CPE (Carbapenemase Producing Enterobacteriaceae)

This leaflet explains how we test for, treat and prevent the spread of bacteria (germs) called carbapenemase-producing enterobacterales (CPE). It also explains how you can help to prevent their spread in hospital. If you have any questions or concerns, please do not hesitate to speak to the doctors or nurses caring for you.

What is CPE?

Carbapenemase-producing enterobacterales (CPE) are a large family of bacteria that usually live harmlessly in your gut. This is called colonisation. Someone who is colonised is called a carrier. You would not know you were a carrier unless you were tested.

Most of the time CPE does not cause any problems and no treatment is needed. However, if the bacteria get into the wrong place, such as the bladder or bloodstream, they can cause an infection, particularly in patients with a low immune system.

This can be a problem because these bacteria:

• can be spread to and cause infection in other vulnerable patients
• are almost totally resistant to some of the strongest antibiotics that we use in hospitals

It is important to note that these bacteria do not cause infections in healthy people in close contact with the patient, such as staff and visitors, but they can be spread by them. For this reason, infection prevention and control measures will be put in place and are included in this leaflet.

Who is most at risk of getting a CPE infection?

People whose ability to fight infections is low. This includes, but is not limited to people:

• with cancer
• having dialysis and those with indwelling lines
• being treated in an intensive care unit, including those with
  • tracheostomies
  • who have had transplants
  • with chronic wounds
  • with enterostomies

How is CPE spread in hospital?

This bacteria can be spread:

• from person to person, on the hands and skin of staff, students, patients and visitors, by touching someone who is infected or colonised
• by touching room surfaces and objects such as equipment, bowls, shared electrical or medical devices, surfaces around patients (for example, bedside tables), commodes and toilets that have CPE on them

They are not spread through the air or by coughing or sneezing.

Preventing the spread of CPE

• Everyone – staff, students and visitors – must have sleeves rolled up above the elbows on entering a clinical area
• Everyone – staff, students and visitors – must wash their hands with soap and water and/or use alcohol handrub before and after direct contact with a patient/their environment
• Wearing personal protective equipment (PPE) in contact with patients is not sufficient alone and must always be combined with hand hygiene before putting on and after taking off PPE
• Patients must wash their hands with soap and water before eating meals and after using the toilet
• Anyone helping a patient with their personal care must wash their hands with soap and water before and after
• We may have to do extra cleaning in some areas so patients may sometimes need to be moved to another bed space to allow this
• We may close a ward to admissions and restrict visiting
• Visitors must not use patient bathrooms
• Visitors should avoid sitting on your bed and use the chairs provided in the ward

How do I know if I have CPE?

We currently test all patients who are admitted to The Walton Centre. Your healthcare team will provide you with information on testing when you attend pre-operative clinic or are admitted to a ward.

What does it mean if the result is positive?

If the result is positive, your doctor or nurse will be able to discuss this with you in detail. 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 will be needed.

• Whilst in hospital you will stay in a single room with toilet facilities (where possible)
• We will put a sign on the isolation room door to remind everyone of the precautions they need to take
• Our staff will wear gloves and a long-sleeved gown or apron when providing care to you and will wash their hands when leaving your room
• It is important you wash your hands (or use a wet wipe) regularly, especially after going to the toilet. You should avoid touching any medical devices (urinary catheter tubes or intravenous drips, for example), particularly at the point where it is inserted into your body or skin.
• We will ask your visitors to wash their hands on entering and leaving your room. We may ask them to wear a gown and gloves if they are helping you with your personal care.

Do people who are carriers of CPE need any treatment?

If a person is a carrier of CPE, they do not need to be treated. However, if the bacteria have caused an infection, antibiotics will be prescribed.

How did I pick up CPE?

It can be difficult to say when or where you came into contact with these bacteria and became colonised or infected. There is a greater chance of picking them up if you have been a patient in a hospital abroad or in a UK hospital that has had patients carrying the bacteria, or if you have been in contact elsewhere with someone who is colonised.

What about when I go home?

There is no clear answer as to how long you will carry this bacteria and you can still be a carrier when you go home. You do not need to take any special measures or have treatment, as we will have treated any infection before you leave hospital. You can carry on as normal and continue with good hand hygiene. If you have any concerns, contact your GP for advice. Your GP will also be informed that you are colonised (carrier) with CPE.

You should tell anyone caring for you that you have had CPE especially if you or a member of your household are admitted to hospital. If you have further treatment in the Trust, we will manage you as a CPE carrier in line with our Trust policy.

Where can I find more information?

If you would like any further information, please speak to a member of your healthcare team, who may also contact the infection prevention team for you.

You can also contact the Infection Prevention and Control Team via 0151 556 3601 / wcft.infectioncontrolteam@nhs.net

Useful links

www.gov.uk/government/collections/carbapenem-resistance-guidance-data-and-analysis 

https://assets.publishing.service.gov.uk/media/63346c44d3bf7f34f1bc882d/Framework_of_actions_to_contain_CPE.pdf