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UL Hospitals Group writing to over 2,000 CPE contacts to notify them of status

Wednesday, 14th November, 2018 12:05pm
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UL Hospitals Group writing to over 2,000 CPE contacts to notify them of status

UL Hospitals Group has this week commenced writing to patients in the community to advise them that they shared a ward or clinical area before their discharge with a patient who subsequently had a positive result for the CPE bug.
 
As such, these patients are designated CPE Contacts. A patient who is a CPE contact is so defined because they have shared a ward or clinical area with someone who has been found to be carrying CPE. There is about a 1 in 20 chance that someone who is designated a contact will become a carrier of CPE. There is about a 1 in 400 chance that they might get a serious CPE infection at some time in the future. CPE infection can be serious but there are antibiotics that can be used to treat CPE infection.
 
In August 2018, the HSE announced that it was undertaking a national communications programme to write to patients who had been identified as being a CPE contact. This decision was based on recommendations from a National Expert Group published in July. The HSE asked every hospital to review their files and compile a list of patients. UL Hospitals Group has now completed this validation exercise and has commenced writing to patients this week.
 
Patients who are designated as CPE contacts are already informed while in hospital if they were still an inpatient when an exposure event was identified. Up until now, patients who had left hospital before they were identified as contacts were only informed on their return to that hospital if ever re-admitted. However, if they did not come back to hospital, they may not have been informed.
 
In the absence of defined best practice internationally, the National Expert Group has recently advised that these patient contacts be informed proactively, both retrospectively and on a continuing basis.
 
CPE is an antibiotic resistant organism. Antibiotic resistant organisms are often called superbugs.  The word superbug is used to mean bacteria that are hard to kill with antibiotics. CPE is a relatively recent global health problem. A number of different kinds of CPE have been introduced into Ireland and have spread in the healthcare system in recent years.  
 
For most patients who carry CPE it never causes any illness, but lies harmlessly in the gut. Most people in Ireland who carry CPE have picked it up in hospital in Ireland. We believe, based on testing, that the number of people who carry CPE in Ireland is still fairly small (probably about 2,000). Last year (2017) 433 new people were found to be carrying CPE in Ireland. The HSE has committed resources and clinical support to help reduce the spread of CPE and to manage healthcare associated infections.
 
UL Hospitals Group has commenced sending letters to 2,160 patients advising them of their CPE contact status. This does not mean they have CPE. Their status as a contact means that they will be tested upon re-admission to a hospital. Comprehensive information about the CPE Contacts Communications Programme is available on the HSE website
 
A dedicated helpline is being provided to all CPE Contacts should they have any questions. Both the GPs and the consultants of each patient contact will also receive letters to ensure they are also informed about this contact.
 
Testing for CPE is not recommended for patients in the community as per national guidance. CPE contacts do not need any special treatment or medicine because of this exposure. It is important, as it is for everyone, that hands are washed regularly especially after visiting the toilet. All CPE contacts will be issued with a CPE Contact Card which should be brought into any hospital if attending for medical care.
 
Speaking about the National CPE Contacts Communications Programme, Ms Noreen Spillane, Chief Operations Officer, UL Hospitals Group, stated:
 
“We are aware that receiving this letter from the hospital may cause anxiety for some of our discharged patients. We would like to reassure patients that the risk of them having CPE is very low and that the risk of them becoming ill if they do have CPE is also very low. Comprehensive information and a helpline details are being provided for patients who have any questions.
 
"These letters are being issued as a result of changes in the national guidance around CPE and we are not proposing to do anything differently in practical terms when it comes to screening CPE contacts. We do ask that patients who receive the letter bring their contact card with them when they next present to hospital so that appropriate contact precautions can be taken by our staff. We do not recommend that contacts get tested before they are re-admitted to an acute hospital but, as is stated in the letter, this can be facilitated if the patient requests testing.”
 

 
What is CPE:
CPE is the newest in a long line of what people sometimes call “superbugs”. When we talk about “superbugs”, we mean bacteria that are hard to kill with antibiotics. Of all the “superbugs” we have had so far, CPE is the hardest to kill with antibiotics. We think the number of people who carry CPE in Ireland is still fairly small (probably hundreds of people). This means that if we take very good care of people who carry CPE over the next couple of years, there is still time to stop CPE becoming very common.
 
E stands for Enterobacterales. Enterobacterales means a larger family of bugs that live in the gut. E. coli is one of this family of gut bugs but there are many others.
 
C stands for Carbapenemase. The carbapenems are a very important group of antibiotics. The best known example in Ireland is an antibiotic called meropenem. A carbapenemase is an enzyme (a type of protein) that destroys meropenem and other antibiotics like meropenem.
 
P stands for Producer. So CPE is a gut bug that produces a protein/enzyme that destroys meropenem.
 
CPE Contacts:
Most people who are CPE Contacts do not carry CPE. They are simply advised to follow good practice in relation to hand hygiene to prevent spread of bacteria and viruses which is the same for everyone.  Information on proper hand hygiene techniques is available on www.hse.ie/handhygiene. If CPE Contacts go to see the doctor or if they have to go to hospital it is helpful if they can tell the doctor or nurse that they are CPE Contacts.
 
Any patients who are concerned can access comprehensive information on CPE here;. www.hse.ie/hcai/patient-toolkit
While we do not recommend that CPE Contacts need testing for CPE, such testing will be made available to those CPE Contacts who want to be tested, free of charge.

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