Download Producing Enterobacteriaceae policy

Document name:
Detection, Management and Control
of Carbapenemase – Producing
Enterobacteriaceae
Document type:
Policy
What does this policy
replace?
This is a new Policy
Staff group to whom it
applies:
All clinical Staff in Inpatient Areas
Distribution:
The whole of the Trust
How to access:
Intranet
Issue date:
Reviewed:
April 2015
Next review:
April 2017
Approved by:
Executive Management Team
Developed by:
Julie Hartley
Infection Prevention and Control
Nurse
Director leads:
Director of Nursing, Clinical
Governance and Safety, acting as
Director of Infection Prevention and
Control
Infection Prevention & Control Team,
01226 433364
Contact for advice:
1
Contents
Page
1
Introduction
4
2
Aims and Objectives
4
3
Scope of Policy
4
4
Carbapenemase Producing Enterobacteriaceae (CPE)
4
5
Duties & Responsibilities
6
6
Detection, Screening and Reducing the Risk of Transmission
8
7
Infection Prevention and Control Measures:
7.1Isolation
7.2 Hand Hygiene
7.3 Personal Protective Clothing
7.4 Aseptic Non-Touch Technique (ANTT)
7.5 Waste and Linen
7.6 Decontamination of Equipment
7.7 Environmental Cleaning
7.8 Departmental Visits
7.9 Deceased Patients
10
8
Discharge/Transfer of Patients
12
9
Screening of Contacts
13
10
Treatment/Decolonisation
14
11
Outbreak
14
12
Consultation Process
14
13
Implementation and Dissemination
15
14
Monitoring Compliance and Effectiveness
15
15
Further Advice and Support
15
16
References/Further Reading
15
Appendix 1: Screening Flowchart
Appendix 2: Carbapenemase-producing Enterobacteriaceae: I may be a
carrier (or have an infection) – what does this mean?
Appendix 3: Advice for patients who have a positive result
2
Appendix 4: Carbapenemase-producing Enterobacteriaceae – I am a contact
of someone who is a carrier or has an infection – what does this
mean?
Appendix 5: Inter-healthcare Infection Control Risk Assessment Transfer Form
Appendix 6: Hand held card to be given to CPE positive patients
Appendix 7: Infection Prevention and Control Staff Contact Details
3
Detection, Management and Control of Carbapenemase –
Producing Enterobacteriaceae
1
Introduction
In the United Kingdom (UK), over the last five years, there has been a rapid
increase in the incidence of infection and colonisation by multi-drug resistant
carbapenemase-producing organisms. These organisms have become
increasingly resistant to the commonly prescribed antibiotics used within the
hospital environment. Carbapenem antibiotics are a powerful group of βlactam (penicillin-like) antibiotics used in hospitals. Until now, they have been
the antibiotics that doctors could always rely upon (when other antibiotics
failed) to treat infections caused by Gram-negative bacteria. Immediate action
is now required, learning from experiences elsewhere across the globe, rapid
spread of carbapenem-resistant bacteria has great potential to pose an
increasing threat to public health and modern medicine as we know it in the
UK.
2
Aims and Objectives
This policy covers the detection, management and control of Carbapenemase
– Producing Enterobacteriaceae (CPE) within the South West Partnership
NHS Foundation Trust (there after referred to as the Trust). It should be read
in conjunction with the following Trust policies Hand Hygiene, Standard
Infection Prevention and Control Precautions, Infectious Outbreak Guidelines,
Decontamination and Isolation Policy.
3
Scope of Policy
Adherence to this policy is the responsibility of all staff employed within the
Trust including those on temporary or honorary contracts, secondment,
agency staff and students. The contents of this policy promote safe working
practices and protect patients and staff. It reflects current guidance and best
practice within infection prevention and control and meets the requirements
set out in the Health and Social Care Act 2008 – Code of Practice for the NHS
on the Prevention and Control of Healthcare Associated Infections.
4
Carbapenemase Producing Enterobacteriaceae (CPE)
Enterobacteriaceae are a large family of bacteria that usually live harmlessly
in the gut of all humans and animals. However, these organisms are also
some of the most common causes of opportunistic urinary tract infections,
intra-abdominal and bloodstream infections. They include species such as
Escherichia coli, Klebsiella spp. and Enterobacter spp. Carbapenems are a
valuable family of antibiotics normally reserved for serious infections caused
by drug-resistant Gram-negative bacteria (including Enterobacteriaceae).
They include meropenem, ertapenem, imipenem and doripenem.
Carbapenemases are enzymes that destroy carbapenem antibiotics,
conferring resistance. They are made by a small but growing number of
Enterobacteriaceae strains. There are different types of carbapenemases, of
which KPC, OXA-48, NDM and VIM enzymes are currently the most common.
Refer to table 1 for countries and regions with reported high prevalence of
healthcare-associated Carbapenemase-Producing Enterobacteriaceae
4
Table 1: Countries and Regions with Reported High Prevalence of HealthcareAssociated Carbapenemase-Producing Enterobacteriaceae
Bangladesh
North Africa (all)
The Balkans
Malta
China
Middle East (all)
Cyprus
Pakistan
Greece
South East Asia
India
South/Central America
Ireland
Turkey
Israel
Taiwan
Italy
USA
Japan
This is not an exhaustive list; admission to any hospital abroad should be considered when making a
risk assessment. Lack of data from a country not included in this list may reflect lack of reporting /
detection rather than lack of a carbapenemase problem (which may additionally contribute to an
under-estimation of its prevalence)
UK regions / areas where problems have been noted in some hospitals:
North West especially:
Manchester
London
Based on reported prevalence, correct as known (19 November 2013). Please refer to
www.hpa.org.uk for most current updates.
5
5. Duties and Responsibilities
South West Yorkshire Partnership NHS Foundation Trust has a duty and is committed to
reducing the risk of HCAI. This includes providing the hand hygiene products required to
decontaminate hands effectively, and the on-going education and audit required to ensure
compliance. Infection prevention and control is everybody’s responsibility. All Trust staff are
responsible for demonstrating compliance with this policy. The following specific duties apply:
5.1 Chief Executive
The Chief Executive has overall responsibility for the strategic direction and operational
management of the organisation, and the assurance that Trust policies comply with all
legal, statutory and good practice guidance requirements. They are also accountable for
the continuing development of the organisation, and the provision of accessible/relevant
training for all identified staff groups.
5.2 Trust Board
Trust Board is responsible for signing off the approval, dissemination and implementation of this
policy.
The Trust Board will receive and approve the annual IPC report and annual plan, and monitor
progress.
The Trust Board will review and monitor relevant IPC data, including compliance with education
and training.
5.3 Executive Management Team (EMT)
The Executive Management Team is responsible for approving the contents of the policy.
5.4 Clinical Governance & Clinical Safety Committee
The Clinical Governance & Clinical Safety Committee is responsible for the dissemination
and implementation of this policy on behalf of theTrust Board. They will review relevant
Infection Control data.
5.5 Director of Infection Prevention and Control (DIPC)
The DIPC will report directly to the chief executive and the board, and not through any other
officer.
He/she will challenge inappropriate clinical hygiene practice, as well as antibiotic prescribing
decisions.
He/she will be an integral member of the organisation’s clinical governance and patient safety
teams and structures.
He/she will assess the impact of all policies and plans on infection, and make recommendations
for change.
6
He/she is the lead director responsible for engaging relevant stakeholders in the development of
the policy.
He/she will ensure appropriate arrangements are in place for managing any resource
implications, including dissemination, implementation and training.
He/she is responsible for ensuring the most current version of the policy is in use and obsolete
versions have been withdrawn from circulation.
He/she will produce an annual report on the state of HCAI in the organisation, and release it
publicly.
5.6 Infection Prevention and Control Trust Action Group (IPC TAG)
The IPC TAG will review new legislation and guidance and ensure that its implications are fully
understood within the Trust.
It will commission a revision of the existing policy accordingly and oversee the dissemination
and implementation of the revised policy. Commissioning and development of this policy may be
undertaken in liaison with the Health and Safety TAG, Drugs and Therapeutics TAG, and the
Estates TAG.
The IPC TAG will receive quarterly reports from the IPCT in order to monitor hand hygiene
practice. This report will include all incidents reported on the DATIX system related to practice
and alert the BDUs to any trends.
5.7 Infection Prevention and Control Team
The IPCT will develop, disseminate, implement and review this policy.
The IPCT will co-ordinate audit activity to monitor compliance with this policy.
The IPCT will provide corporate induction and on-going mandatory infection prevention and
control training to educate and monitor staff awareness of the policy content.
The IPCT will lead on campaigns to raise awareness and compliance with the policy
requirements.
The IPCT will ensure that Directors of BDUs are made aware of issues which occur within their
care groups as they arise.
The IPCT will lead by example and challenge poor practice.
5.8 Business Delivery Units
BDUs will be consulted in the development of the policy.
BDUs will ensure that the policy is implemented within their areas.
7
BDUs will ensure that adequate resources and facilities are made available to fulfil the policy
requirements.
BDUs will ensure staff compliance with this policy.
5.9 Matrons and Unit / Department Managers
Need to ensure that staff are aware of this policy document and that they implement it in
practice.
5.10 Staff
Have a responsibility to:

Read and comply with this policy

Attend training to promote awareness and compliance with this policy

Raise any enquiries about this policy with their managers

Deliver the equality and diversity strategy with regard to this policy
6.
Detection, Screening and Reducing the Risk of Transmission
6.1
All in-patient admissions (excluding outpatient appointments) must be risk
assessed on the day of admission or day of transfer from another hospital
outside of the Trust as follows:
In the last 12 months has the patient:
Been an inpatient in a hospital abroad?
Or
Been an inpatient in a UK hospital known to have had problems with
spread of CPE? (refer to table 1 page 4)
Or
Previously been colonised or had an infection with CPE or is a close
contact (a person living in the same house; sharing the same sleeping
space room or hospital bay; or a sexual partner) with a person who has
CPE, if known?
IF THE ANSWER IS NO TO ANY OF THESE QUESTIONS THEN NO
FURTHER ACTION IS REQUIRED.
See Appendix 1 for Screening Flowchart
8
Suspected Case of CPE and Actions Required
If the answer is yes to one or more of the questions above the patient is
considered to meet the criteria for being suspected of having a CPE and the
following is required:

Screen the patient by taking a rectal swab, there should be visible
faecal material on the swab or alternatively/if contra-indicated a stool
sample can be submitted (provide explanation and patient fact sheet in
appendix 2)
And

Send to laboratory as soon as possible marking request form
‘Possible CPE ‘colonisation or infection’ (or ‘exposure’ if a contact)
Also

If patient is known to have been hospitalised in the last 12 months in
a country with reported high prevalence (or area known to have a
CPE problem (refer to table 1) include additional samples from any
wounds and device-related sites.
And
 Immediately isolate the patient and instigate infection prevention and
control measures, see section 7.Risk assess the patient with the IPC team
if for any reason the patient cannot be isolated. In addition refer to the
Trust Isolation Policy.
NOTE: Loose stools or diarrhoea (for any reason) increase the risk of spread
of the bacteria from the gut. See Diarrhoea Policy.
Actions if the Faecal Sample Tests Negative

The patient should remain in isolation until a further two consecutive
samples test negative - samples being taken 48 hours apart (i.e. day 0
[initial sample], day 2 and day 4).

If all 3 samples are negative the measures can be stopped and the patient
can be moved out of isolation – no further action is required
Actions if the Faecal Sample Tests Positive

Reinforce the need for isolation (the patient should remain isolated for the
duration of their hospital stay) and infection and control measures
continued

Inform the patient of carrier status and provide patient information sheet –
see appendix 3. The patient must also be given a CPE hand held card
9
informing other healthcare providers of their carrier status, this card can be
obtained from the IPC Team, see appendix 6

Consider if screening of contacts is required (not normally required if the
patient was identified on admission and isolated immediately) – see
section on screening of contacts on page 11.
Flag the positive result (colonisation or infection) of CPE on the patient’s
records and in the ICE pathology system.
In Barnsley BDU complete the Patient Alert Notification form (gold coloured)
and send to Q34 Barnsley Hospital NHS Foundation Trust, this informs the IT
Department to put an infection alert on the case noted.

Inform the IPC team immediately of the positive result.

In addition inform the following as soon as possible:
i.
ii.
iii.
iv.
v.

6.2
The ward/department manager
Patient’s Consultant
Infection Prevention and Control Doctor
Director of Infection Prevention and Control
Yorkshire and Humber Public Health England (Consultant
Microbiologist/Infection Prevention Control Doctor to notify)
If it is a hospital acquired CPE then a post infection review will need to
be undertaken and the incident reported onto the DATIX system
If the patient has a laboratory confirmed infection or colonisation during their
in-patient stay then immediately isolate and follow the infection prevention and
control measures and screening of contacts.
7 Infection Prevention and Control Measures
7.1
Isolation
 The patient must be isolated immediately in a single room and barrier
nursed as per the Trust Isolation Policy with an infection risk poster
displayed on the outside of the side room/cubicle door and the door
closed.
 If a side room is not available follow the Isolation Escalation Procedure as
soon as possible so that one can be located elsewhere in the hospital
 If the patient has been assessed as not suitable for a side room, e.g. due
to safety reasons or a side room has not been located this must be clearly
documented in the patient’s records. The matron/ ward manager
responsible for the area and the Infection Prevention and Control Nurse
must be informed. A risk assessment must then be undertaken to identify
where on the ward the patient is placed, to reduce the risk of transmission
of infection to other patients.
7.2
Hand Hygiene

Hands must be thoroughly washed and dried using soap and water or,
if hands are visibly clean disinfectant hand gel can be used, before and
10
after any patient contact (see Hand Hygiene Policy) as transmission is
more likely to occur by healthcare workers hands
7.3
Personal Protective Equipment


7.4
Disposable plastic aprons and gloves must be worn for all direct patient
contact and when working in the patients immediate environment. Where
any part of the staff uniform, not protected by an ordinary apron, is
expected to come into contact with the patient, a long sleeved disposable
gown should be used e.g. when assisting with patient movement/personal
cares for a dependant patient. Standard Infection Prevention and Control
Precautions).
Visitors who only have social contact with the patient do not need to wear
gloves or aprons, but do need to wash hands on entering and leaving
room/bed space.
Aseptic Technique

Strict adherence to aseptic practices is emphasised as being particularly
important when using and caring for devices / equipment such as:
o
o
o
o
o
o
7.5
Waste and Linen

7.6
intravenous peripheral catheter
central venous catheter
urinary catheter
enteral feeding equipment
colostomy or ileostomy
any re-usable diagnostic equipment
Waste and linen must be dealt with as infected and according to the Trust
Waste Policy (refer also to the Standard Infection Prevention and Control
Precautions)
Decontamination of Equipment
 All equipment that has come into contact with the patient must be
decontaminated according to the Decontamination Policy. Tourniquets and
blood pressure cuffs must be single patient use.
 It is the responsibility of staff to clean bed mattresses using a chlorine
releasing agent diluted to 1,000ppm and disposable cloths
 The mattress cover needs to be checked for any damage e.g. torn cover
and unzipped to inspect foam for leakage of blood/body fluids following
each discharge/use of the mattress/contamination of the mattress
 Dynamic mattresses should be cleaned and placed in a yellow mattress
collection bag obtained from facilities with a decontamination notice
attached and returned for disinfection as per the decontamination of
mattresses procedure.
 The patient must have their own toilet/commode/en-suite facilities.
Commodes must thoroughly cleaned, following the IPC cleaning guide,
11
using a chlorine releasing agent diluted to 1,000ppm and disposable cloths
after each use and apply tape correctly indicating that it has been cleaned.
7.7
Environmental Cleaning



7.8
Routine cleaning of the patient’s room/bed area and contents must be
performed twice a day using chlorine diluted to a 1000ppm and detergent
agent, e.g. Chlor-clean or Actichlor Plus using disposable cloths, and
disposable/launderable mops (mop heads must not be re-used) and
designated buckets, particular attention should be paid to all horizontal
surfaces, beds, bed bases, curtain rails and particular attention paid to
surfaces that may have had patient or staff hand contact. Ward staff to
notify domestic services of this requirement. This is referred to as a
twice daily clean.
Following discharge/transfer of the patient, the room/bed area must be
thoroughly cleaned and undergo hydrogen peroxide vaporisation (HPV)
disinfection before it used again by another patient
Unused wrapped single use items in the patient’s vicinity (that may have
become contaminated) should be discarded. The burden of this may be
minimised by keeping limited stocks near the patient and tubes of ointment
and lubricant must be disposed off
Departmental Visits
Visits to departments e.g. X-ray, must be based on the clinical need of the
patient and if at all possible the diagnostic test/procedure should be
undertaken in the patients room. If this is not possible the procedure should
be planned and arranged beforehand with the department as follows:
 Patient to be placed the end of a list/session
 Patient must only be sent for when the department is ready
 Patient must spend the minimum amount of time in the dept. as
necessary
 Equipment and environment must be cleaned with a 1000ppm chlorine
releasing and detergent agent, e.g. Chlor-clean or Actichlor Plus
following the episode of care/treatment
 Staff should adhere to standard infection prevention and control
precautions during investigation or treatment of patients.
7.9
Deceased Patients

8
If a patient with CPE dies, the body does not have to be placed in a
cadaver (body) bag, but standard infection prevention and control
precautions must still be followed.
Discharge/ Transfer of Patients
Robust healthcare communications are crucial to prevent and control the
spread of CPE.
12
An inter-healthcare transfer form must be completed as per the Trust
Infection Control Risk Assessment Policy for Admission, Transfer and
Discharge to Healthcare Settings. See appendix 5 for the form

Patients must not be routinely transferred to other wards unless for
isolation purposes or based on clinical need.

If the patient is to be transferred to another ward/hospital outside of the
Trust the following must be informed beforehand:
o Receiving ward/area -Trusts where there is regular inter-trust
transfer from one unit to another (e.g. Accident & Emergency
Department and an Acute Medical Unit)
o Infection Prevention and Control Team
o Microbiologists and laboratory personnel

If the patient is to be transferred to non-acute/community setting the
following must be informed beforehand:
o Receiving community setting e.g. Care Home
o Infection Prevention and Control Team and microbiologist of
receiving Trust
o Patients GP
o Any other relevant care provider/community healthcare worker e.g.
Community Nurse
Ensure the receiving clinicians are given the completed inter-healthcare
transfer form.
9
Screening of Contacts
Screening of contacts is based on the likelihood of exposure as follows:
 Screening of patients in the same setting is not normally required
if the case was identified on admission and isolated immediately
Contacts that do Require Screening in Inpatient Areas
 Screening of patient contacts of a positive case must be undertaken if
the patient has spent time (or remained) in an open ward or bay with
other patients before (or despite) having a positive result for
carbapenemase-producing Enterobacteriaceae as follows;
Screen all the patients in the bay or ward if the patient has
occupied more than one bay (rectal swab) on a weekly basis for a
period of 6 weeks after the last case was detected and provide
explanation and fact sheet in appendix 4.
 Restrict screening to patient contacts remaining in hospital
13
 It is not necessary to isolate contacts whilst awaiting screening results
– cohort contacts if possible and emphasise the importance of hand
infection prevention and control measures. However, should any
contact screen positive they should be managed as a positive case
and isolated.
Screening of household contacts and healthcare staff
 Screening of household contacts and healthcare staff is not required –
there is no compelling evidence to suggest that screening the
household or healthcare staff to check for colonisation will provide
additional benefit in controlling spread in the healthcare setting. The
main focus should remain on promotion of strict standard precautions
throughout, especially hand hygiene.
 If a patient refuses screening contact the Infection Prevention and
Control Team for further advice and management
10
Treatment/Decolonisation
If the patient is colonised (carrying the organism but not infected) no antibiotic
treatment is required as decolonisation is not required due to the following:


Skin decolonisation – not advised as these bacteria generally colonise
the gut rather than the skin
Gut decolonisation (by prescribing antibiotics) – not advised as
although antibiotics may provide some benefit, there is concern that
their use would contribute to increasing resistance in the longer term.
Treatment Required if the Patient is Infected
If the patient develops an infection please discuss antibiotic management with
the Consultant Microbiologist as treatment will be guided by the susceptibility
results.
11
Outbreaks
In case of an outbreak of CPE immediately report to the Infection Prevention
& Control Team and refer to the Trust Infectious Outbreak Guidelines
Inpatient Departments.
Out of hours please consult the on-call microbiologist for advice.
See appendix 7 for contact details
Ensure a Datix incident report is submitted reporting the outbreak.
12
Consultation Process
This policy has been drawn up by the Infection Prevention and Control Team
on behalf of the Director of Infection Prevention and Control and has been
14
before the ‘wider’ Infection Prevention and Control Team and the Infection
Prevention and Control TAG.
13
Implementation and Dissemination
This policy will, following approval by the Infection Prevention and Control
Group, Director of Infection Prevention and Control and EMT, be available to
staff on the Trust intranet page. It will be communicated to staff via Ward and
Department Managers, Matrons, Associate Directors of Nursing, Clinical
Directors and Heads of Clinical Service.
14
Monitoring Compliance and Effectiveness
Ward and department managers will be responsible for the on-going
monitoring of the performance within their own clinical area. Ward managers
and unit leaders will be responsible for ensuring that staff have received
appropriate training.
The number of CPE cases occurring within the Trust will be monitored to
establish trends within the Trust. This will provide a baseline of the number of
cases and assist in the detection of an emerging problem.
15
Further Advice and Support
For further advice please contact the Infection Prevention & Control Team on the
contact numbers in appendix 7
16
References/Further Reading
Acute Trust Toolkit for the early detection, management and control of
carbapenemase-producing Enterobacteriaceae. Public Health England. December
2013
Acknowledgment
This policy was adapted and developed further from the Mid Yorkshire Hospital NHS
Trust Policy Detection, Management and Control of Carbapenemase – Producing
Enterobacteriaceae
15
Appendix 1
Screening Flowchart on Admission of Inpatients for the Detection of CPE and the Indications for Contact Screening
Risk assess all Inpatient Admissions (excluding
outpatient appointments) on the day of
admission/transfer into the Trust
Screen the patient by taking a rectal swab if:



The patient has been an inpatient in a hospital abroad?
Been an inpatient in a UK hospital known to have had problems with spread of CPE? (refer to table 1 page 4)
Previously been colonised or had an infection with CPE or is a close contact (a person living in the same house; sharing the same
sleeping space room or hospital bay; or a sexual partner) with a person who has CPE, if known?
If sample POSITIVE
Isolate patient immediately and follow actions
and Infection Prevention & Control Precautions
as on page 8
Contact Screening if
isolated on admission
No contact screening
required
Contact Screening if not
isolated on admission
If sample NEGATIVE
The patient should remain in isolation until a further two consecutive
samples test negative - samples being taken 48 hours apart (i.e. day 0
[initial sample], day 2 and day 4).
If all 3 samples are negative the measures can be stopped and the
patient can be moved out of isolation – no further action is required
Screen all the patients in the bay or ward if the patient has
occupied more than one bay (rectal swab) on a weekly
basis for a period of 6 weeks after the last case was
detected
Restrict screening to patient contacts remaining in hospital
Screening of household contacts and healthcare staff is
16
not required
Contact Screening
No screening of contacts is required
Appendix 2
Carbapenemase-producing Enterobacteriaceae: I may be a carrier
(or have an infection) – what does this mean?
What does ‘carbapenemase-producing Enterobacteriaceae’ mean?
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. 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 the 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. Therefore, in a hospital, where
there are many vulnerable patients, spread of these resistant bacteria can cause
problems.
Does carriage of carbapenemase-producing Enterobacteriaceae need to
be treated?
If a person is a carrier of carbapenemase-producing Enterobacteriaceae (sometimes
called CPE), they do not need to be treated. As mentioned, these bacteria can live
harmlessly in the gut. However, if the bacteria have caused an infection then
antibiotics will be required.
How will I know if I am at risk of being a carrier or having an infection?
Your doctor or nurse may suspect that you are a carrier if you have been in a
hospital abroad, or in a UK hospital that has had patients carrying these bacteria, or
if you have been in contact with a carrier elsewhere. If any of these reasons apply to
you, screening will be arranged for you and you will be accommodated in a single
room with your own toilet facilities at least until the results are known.
How will I be screened for carbapenemase-producing Enterobacteriaceae?
Screening usually entails taking a rectal swab by inserting it just inside your rectum
(bottom). Alternatively, you may be asked to provide a sample of faeces. The swab /
sample will be sent to the laboratory and you will normally be informed of the result within
two to three days. If the result is negative, the doctors or nurses may wish to check that a
further two samples are negative before you can be accommodated on the main ward.
These measures will not hinder your care in any way. If all results are negative no further
actions are required
17
Appendix 3
Advice for patients who have a positive result
What happens if the result is positive?
If the result is positive, do ask your doctor or nurse to explain this to you in more
detail. You will continue to be accommodated in a single room whilst in hospital. If
you have an infection, you will need to have antibiotics. However, if there are no
signs of infection and you are simply ‘carrying’ the bacteria, no treatment is required.
How can the spread of carbapenemase-producing Enterobacteriaceae be
prevented?
Accommodating you in a single room, if the result is positive, helps to prevent spread
of the bacteria. Healthcare workers should wash their hands regularly. They will use
gloves and aprons when caring for you. The most important measure for you to take
is to wash your hands well 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.
What about when I go home?
Whilst there is a chance that you may still be a carrier when you go home, quite
often this will go away with time. No special measures or treatment are required; any
infection will have been treated prior to your discharge. You should carry on as
normal, maintaining good hand hygiene. If you have any concerns you may wish to
contact your GP for advice.
If you or a member of your household is admitted to hospital you should let the
hospital staff know that you are, or have been, a carrier.
Where can I find more information?
If you would like any further information please speak to a member of your care staff,
who may also contact the Infection Prevention and Control Team for you. The Public
Health England website is another source of information:
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/CarbapenemResistan
ce/
18
Appendix 4
Carbapenemase-producing Enterobacteriaceae – I am a contact of
someone who is a carrier or has an infection – what does this
mean?
What does ‘carbapenemase-producing Enterobacteriaceae’ mean?
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. 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 the 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. Therefore, in a hospital, where
there are many vulnerable patients, spread of resistant bacteria can cause problems.
Does carriage of carbapenemase-producing Enterobacteriaceae need to
be treated?
If a person is a carrier of carbapenemase-producing Enterobacteriaceae (sometimes
called CPE), they do not need to be treated. As mentioned, these bacteria can live
harmlessly in the gut. However, if the bacteria have caused an infection then
antibiotics will be required.
How is carbapenemase-producing Enterobacteriaceae spread?
If a patient in hospital is carrying these bacteria it can get into the ward environment
and can also be passed on by direct contact with that particular patient. For that
reason, the patient will normally be accommodated in a single room. Effective
environmental cleaning and good hand hygiene by all, staff and patients, can reduce
the risk of spread significantly.
Do I need to be screened?
Occasionally, it isn’t immediately known that a patient is carrying these bacteria and
so they may not be placed into a single room straight away. Screening will be offered
if you have shared the same bay (or ward) with a patient who has been found to be
carrying carbapenemase-producing Enterobacteriaceae. This screening is offered as
there is a slight chance that you could have picked up the bacteria and are carrying it
too.
How will I be screened for carbapenemase-producing
Enterobacteriaceae?
Screening usually entails taking a rectal swab by inserting it just inside your rectum
(bottom). Alternatively, you may be asked to provide a sample of faeces. The swab /
sample will be sent to the laboratory and you will normally be informed of the result
within two to three days. If the result is negative nothing further is required unless
you are staying in hospital for some time. In that case, you will probably be asked to
provide a sample on a regular basis e.g. once a week, as a precautionary measure.
What if the result is positive?
If the result is positive do ask your doctor or nurse to explain this to you in more
detail and to provide a leaflet relating to positive results. You will be given a single
room until you leave hospital. No treatment is necessary unless you have an
infection when antibiotics will be given.
Where can I find more information?
The Public Health England web site is another source of information:
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/CarbapenemResistan
ce/
20
Appendix 5
Inter-healthcare Infection Control Risk Assessment Transfer Form
To be completed by South West Yorkshire Partnership NHS Foundation Trust and given to
receiving healthcare worker on transfer of service user into another healthcare setting
Service user details: (insert label if available)
Consultant:
GP:
Name:
Current service user location:
Address:
Transferring facility – hospital, ward, care
home, other:
Contact no:
NHS Number:
Date of birth:
Receiving facility – hospital, ward, care home,
district nurse
Is IPCT aware of transfer?
Yes/No
(If no contact IPCT for risk assessment prior to
transfer. Use on-call microbiologist if out of
hours)
Is the service user an infection risk?
Please tick most appropriate box and give
confirmed or suspected organism
 Confirmed risk Organism:
 Confirmed risk Organism:
 Suspected risk Organism:
 No known risk
Service user exposed to others with infection e.g.
D&V - Yes/No
(If yes give further details)
Contact no:
Is IPCT/ambulance service aware of transfer?
Yes/No
If service user has diarrhoeal illness, please indicate bowel history for last week:
(Based on Bristol stool form scale attached)
Is
the
diarrhoea
thought
to
be
of
an
infectious
Yes/No
(If yes, has the person had any symptoms within the last 48 hours, please give details)
nature?
Relevant specimen results (including admission screens – MRSA, glycopeptides-resistant
enterococcus, C.difficile, multi-resistant Acinetobacter and treatment information, including
antibmicrobial therapy:
Specimen:
Specimen:
Date:
Date:
Result:
Result:
Treatment information:
Existing Care Plans:
Is the service user aware of their diagnosis/risk of infection?
Yes/No
Does the service user require isolation?
Yes/No
Should the service user require isolation, please phone the receiving unit in advance.
Signature of staff member completing form
…………………………………………………………
Print Name:
21
Contact number:
Appendix 6
HAND HELD CARD TO BE GIVEN TO CPE POSITIVE PATIENTS
The holder of this card has had a
CPE infection if he/she is treated or
admitted into hospital take IPC
precautions as per the Trust CPE Policy &
notify the Infection Prevention & Control
team on 01226 435794
Consult the Local Consultant
Microbiologist if antibiotics are required
July 2014
CPE
Carbapenemase
Producing
Enterobacteriaceae
Please show this card to any doctor or
nurse when accessing Health or Social care
22
Appendix 7
Infection Prevention and Control Staff Contact Details





Alison Thomas, Lead Infection Prevention & Control Nurse
[email protected]
Adele Watson, Senior Infection Prevention & Control Nurse
[email protected]
Julie Hartley, Senior Infection Prevention Practitioner,
[email protected]
Katy Symon, Infection Prevention Practitioner,
[email protected]
Yvonne Sambrook, Infection Prevention & Control Nurse
Yvonne.sambrook @swyt.nhs.uk
01226 433364
Barnsley Hospital NHS Foundation Trust Consultant Microbiologist

Consultant Microbiologist,
BHNFT
Tel: 01226 730000
Calderdale, Kirklees and Wakefield In-Patients Services Microbiologist

Consultant Microbiologist
Tel: 0844 8110101
23
Equality Impact Assessment Tool
To be completed and attached to any policy document when submitted to the Executive Management
Team for consideration and approval.
Date of Assessment: 4-7-14
Equality Impact Assessment
Questions:
Evidence based Answers & Actions:
1
Name of the document that you are
Equality Impact Assessing
2
Describe the overall aim of your
document and context?
Who will benefit from this
policy/procedure/strategy?
3
Who is the overall lead for this
assessment?
4
Who else was involved in
conducting this assessment?
5
Have you involved and consulted
service users, carers, and staff in
developing this
policy/procedure/strategy?
The overall aim of the policy is to provide staff with
clear and practical evidence based information on
the detection, management and control of
Carbapenemase – Producing Enterobacteriaceae
All staff
Director of Nursing and Infection Prevention &
Control
Infection Prevention & Control Team
Yes comments incorporated into policy from IPC
team and Trust wide Clinical Policies & Procedures
Group
What did you find out and how have
you used this information?
6
What equality data have you used to
inform this equality impact
assessment?
N/A
7
What does this data say?
N/A
8
Taking into account the
information gathered above,
could this policy
/procedure/strategy affect
any of the following equality
group unfavourably:
No
N/A
8.1
Race
No
N/A
8.2
Disability
No
N/A
8.3
Gender
No
N/A
8.4
Age
No
N/A
24
Equality Impact Assessment
Questions:
Evidence based Answers & Actions:
8.5
Sexual Orientation
No
N/A
8.6
Religion or Belief
No
N/A
8.7
Transgender
No
N/A
8.8
Maternity & Pregnancy
No
N/A
8.9
Marriage & Civil
No
N/A
No
N/A
partnerships
8.10
Carers*Our Trust
requirement*
9
What monitoring arrangements are
you implementing or already have in
place to ensure that this
policy/procedure/strategy:-
This policy aims to standardise the approach to
9a
Promotes equality of opportunity for
people who share the above
protected characteristics;
Yes Infection prevention and control is nondiscriminative and applies to everyone.
9b
Eliminates discrimination,
harassment and bullying for people
who share the above protected
characteristics;
Yes
9c
Promotes good relations between
different equality groups;
Yes
9d
Public Sector Equality Duty – “Due
Regard”
Have you developed an Action Plan
arising from this assessment?
Assessment/Action Plan approved
by
Yes
10
11
No
Signed: Julie Hartley Date: 4-7-14
Title: Infection Prevention & Control Nurse
25
Version Control Sheet
This sheet should provide a history of previous versions of the policy and changes made
Version
Date
Author
1
July 2014
Julie Hartley
IPCN
Status
Comment / changes
New Policy
26