Tuesday, February 4, 2014
wanted to know about CPE but were afraid to ask
Released by Fraser Health Authority
Health is informing the public of an outbreak of Carbapenemase-Producing
Enterobacteriaceae (CPE) on a medicine unit at Royal Columbian Hospital.
Infection prevention and control measures are already in place; however,
because of sustained transmission of the bacteria on this unit, we are now
declaring an outbreak and have implemented further measures.
This includes separating patients, who are known through our screening
protocol to be colonized, providing them with dedicated staff and equipment
and clearly dividing the affected unit between patients who are carrying the
bacteria and those who are not. As RCH is an older facility with most rooms
being occupied by multiple people, this is a necessary and effective control
"We have been preparing for increased cases of CPE for some time and have
adopted aggressive infection control protocols to detect and isolate these
cases in our hospitals," says Dr. Elizabeth Brodkin, Executive Medical
Director for Infection Prevention and Control at Fraser Health. "Our
patients and families can be confident that all measures are in place to
protect them while they are in our care."
Over the past 10 years, there has been a global increase in the appearance
of CPE. As international travel becomes more accessible, the prevalence of
this bacteria in our region has also increased. Fraser Health has
implemented a screening process for all patients admitted into our
hospitals, particularly those being treated in intensive care units. The
screening process involves asking whether or not patients have been admitted
into a hospital or received renal dialysis outside of Canada within the past
six months. Anyone who answers yes to the screening question will be tested
Health care providers working with patients who are carriers of CPE are
taking extra measures to prevent spreading the organism to other patients.
This includes the use of gowns and gloves during care and cohorting patients
that are colonized with CPE. It is very important for visitors and health
care providers to practice good hand cleaning at all times to help keep them
and our patients safe.
Unlike some other infections, CPE colonization develops slowly, which means
it will take several weeks before we can declare the outbreak over. In the
meantime patients and visitors should not be discouraged from coming to the
hospital for care or to visit.
For more information, view this
interview with Dr. Elizabeth Brodkin, Executive Medical Director for
Infection Protection and Control at Fraser Health or visit
About Fraser Health
Fraser Health provides a wide range of integrated health services to the
largest and fastest growing population in B.C. The health authority is
committed to improving the health of the population and the quality of life
of more than 1.7 million people living in communities from Burnaby to Hope.
What are Carbapenemase-Producing Enterobacteriaceae (CPE)?
CPE refers to a common family of bacteria called Enterobacteriaceae, which
are found in human intestines. Most people who carry CPE are colonized, but
not infected, meaning the organisms are present in their bodies, but are not
causing any symptoms. Patients who are healthy with a strong immune system
are very unlikely to be made sick by CPE. Those who become infected with
symptoms due to the bacteria are usually already very ill for other reasons.
CPE can be very difficult to treat because the antibiotics doctors usually
give may not work.
What is the difference between CPE and CRE?
Because these bacteria emerged in various places globally, several terms are
used to describe them, including CPE (Carbapenemase-producing
Enterobacteriaceae), CRE (Carbapenem-resistant Enterobacteriaceae), and CPO
(Carbapenemase-producing organism). They are all referring to the same
thing, which are a class of bacteria that have a developed a resistance to a
family of antibiotics called Carbapenems. In Fraser Health, we are using the
term CPE because it is the most specific, and the bacteria we are seeing
fall into that category.
Where is CPE found?
CPE bacteria are usually acquired through health care exposures in countries
where these bacteria are commonly found. These include countries where CPE
have been identified in health care facilities. These bacteria are most
likely brought back to Fraser Health by travellers to endemic areas, such as
South Asia, some parts of the United States and Greece, where they are
regularly found in health care settings.
What are the risk factors for CPE?
The initial risk factor is exposure to a health care facility in countries
where these bacteria are commonly found. This means individuals who have had
surgery, dialysis or been admitted to health care facilities affected by CPE
are at increased risk of acquiring the bacteria and becoming colonized.
How are CPE infections treated?
CPE is sometimes difficult to treat because they have high levels of
resistance to many antibiotics. However, there are combinations of
antibiotics available to effectively treat most infections. Strains of CPE
resistant to all antibiotics are very rare but have been reported
What is Fraser Health doing to reduce the risk of the organism spreading?
To reduce the risk of the organism spreading, Fraser Health has implemented
a rigorous screening process for all patients admitted into our hospitals,
particularly those being treated in our intensive care units. The screening
process involves asking whether or not patients have been admitted into a
hospital or received renal dialysis outside of Canada within the past 6
months. Anyone who answers yes to the screening question will be tested for
Health care providers working with patients who are carriers of CPE will
take extra measures to prevent spreading the organisms to other patients.
This will include the use of gowns and gloves during care and cohorting
patients that are colonized with CPE. It is very important for visitors and
health care providers to practice good hand hygiene at all times to help
keep them and our patients safe.
What can the public do to prevent the spread of CPE?
• Inform your health
care professionals if you've had a medical procedure done
recently while travelling to an endemic country prior to a
procedure or seeking treatment in a facility in Canada.
• Wash your hands often, especially after going to the bathroom
and before preparing and eating food.
• Do not share personal care items such as towels, toothbrushes
or bar soap.
• Clean bathrooms and other frequently touched surfaces (for
example, light switches and water taps) once per day and more
often if visibly soiled.
• Wash non-disposable cleaning cloths after each use.
• Keep a clean dressing on open draining wounds
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