In the shadow of COVID-19: a carbapenemase-producing Enterobacterales (CPE) outbreak in an Australian intensive care unit

Ms Denise Del Rosario-Kelly1, Ms Megan  Gritt1, Mr Marcus  Kusiak1, Ms Pauline Bass1, Ms Sue Borrell1, Ms Sue McLellan1, Dr Andrew Stewardson1, Professor Allen Cheng1, Associate Professor Leon Worth1

1Alfred Health, Melbourne, Australia

Background: The COVID-19 pandemic has caused an unprecedented burden on intensive care units globally. Our health service dedicated a pod within the Intensive Care Unit (ICU) to cohort SARS-CoV-2 infected patients. With increased focus on infection prevention and control (IPC) measures, the risk of transmission of other microorganisms is presumed to be reduced. However, we report a cluster of IMP-4 producing Enterobacter cloacae during May and June 2020, involving 7 ICU patients. We sought to evaluate factors contributing to this outbreak.

Method: The following measures were used to investigate potential contributing factors: review of Hand Hygiene (HH) compliance, PPE compliance, environmental cleaning, shared patient equipment cleaning, and mean bed moves for confirmed CPE cases.

Results: All but one patient had a stay in the dedicated COVID pod, where double gloving, continual glove use, and performing HH on gloves, were observed during auditing. HH compliance rates fell to <83% (April 55%, May 70%, June 70%), with moments 1, 2, and 4 less than 50%. Average bed moves for an ICU patient during this period increased from 1.5 to 2.  Increased compliance with environmental and shared patient equipment cleaning processes was observed.

Conclusion: The prevention of CPE transmission requires a rigorous application of multiple IPC measures. Factors potentially contributing to transmission included increased bed moves within the ICU to facilitate COVID-19 cohorting, inappropriate use of gloves by healthcare workers and reduced HH compliance in setting of increased glove use. Therefore, vigilance is required to ensure IPC processes are maintained during pandemic responses.


Denise has been at Alfred Health for 17 years, and is a CPE Project Coordinator. She has postgraduate qualifications in neuroscience nursing and infection control nursing, and in the past year has been a team leader in the COVID-19 Contact Tracing team at The Alfred. Away from work, Denise is an avid fan of the arts and has a great love of animals, including her rescue greyhound, Slipper.

Megan is the Aseptic Technique Coordinator at Alfred Health. She has a background in Infectious Diseases and is working towards a Masters of Public Health and Tropical Medicine. Away from work, she is passionate about the preservation of bees, her dogs – Oscar and Dudley and is an avid tea and crumpet enthusiast.