Tuesday, February 4, 2014

Health News

Safer Hospitals

Everything you wanted to know about CPE but were afraid to ask

Released by Fraser Health Authority

 

raser 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 measure.

"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 for CPE.

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 www.fraserhealth.ca.

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 internationally.

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 CPE.

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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