Ms Stephanie Spilsbury1, Ms Denise Del Rosario-Kelly1, Ms Sue Borrell1, Ms Pauline Bass1, Ms Sue McLellan1, Mr Andrew Stewardson1, Mr Allen Cheng1, Mr Leon Worth1
1Alfred Health, Melbourne, Australia
Introduction: Carbapenemase-producing Enterobacteriaceae (CPE) are increasingly identified in Australian healthcare facilities. In 2015, guidelines for management were released by the Victorian Department of Health and Human Services, including definition of ‘transmission risk areas’ (TRAs) where local transmission of CPE has occurred, and recommended screening practices. We report program requirements and yield of CPE screening in 2 wards.
Method: TRA classification was applied to 2 wards (ICU, Rehabilitation) following clusters of IMP-4-producing Enterobacter cloacae complex in 2017. Two project nurses (combined 1.0 EFT) were assigned to implement contact-tracing, maintain a CPE database, educate staff/patients, and perform point-prevalence (PPS) and look-back screening. Look-back screening consisted of identifying surviving patients cared for in the defined wards during periods of potential CPE exposure, notifying the patients and placing electronic alerts for isolation/screening.
Results: For the ICU, 980 patient contacts (7-month period) were identified. Of these, 522 were screened and 2 additional CPE cases were identified (0.4% positive). For the Rehabilitation ward, 69 patient contacts (2-month period) were identified. Of these, 55 were screened and 1 additional CPE case was identified (1.8% positive). PPS in affected wards did not identify additional CPE transmission. Additional resources were required to facilitate screening, education and microbiological testing.
Conclusion: In the setting of local CPE transmission, we observed a low prevalence of CPE colonisation in our acute and sub-acute wards. Despite this, screening of high risk patients requires a standardised strategy with dedicated resources, and is fundamental in managing CPE transmission according to current Victorian guidelines.
Stephanie is a CPE Project Coordinator for the Alfred Health Melbourne. She has a background in critical care nursing in Intensive Care at The Alfred and currently works in Infection Prevention & Epidemiology and is working towards a Masters in Public Health. A busy mum of two kids under 5, Stephanie enjoys the outdoors and a good glass of bubbles.
Denise has been at Alfred Health for 14 years, and has a wealth of clinical experience in surgical and medical nursing. She has postgraduate qualifications in neuroscience nursing, and has recently completed her Graduate Certificate in Infection Control Nursing. She currently works as a CPE Project Coordinator in the Infection Prevention & Epidemiology department. Away from work, Denise enjoys doing massage therapy, watching musical theatre and Disney films.