What it takes to manage Carbapenemase Producing Enterobacteriaceae (CPE) organisms – Preventing the spread of CPE within an open plan ICU department

Mrs Lauren Cullen1

1Healthscope – Knox Private Hospital, Coldstream, Australia



Knox Private Hospital is a large 359 bed private hospital located in the Eastern suburbs of Melbourne; comprising 10 ICU beds, 10 theatres, 1 day theatre, 3 birth suites and an emergency department. The Health Services Organisation (HSO) specialises in Maternity/Paediatrics and acute surgical/medical patient care.

July 2017: Carbapenemase Producing Enterobacteriaceae (CPE) was identified in two patients, on investigation, both patients had been inpatients in the same room in ICU within days of each other. Therefore, an investigation was initiated, along with contact tracing and Department of Health Victoria involvement.


Initially, incorrect identification of a sensitive gram negative organism, within pathology samples from both patients, meant that no isolation precautions were initiated. Further follow-up and notification to infection control from Infectious Diseases Physician occurred, confirming Enterobacter cloacae CPE had been identified in both patients; one from a sputum specimen and the other a blood culture. Genome sequencing of both patients CPE samples was undertaken and it was subsequently determined that these two isolates were unrelated. ‘RL Solutions’ HAI surveillance program was used to complete patient contact tracing. 17 contacts were followed-up which involved CPE testing (2 faecal samples per person >48hrs apart).


There was no transmission of CPE to the patient population within ICU during the time when the infected patients were present. Demonstrating that, despite the challenging design of the unit, i.e open plan and only one single patient room, with the application of consistent standard precautions practices/cleaning procedures, transmission of any MRO can be prevented.


Infection Prevention & Control Consultant Bellbird & Knox Private Hospitals with over 10 years’ experience, Bachelor Degree of Nursing – RMIT (2004),   Certificate of Infection Control and Sterilisation – Mayfield Education (2009), Nurse Immuniser Program – Latrobe University (2010) & Pre and Post test counselling course – HIV & Hepatitis C – Deakin University/ Latrobe University (2011), ACIPC Member

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