Introduction
Enterobacteriaceae are bacteria that usually live harmlessly in the gut of humans. This is called ‘colonisation’ (a person is said to be a ‘carrier’). However, if the bacteria get into the wrong place, such as the bladder or bloodstream they can cause infection. Carbapenems are one of the most powerful types of antibiotics. Carbapenemases are enzymes (chemicals), made by some strains of these bacteria, which allow them to destroy carbapenem antibiotics and so the bacteria are 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 successfully treat certain ‘difficult’ infections when other antibiotics have failed to do so. Therefore, in a hospital, where there are many vulnerable patients, spread of these resistant bacteria can cause problems.
If a person is a carrier of carbapenemase-producing Enterobacteriaceae (CPE), they do not need to be treated. As mentioned, these bacteria can live harmlessly in the gut. However, if the bacteria have caused an infection then antibiotics will be required.
Why am I being screened?
Your doctor or nurse may suspect that you are a carrier if you live abroad or have been in a hospital abroad, or in a UK hospital that has had patients carrying these bacteria, or if you have been in contact with a carrier elsewhere. If any of these reasons apply to you, screening will be arranged and you may be accommodated in a single room at least until the results are known.
Screening will entail taking a rectal swab by inserting a small swab just inside your rectum (bottom), alternatively you will be asked to provide a stool sample. The swab / sample will be sent to the laboratory and you will normally be informed of the result within two to three days. If the result is negative, the doctors or nurses may wish to check that a further two samples are negative before isolation precautions can be discontinued. These measures will not hinder your care in any way. If all results are negative no further actions are required.
If you are being screened prior to admission, your results will be sent to the pre operative assessment team. If you are positive you may be contacted prior to admission, or you may be informed on admission that you will need to remain in a single room during your stay in hospital. You will not be contacted if you are found to be negative. However when admitted you will be placed in a side room and will still need two further negative screen results before isolation precautions can be discontinued. If you have been admitted as an emergency you will be informed of the result by the nursing staff.
What if I test positive?
If the result is positive, do ask your doctor or nurse to explain this to you in more detail. You will continue to be accommodated in a single room whilst in hospital. If you have an infection, you will need to have antibiotics. However, if there are no signs of infection and you are simply ‘carrying’ the bacteria, no treatment is required.
Accommodating you in a single room, if the result is positive, helps to prevent spread of the bacteria. Healthcare workers should wash their hands regularly. They will use gloves and aprons or long sleeved gowns when caring for you. The most important measure for you to take is to wash your hands well with soap and water, especially after going to the toilet. You should avoid touching medical devices (if you have any) such as your urinary catheter tube and your intravenous drip, particularly at the point where it is inserted into the body or skin. Visitors will be asked to wash their hands on entering and leaving the room and may be asked to wear an apron and gloves.
What about when I go home?
Whilst there is a chance that you may still be a carrier when you go home, quite often this will go away with time. No special measures or treatment are required; any infection will have been treated prior to your discharge. You should carry on as normal, maintaining good hand hygiene. If you have any concerns you may wish to contact your GP for advice.
Before you leave hospital you will receive a letter or card advising that you have had an infection or been colonised with carbapenemase-producing Enterobacteriaceae. This will be useful for the future and it is important that you make health care staff aware of it. Should you or a member of your household be admitted to hospital, you should let the hospital staff know that you are, or have been, a carrier and show them the letter/card.
Where can I find more information?
If you would like any further information please speak to a member of your care staff, who may also contact the Infection Prevention Team for you. The Public Health England website is another source of information: http://www.hpa.org.uk/Topics/ InfectiousDiseases/InfectionsAZ/ CarbapenemResistance/
