• Reference Number: HEY-512/2023
• Departments: Infection Prevention and Control
• Last Updated: 1 August 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, however may act as a starting point for discussion.

If after reading it, if you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is CPE?

Carbapenemase Producing Enterobacteriaceae commonly referred to as CPE. Enterobacteriaceae are a type of bacteria (germs) that live in the gastrointestinal tract (bowels/gut) of most people or animals and do not cause illness. This is called colonisation, as there are normally no signs or symptoms because a person’s immune system keeps them in check. Sometimes these bacteria can cause infection if they get into an area of the body where they are not normally found such as a wound, urinary tract, heart valves and bloodstream. If they get into other parts of the body e.g. the urine or the bloodstream, they can cause an infection and will need treatment. Patients who have a weakened immune system may be more at risk of developing infection.

Carbapenem are very strong antibiotics. Carbapenemase are enzymes made by certain types of this bacteria, which allow them to destroy carbapenem antibiotics and so the bacteria referred to as resistant to these antibiotics.

Who is at risk of CPE?

People can become colonised with CPE if:

• they have been in hospital in the United Kingdom or abroad;
• they have had several courses of antibiotics in the past;
• they are a contact of a CPE positive case.

How is CPE acquired?

People can become colonised with CPE if they have been in hospitals abroad or in hospitals in the United Kingdom. For this reason you must let your doctor know if you have been in a hospital in a different country so that they can care for you properly.

You can also become colonised with CPE if you have been given several courses of antibiotics in the past. This is because the resistant bugs that survive after you have taken antibiotics can then grow.

CPE can be passed from person to person after touching contaminated surfaces such as bed rails, toilets or devices. This means that it is important to regularly wash your hands with soap and water.

Why we test for CPE

You will be tested for CPE if:

• You have been a patient in a hospital in a foreign country within the last twelve months.
• You have been a patient in a hospital in the UK and directly transferred to a Hull and East Yorkshire hospital.
• You have had CPE in the past.
• A person you are in close contact with has CPE.

How we test for CPE

The presence of CPE is detected by staff taking a faecal (poo) sample or a swab of the rectum (back passage). Three samples are required over a five day period. One sample on day one, one on day three and one on day five. The sample will be sent to the test centre and the results will be sent to the ward doctor. While you are waiting for the results you may be kept in a side room as a safety measure to prevent the bugs being passed to other patients.

What happens if you have a negative result?

This means that you are not infected or colonised with CPE and you may be moved back to the main ward area. You could be tested for CPE again if you are re-admitted to hospital.

What happens if you have a positive result?

If you test positive for CPE it means that you have these bugs in your body, but it does not always mean that you are infected. If you show signs of an infection, doctors may start suitable antibiotics to treat the infection. You will stay in a side room with your own toilet facility whilst you are in hospital. The staff will wear aprons and gloves whilst they are caring for you. All staff will wash or sanitise their hands before and after they touch you or your environment.

Are you able to still have visitors?

CPE is not a problem for healthy people and so you are still encouraged to have family and friends come to visit. We ask that they wash their hands before and after they leave your room and ensure they do not mix with other patients on the ward. This makes it easier to prevent the spread of the bugs.

What happens following your discharge from hospital?

On your discharge home CPE may continue to be present for some time.

If you are re-admitted to hospital in the future it is very important that you let the doctors know that you have previously had CPE (or show them this leaflet). On your re-admission you may be asked to stay in a side room on the ward.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Infection Prevention and Control Department on telephone number (01482) 623066 or (01482) 675551.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.