• Reference Number: HEY-512A/2023
• Departments: Infection Prevention and Control
• Last Updated: 1 July 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, however may act as a starting point for discussion.

If after reading it, if you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is CPE?

Carbapenemase Producing Enterobacteriaceae commonly referred to as CPE. Enterobacteriaceae are a type of bacteria (germs) that live in the gastrointestinal tract (bowels/gut) of most people or animals and do not cause illness. This is called colonisation, as there are normally no signs or symptoms because a person’s immune system keeps them in check. Sometimes these bacteria can cause infection if they get into an area of the body where they are not normally found such as a wound, urinary tract, heart valves and bloodstream. If they get into other parts of the body e.g. the urine or the bloodstream, they can cause an infection and will need treatment. Patients who have a weakened immune system may be more at risk of developing infection.

Carbapenem are very strong antibiotics. Carbapenemase are enzymes made by certain types of this bacteria, which allow them to destroy carbapenem antibiotics and so the bacteria referred to as resistant to these antibiotics.

CPE infections can be difficult to treat because they are resistant to many antibiotics, however there is still treatment option available.

How is CPE spread?

CPE is spread by:

1. Direct person-to-person. This can be from patient to patient or from staff who have been nursing a patient who is infected or colonised with CPE and not washed their hands appropriately between patients and/or not worn appropriate personal protective equipment e.g. gloves and aprons.
2. This is through touching room surfaces or medical equipment which is contaminated and not cleaned appropriately
3. CPE that lives harmlessly in a person’s bowel (gut) can move to another area of their body e.g. into a wound.

What happens if I have CPE?

If you are confirmed to have CPE from your samples, whilst you are in hospital, your clinical teams would take some extra precautions whilst caring for you:

1. You should be moved to a single occupancy room (isolation) for the duration of your hospital stay.
2. All clinical staff and visitors must wash their hands using soap and water or alcohol gel before going into your room and after leaving your room.
3. All clinical staff providing you with direct care will be required to wear personal protective equipment e.g. gloves, gown/apron etc.
4. Your room will be cleaned daily with a chlorine-based disinfectant (personal items should be kept to a minimum and stored in the drawers or cupboard provided to keep surfaces clear).
5. Clean any equipment that we take into your room with chlorine after each use and we may leave other equipment in your room for the duration of your hospital stay.
6. Provide you with your own commode (a chair with a hidden toilet) to use if your isolation room does not have an en-suite.
7. You should avoid touching your medical devices e.g. catheters, drip lines etc.
8. You should wash your hands with soap and water or use alcohol gel before entering and leaving your room. We ask you try not to leave your room and walk around areas, which have many other patients, such as canteen/ cafe etc.
9. You may notice a sign on your door which is to inform staff of an infection risk, however this does not specify the type of infection.

Do visitors need to to anything differently?

CPE is not a problem for fit and healthy people, therefore family, friends and carers can visit you. To prevent the spread of CPE to other patients or elsewhere in the hospital, visitors must:

• Always wash their hands with soap and water or alcohol gel before going into your room and after leaving your room, and when entering and leaving the ward you are in.
• Do not eat food at your bed side.
• Do not use your en-suite bathroom, if you have one.
• Do not sit on your bed.
• Visitors who feel unwell should not visit you.
• Visitors who have had a recent infection or illness should discuss with your nursing team for advice before they visit you.
• Children and babies are more prone to any type of infection and are advised not to visit.
• Visitors can still touch you e.g. hold your hand etc. they must wash their hands before leaving your room with soap and water or alcohol gel.

Will CPE delay my discharge home?

Having CPE should not delay your discharge home; however, if you have a CPE infection, the clinical team will advise discharge when you are better, with some patients completing course of antibiotics once at home, some patients may require follow up as an outpatient.

Colonised CPE may continue to be present for some time once you are discharged home.

If you are from a residential home, nursing home or have carers and have CPE your discharge should not be delayed to these facilities/circumstances – additional information may be provided to staff who care for you on discharge to ensure you and other service users are cared for safely.

You should inform anyone who provides you with care e.g. GP, district nurse, outpatient appointments, that you have CPE.

Will CPE impact people I live with?

When you go home, we advise good hand and personal hygiene. Handwashing is very important to prevent these bacteria spreading, so you must wash your hands well after going to the toilet and before preparing and eating food. Any person looking after you must also regularly wash their hands.

Regularly change your bedsheets and do not share towels with others in your household. You can wash clothes and bed linen as normal at the hottest temperature suitable for the fabric and if soiled (dirty with faeces or urine) wash separately. Try to ensure you regularly clean your toilets and bathrooms with your usual household cleaning products. You should continue to maintain your regular activities. This should help to prevent others living in your household contracting CPE.

What if I need to go back into hospital or go to hospital as an outpatient?

If you are admitted back into hospital or go to hospital for an outpatient appointment, it is important that you let the staff caring for you know that you are positive for CPE in the past. A record of this should be included in your electronic hospital notes. This will make sure that you receive the best care to reduce the risk of you developing a CPE infection. It might be helpful to take this leaflet with you to show the clinical team.

Who can I contact with any queries or concerns I may have?

If you, your family or carers have any questions or concerns surrounding CPE, please contact Hull University Teaching Hospitals Infection Prevention and Control Team (IPCT) via the below contact routes:

Telephone: 01482623967, between 8am-4pm

Email: hyp-tr.huth-ipc@nhs.net

What does Hull University Teaching Hospitals do to prevent CPE spreading?

To prevent the spread of CPE in HUTH we are embedding the following:

• Education of our workforce
• Education of our patients
• Isolation precautions of patients infected or colonised with CPE
• Enhanced cleaning in ward areas
• Routine screening for CPE in high risk groups

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.