk
Inform Infection Control Team
Patient toilets cleaned as appropriate
Side room and communal equipment cleaned appropriately
Section 5: Discharge to Home:
Inform Infection Prevention Control Team
Ensure patient and family are given CPE leaflet
Ensure patient is given CPE card
Infection Prevention Control Team ensure GP is informed
ANNEX 2
GP Letter for Discharge of CPE positive patient- North West Version,
May 2014
TRUST DETAILS
Date
General Practice
Dear Dr
Carbapenemase- producing Enterobacteriaceae Infection or
Colonisation
NAME
DOB
ADDRESS
NHS Number
(Sticker, automated data entry or by hand)
The above patient had a carbapenemase- producing Enterobacteriaceae
(CPE) identified from a screening /clinical [Delete as appropriate] sample
on [Date].
CPE are an emerging healthcare associated infection, and have caused
a number of significant outbreaks across the North West. CPE are
carried in the faeces and there is currently no treatment to eradicate
carriage.
Please list carbapenemase- producing Enterobacteriaceae
infection/colonisation as an active significant problem on your
records for this patient so that it appears on any referral letter,
especially for admission. We suggest using read code A3BA
[Organism resistant to multiple antibiotics], and adding
carbapenemase- producing Enterobacteriaceae in free text.
If this patient presents with an infection requiring antibiotics,
please contact your local microbiologist to discuss sample
collection and antibiotic choice.
In your surgery, standard infection control practices will minimise
the spread of this faecal organism. Standard practice should be
rigorously implemented but no additional infection control
precautions are required.
As part of a patient information package, this patient has been given a
CPE card and they have been asked to show this card to staff when
visiting any health or social care setting. A copy of the patient
information leaflet is attached.
Further information on CPE is available on the Public Health England
website,
http://www.hpa.org.uk/Publications/InfectiousDiseases/AntimicrobialAnd
HealthcareAssociatedInfections/1312Toolkitforcarbapenementero/
If you or your team have any concerns or queries regarding infection
control for CPE, please contact your local community infection,
prevention and control team on XXXX
Yours sincerely
ANNEX 3
Carbapenemase-producing Enterobacteriaceae (CPE)
Information Leaflet for Patients in North West England
What are CPE?
CPE stands for carbapenemase-producing Enterobacteriaceae.
Enterobacteriaceae are bacteria (germs) that usually live
harmlessly in the gut of humans. This is called ‘colonisation’ (a
person is said to be a ‘carrier’). However, if the bacteria get into
the wrong place, such as the bladder or bloodstream they can
cause infection. Carbapenems are one of the most powerful types
of antibiotics. Carbapenemases are enzymes (chemicals), made
by some strains of these bacteria, which allow them to destroy
carbapenem antibiotics and so the bacteria are said to be
resistant to most antibiotics.
Why does carbapenem resistance matter?
Carbapenem antibiotics can only be given in hospital directly into
the bloodstream. Until now, doctors have relied on them to
successfully treat certain ‘difficult’ infections when other antibiotics
have failed to do so. In a hospital, where there are many
vulnerable patients, spread of resistant bacteria can cause
problems.
Does carriage of CPE need to be treated?
If a person is a carrier of CPE, they do not need to be treated.
However, if the bacteria have caused an infection then antibiotics
will be required. Your doctor or nurse will be able to tell you if are
a carrier or a case (infected).
How did I pick up CPE?
Ask your doctor or nurse to explain this to you in more detail. As
mentioned above, sometimes the bacteria can be found, living
harmlessly, in the gut of humans and so it can be difficult to say
when or where you picked it up. However, there is an increased
chance of picking up these bacteria if you have been a patient in
a hospital abroad or in a UK hospital that has had patients
carrying the bacteria, or if you have been in contact with a carrier
elsewhere.
How will I be cared for whilst in hospital?
You will be assessed by healthcare staff as to whether you need
to be nursed in a single room or in a bay with others. You may be
asked to provide a number of samples / swabs depending on your
length of stay, to check if you are still carrying the bacteria. These
will probably be taken on a weekly basis. Samples and swab sites
may include where the tube for your drip (if you have one) enters
the skin, a rectal swab [a sample taken by inserting a swab briefly
just inside your rectum (bottom)], and / or a faecal (poo) sample.
You will normally be informed of the results within two to three
days.
How can the spread of CPE be prevented?
Healthcare workers should wash their hands regularly with soap and water
or alcohol gel. They will use gloves and aprons (occasionally gowns) when
caring for you.
The most important measure for you to take is to wash your hands
thoroughly with soap and water especially after going to the toilet. You
should avoid touching medical devices (if you have any) such as your
urinary catheter tube and your intravenous drip, particularly at the point
where it is inserted into the body or skin. Visitors will be asked to wash
their hands on entering and leaving the room and may be asked to wear
an apron / gloves if they are helping you with personal care.
What about when I go home?
As soon as your general condition allows and your doctors consider you
are ready for discharge, you can go home.
Remember that even though you may not be showing signs of infection,
you may still be carrying the CPE. It is important to inform a member of
health or social care staff when attending such settings, that CPE has
been identified previously. You will receive a patient card on CPE from
your care staff for you to carry and present to staff if you need to attend
a health or social care setting. This will ensure that you are looked after
appropriately.
If you visit the GP surgery after discharge, please tell your GP that you
have been diagnosed with CPE.
Good personal hygiene is important; this will help to protect you from
infection and reduce the risk of spread to others.
Hand hygiene is essential using soap and warm running water. You
should wash your hands before preparing food or eating and directly after
using the toilet.
If you have personal care at home, please contact your community
infection control team for further advice.
Where can I find more information?
If you would like any further information please speak to a member of
staff, who may also contact the Infection Prevention and Control Team
for you. The Public Health England website is another source of
information:
www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/CarbapenemRe
sistance/
Patient held card – North West, April 2014
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