Ms Judith Brett1, Ms Sandra Johnson1, Ms Donna Cameron2,3, Ms Courtney Lane2, Ms Marion Easton3, Dr Annaliese van Diemen3, Dr Brett Sutton3, Dr Ann Bull1, Professor Michael Richards1, A/Professor Leon Worth1
1Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Australia
2Microbiological Diagnostic Unit – Public Health Laboratory, Melbourne, Australia
3Department of Health and Human Services, Melbourne, Australia
Introduction: Carbapenemase-producing Enterobacteriaceae (CPE) are increasingly identified in Australian healthcare settings, but baseline prevalence is unknown. As part of a coordinated public health response, all Victorian hospitals conducted six-monthly point prevalence surveys (PPS) for CPE in high-risk wards in 2016.
Methods: All patients in high-risk wards (intensive care, haematology, transplant) were identified for CPE screening. If not screened, the reason was documented. Multiple specimen collection methods were available (faeces, rectal swab, inguinal swab). All positive cases were referred to a single reference laboratory for confirmation and molecular characterisation.
Results: 43 hospitals performed 134 CPE point prevalence surveys in high-risk wards. Overall, 79% of patients (1,839/2,342) were screened. In addition, six hospitals performed 24 CPE surveys in other areas, of which 88% of patients (556/632) were screened. Rectal swabs were most commonly utilised in adult patients, and faecal specimens were most frequently collected in paediatric patients. Screening uptake varied between ward types, with inability to obtain patient consent the most frequent reason for non-participation. Of patients screened in high-risk wards, no new cases of CPE were detected. One new CPE case was identified through screening within a renal ward, corresponding to a prevalence of 0.6%.
Conclusion: Given the low CPE prevalence in high-risk wards, revised Victorian guidelines stipulate PPS only after local transmission has occurred. Findings demonstrate CPE screening to be acceptably performed by hospitals, although preferred specimen collection methods vary by ward type. Uptake of future screening surveys may be increased by refinement to the patient consent process.
Judith Brett has been employed as an Infection Control Consultant since 2000 and is currently Senior Infection Control Consultant at VICNISS Coordinating Centre.
She is a member of the Victorian CPE Surveillance and Response Unit that have developed & refined the Victorian guideline on CPE since 2015.