Carbapenemase-producing organism (CPO) / Carbapenemase-producing Enterobacteriaceae (CPE)

You or your relative, have been found to be a carrier or are infected with a carbapenemase-producing organism (CPO). This leaflet explains:

• how we test for and treat bacteria (germs) called carbapenemase-producing enterobacterales (CPE), and

• how you can help us prevent their spread in hospital.  

If you have any questions or concerns, please speak to the doctors or nurses caring for you.

What are carbapenemase-producing organisms / Enterobacteriaceae?

There are many different types of bacteria that live harmlessly in the human gut; this is called colonisation. Colonisation is when a person is said to be a carrier. However, if this bacteria gets into the wrong place, such as the bladder or bloodstream, they can cause infection.

Carbapenemases are enzymes (chemicals) made by some strains of these bacteria, which allow them to destroy carbapenem antibiotics, a powerful group of antibiotics. The bacteria are then said to be resistant to the antibiotics.

Why does carbapenem resistance matter?

Carbapenem antibiotics can only be given in hospital directly into the bloodstream. Until now, doctors have relied on them to treat certain ‘difficult’ infections, when other antibiotics have failed.

In hospital, where there are many vulnerable patients, the spread of resistant bacteria can cause problems.

There is an increased chance of picking up these bacteria if you have been:

• a patient in a hospital abroad

• in a UK hospital that has had patients carrying the bacteria, or

• in contact with a carrier elsewhere.

Who is most at risk of getting a CPE infection?

People whose ability to fight infections is low, are more likely to get a CPE infection. This can include people:

• with cancer

• having dialysis and those with indwelling lines

• being treated in the Critical Care Unit, including those with a tracheostomy tube

• who have had transplants

• with chronic (long-term) wounds

• with enterotomies (a surgical cut in the intestine).

When am I screened for CPOs / CPEs?

We will ask to screen (test) you when:

• You are transferred to a ward with vulnerable patients.

• You are transferred to the UK from a hospital abroad.

• You have been an inpatient in a hospital abroad over the last 12 months.

• You are moved to one of our hospitals from another hospital in the UK.

• You are known to be colonised with CPO from a previous stay in hospital.

How is the infection found?

Samples (swabs) may be taken from one of the following places.

• Where the tube for a drip enters your skin.

• A rectal swab, taken by inserting a swab briefly just inside your rectum (bottom).

• A stool (poo) sample.

You will be asked for your consent before we take a rectal swab.

Does carriage of CPOs / CPEs need to be treated?

If you are a carrier, you do not need treatment. However, if the bacteria causes an infection, you will need antibiotics.

How am I cared for in hospital?

Whilst in hospital, you will be looked after in a single room, either with an en suite toilet or a dedicated commode.

To stop the spread of the bacteria, your door will need to stay closed and you will remain in your room. We will ask to take screening swabs as described below.

How is the spread of CPOs / CPEs prevented?

• Looking after you in a single room helps to stop the spread of the bacteria.

• We will put a sign on the isolation room door, to remind everyone of the precautions they need to take.

• Healthcare workers will use gloves and aprons when caring for you. They will clean their hands regularly with alcohol hand rub.

• You must wash your hands well with soap and water, especially after going to the toilet and before eating. If needed, a nurse can help you with this.

• Avoid touching any medical devices, such as your urinary catheter tube and / or your IV (intravenous) drip. This is particularly important where the device enters your body or skin.

• Visitors must clean their hands with alcohol hand rub before entering and leaving your room.

What happens when I go home?

You can go home when your doctors are happy that you are well enough. Whilst there is a chance that you may still be a carrier when you go home, often this will go away with time.

No special measures or treatment are needed. Any infection is treated before you leave hospital. Carry on as normal, and keep washing your hands regularly. If you have any concerns contact your GP for advice.

The hospital will tell your GP that you are colonised with CPOs / CPEs.

If you or a member of your household are admitted to hospital, tell hospital staff that you are or have been a carrier.

Where can I find more information?

If you have any questions or concerns, please speak to either the nurse in charge of the ward or the matron. If they cannot help you or you need further information, please contact a member of the Infection Prevention and Control Team.

• Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 766877 extension 722-4216 or 722-6810

• Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
  Telephone: 01843 225544 extension 725-4234 or 725-3625

• William Harvey Hospital, Ashford
  Telephone: 01233 633331 extension 723-8202 or 723-8198