7 March 2014
Next update: 14 March 2014
Guidance for acute trust staff on managing carbapenemase-producing Enterobacteriaceae
Public Health England (PHE) is planning a series of regional launch events across England for the recently-published Acute Trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae [1,2].
Carbapenemase-producing Enterobacteriaceae (CPE) represent one of the most serious emerging global infectious disease threats. In recent years the UK has seen a rapid increase in the incidence of infection and colonisation by these multi-drug resistant organisms. Identification of CPE in England by the PHE national reference laboratory has risen from fewer than five patients reported in 2006 to over 600 in 2013. These figures include patients with infections and also those where they have tested positive for the presence of the bacteria in the gut. This increase has not been as great, however, as the escalating situation seen in some other countries; a small window of opportunity therefore exists to learn from experiences elsewhere to prevent widespread problems in the UK.
In England, approximately two thirds of trusts have had between one and 20 patients identified with CPE carriage or infection over the past five years, including two Trusts in Manchester that have had more than 100 patients identified with CPE during the same period . The acute trust toolkit has been written to provide expert advice on the management of carbapenemase-producing Enterobacteriaceae in England, to prevent or reduce spread of these bacteria into (and within) health care settings, and between health and residential care settings. It provides practical advice for clinicians and staff at the frontline and information intended for use at executive level to help trusts plan and prepare. Additionally, it provides some basic public health risk assessment tools, and advice and information for the patient.
As professional mobilisation in disseminating and implementing the toolkit is crucial, to support this, PHE is developing an education and training programme together with a suite of resources for infection prevention and control teams and frontline staff. The programme will be best delivered through launch events, hosted by PHE Centres, that will provide an opportunity for multi-disciplinary learning. A pilot event is scheduled for 31 March 2014 in the East Midlands, which will inform national roll-out of the programme.
Last week PHE also wrote to every Acute Trust Chief Executive Officer to draw their attention to the risks posed to their organisation by carbapenemase-producing Enterobacteriaceae (and other resistant Gram-negative organisms) and the need to effectively implement the toolkit to mitigate against those risks. A joint Stage 2 Patient Safety Alert has also been issued, with NHS England, for immediate action by trusts .
For more information please contact HCAI@phe.gov.uk.
1. Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae , PHE health protection website: Publications › Infectious diseases › Antimicrobial and healthcare associated infections.
2. Public Health England press release, “PHE launches toolkit to manage hospital infections caused by antibiotic-resistant bacteria”, 6 March 2014.
3. NHS England Patient Safety Alert, “Patient safety alert on addressing rising trends and outbreaks in carbapenemase-producing Enterobacteriaceae”, 6 March 2014.
Group A streptococcal infections: seasonal activity, 2013/14
Surveillance data for group A streptococcal (Streptococcus pyogenes; GAS) infections are indicating higher levels of scarlet fever incidence so far this season (2013/14) than seen in recent years.
Increased levels of invasive and non-invasive GAS infection typically occur between December and April, with peak season usually in March/April.
An update on the current seasonal activity is presented in this report, which can be downloaded using the link below.