Risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (CPE) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer
The purpose of this risk assessment is to evaluate the risk to the citizens of Europe of CPE spread through patient mobility and to assess the effectiveness of infection control methods to stop the spread of CPE within healthcare institutions.
This risk assessment is based on two systematic reviews. The first review looked at the risk factors for patient colonisation or infection with CPE and the second examined the effectiveness of using screening and/or targeted infection control measures to decrease the incidence of colonisation or infection in acute healthcare settings. In addition, a group of ten experts in infectious diseases, infection control, public health and microbiology attended a meeting in Stockholm, Sweden on 24 November 2010 to give feedback on the systematic reviews, and to provide their expert opinion and recommendations, which are all included in the risk assessment.
Patient transfer between healthcare facilities, in particular cross border transfer of patients, is a risk factor for the spread of resistance to last line antibiotics bacteria, concludes the report. For highly resistant bacteria, like CPE, the risk is heightened when patients are transferred from, or have received previous medical care in areas with high rates of resistance.
The infection control measures, found effective in the risk assessment are:
a) active surveillance (active screening of all cross-border patients on admission and a prompt laboratory detection);b) additional precautions for CPE-positive patients (e.g. contact precautions, such as wearing of disposable gloves and gown, and isolation measures);c) cohort nursing by a separate, dedicated team for all suspected and positive CPE patients.
Additional suggestions from ECDC are for countries to perform active surveillance on any patient transferred across borders upon admission to a hospital or other healthcare facility; to develop national guidance for how to stop the spread of CPE and to actively report cases of CPE to public health authorities.
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