CPE (Carbapenemase-Producing Enterobacterales)

A risk assessment at admission should be completed for all patients using the Key Inpatient Information (KIPI) tool in EPR. This is found in the AdHoc menu. Completing KIPI will generate a request for CPE screening in the tasks list if this is indicated.

1. Has the patient been transferred from another hospital in the UK?
2. Has the patient been transferred from/recently been in a hospital abroad?
3. Has the patient been an in-patient in a hospital abroad within the last 12 months?
4. Has the patient been previously colonised / infected with CPE?  
5. Is your patient currently receiving renal replacement therapy (haemodialysis, filtration or peritoneal dialysis)?
6. Is your patient being admitted to a high-risk unit? 
   • Critical care units (including adult, neuro, cardiac, Horton)
   • Medical services:
     • Blood and marrow transplantation
     • Clinical haematology
     • Clinical oncology (radiotherapy)
     • Gynaecological oncology
     • Medical oncology
     • Nephrology
     • Transplantation surgery

(N.B. Your patient is likely to also need a MRSA screen, see MRSA screening recommendations.)

If YES to any of the above:

• Immediate isolation           

• Enhanced Contact IPC precautions

• Screening of patient to assess current status

• Assessment for appropriate treatment - discuss with Micro/ID SpR or Consultant

• Inform the Infection Prevention &Control  (IPC) Team (bleep 1747, or Micro SPR if out of hours)

•  Offer the patient an information sheet (if appropriate) 

• Isolation within single room
• Door to isolation room must be closed
• Door is labelled with OUH Trust Enhanced Contact Precautions isolation sign
• Hand Hygiene is performed as per WHO five moments
• Aprons and gloves are worn by all staff entering the room at ALL times
• Additional PPE may be required if an outbreak is suspected or where any part of a staff uniform, not protected by an ordinary apron, is expected to come into contact with the patient, in this case, a long-sleeved disposable gown should be used e.g. when assisting movement for a dependent patient, or if aerosolisation of body fluids is expected.
• Linen must be placed in a red alginate (dissolvable) bag in the room which should be placed in a white plastic bag outside the room and sent to the laundry.
• In the event of an outbreak, additional measures may be needed (advised by Infection Prevention & Control)
• Relatives and visitors do not need to wear aprons and gloves but should perform hand hygiene on entering and leaving the isolation room. Relatives and visitors should not use common areas of the ward.

All cases who could be at risk of CPE should have screening undertaken promptly.          

• Take a rectal swab or a stool swab. Request CPE screen MCS, 'Rectal/Stool swab' (can be printed from tasks list if KIPI completed on EPR) and send to microbiology lab.
• If patient is admitted with a urine catheter, also take a urine sample. Request CPE screen MCS, 'Urine, catheterised' and send to microbiology lab.
• If patient is admitted with a wound, also take a wound swab. Request CPE screen MCS, 'Wound swab' and send to microbiology lab.

Patient decolonisation is not feasible currently. 

Decontamination of patient equipment

• single use where possible
• dedicated equipment - decontaminate with green Clinell wipes®

Environment

For confirmed or presumptive cases daily enhanced cleaning of the isolation area should be performed by the domestic staff using dedicated YELLOW colour coded equipment and cleaned using a combined product of detergent and hypochlorite (e.g. Actichlor plus® or Chlor-clean®)

Terminal cleaning of the room and equipment will be required at discharge, prior to admission of a new patient

Patients who need to be treated because of pneumonia, UTI, intra-abdominal infection or sepsis should ALWAYS be discussed with Micro/ID.

Antibiotics are usually used in combination with 2 or more agents being used together. 
Usual therapy may include: Ceftazidime with avibactam (Zavicefta®),  colistimethate sodium, tigecycline, amikacin or aztreonam. See also Treatment of infections due to CPE

• Micro/ID team - SPR or Consultant. Out of hours - ask switchboard to bleep on call Microbiology SPR or Consultant
• Infection control team can be contacted Bleep 89-1747