CPE (Carbapenemase-Producing Enterobacterales)

A risk assessment at admission should be completed for all patients. This should be completed using the Key Inpatient Information (KIPI) tool in EPR when possible, which will generate a request for CPE screening in the Tasks list.

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 previously been 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 paediatric intensive care and neonatal intensive care)
     • Medical services:
       • Blood and marrow transplantation
       • Clinical haematology
       • Clinical oncology (radiotherapy)
       • 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

• Isolation
• Enhanced contact IPC precautions (see below)
• CPE screening of patient to assess colonisation status
• Assessment for appropriate treatment if needed - discuss with Micro/ paeds ID SpR or Consultant
• Inform the IPC Team (bleep 1747, or Micro SpR/Paeds ID Consultant if out of hours)
• Offer the patient and family an information sheet (if appropriate) access here

• 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 (long sleeve impermeable disposable gown and/or visor/ mask) may be required if any part of the staff uniform is expected to come in contact with the patient or if aerosolisation of body fluids is expected.
• In the event of an outbreak, additional measures may be needed (advised by IPC team)
• 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, the latter might be more appropriate for neonatal and paediatric patients. Request CPE screen MCS, Rectal/Stool swab' (can be printed from Tasks list if a Key Inpatient Information assessment has been 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

• Micro/paeds ID team - SpR bleep 4374 or Paeds ID consultant via switchboard
• Infection control team: bleep 1747 or ext 22192
• Out of hours - ask switchboard to bleep on call Microbiology SpR or Paeds ID Consultant