THE NUMBER OF new patients found with the dangerous superbug CPE has reached the highest level to date according to the Department of Health.
Patients identified with CPE have been increasing year-on-year, rising to 537 in 2018. Last year’s figures are set to break records once more with over 660 new patients already identified by November, according to the latest figures just released.
“While the number of newly-diagnosed CPE patients has increased in 2019 over previous years, this is in the context of substantially increased screening activity over the past year,” according to a spokesperson from the Department of Health.
Rectal screening has allowed the identification of people with these bowel bugs. This “helps manage the risk”, according to professor Martin Cormican, HSE National Lead for Health Care Associated Infection and Antimicrobial Resistance.
Cormican said that he’d “like to see the number of people with CPE coming down but we’re not there yet”. He added that the rate of increase has slowed and “the number of people who are getting sick with CPE has stabilised”. In Ireland, CPE is mainly identified in patients from screening swabs rather than from infections.
Standing down the emergency
A public health emergency was declared by the Health Minister Simon Harris over two years ago to control the spread of CPE which is resistant to the most powerful last-resort antibiotics. In spite of this, the number of affected patients has continually increased.
According to the Department of Health there will be a meeting “in the first quarter of 2020 to monitor progress with a view to standing down the National Public Health Emergency Team at that stage”.
If the emergency is declared over, Cormican said “it is important that we don’t take the foot off the pedal on this”. He added that focus needs to be maintained in order to keep CPE under control.
One of the problems with infectious disease is you can do a lot of work over three years and lose that progress in three months.
Non-compliance with guidance
There are currently 13 hospitals across the country reporting a CPE outbreak, according to Cormican. Some of these have been dealing with outbreaks for more than a year including hospitals in Tallaght, Galway, Sligo and Limerick.
Beaumont Hospital in Dublin had an outbreak of this superbug for every reported month last year. A HIQA inspection last February identified two “high risks”. The hospital was not complying with HSE screening guidance for CPE and it continued to admit patients to a CPE outbreak ward which had been closed to admissions.
More detail on this outbreak was also given in a report compiled last February by Cormican after a visit to the Hamilton Ward, where the outbreak occurred. This was obtained by Noteworthy under the Freedom of Information (FOI) Act.
He wrote that adult cystic fibrosis (CF) patients were admitted to the ward but were not screened for CPE because the “consultant responsible for their care has indicated his opposition to CPE screening for this patient cohort”. He added that individual consultants “should not be able to opt-out of an institutional policy on screening without agreement” from the infection prevention and control team.
Fear of screening
Screening is an issue that consultants and patients are worried about, according to Cormican. This is because if patients are identified as having a superbug they fear “that they will be treated differently and will have difficulty accessing services”.
This fear isn’t unfounded as due to a lack of isolation facilities, this has happened in the past. However, Cormican said they “try very hard to make sure that doesn’t happen”. The health service has an obligation to “treat the patient fairly”, said the microbiologist.
“We need this testing to happen but also to make sure people who are identified as positive don’t suffer harm because they are identified.”
A new guidance document issued this week by the CPE Expert Group states that “the management of CPE risk cannot be allowed to cause significant delay in patient access to investigations or interventions”.
When asked about screening of cystic fibrosis patients, a spokesperson from Beaumont Hospital said that “appropriate CPE screening based on national guidelines is being adhered to across all patient cohorts”. Cormican said he understands that CF patients are being offered screening now.
“There are no current outbreaks pertaining to this”, stated a spokesperson for Beaumont Hospital. “All practices in relation to infection prevention and control are being implemented in regard to patient placement / bed management.”
Lack of isolation rooms
Cormican told Noteworthy that bed capacity and lack of single rooms is an issue in Beaumont, along with many of Ireland’s major hospitals. This problem was also noted in many of HIQA’s recent hospital inspections.
Over 290 CPE inpatients were not accommodated in an ensuite single room or appropriate area for part of their admission in HSE acute hospitals since the emergency was declared in October 2017. This increases the risk of spread to other patients.
One inspection report published last month stated “University Hospital Galway did not have adequate single room facilities to effectively isolate or segregate all patients being cared for with transmission-based precautions”.
The same report had evidence that the ongoing outbreak of CPE has had an impact on the management of other superbugs. It stated that ESBL screening “had been suspended at the hospital due to the additional workload generated by CPE screening”. ESBL is the superbug that caused Savita Halappanavar’s blood-stream infection at the same Galway hospital.
A spokesperson for Galway University Hospitals told Noteworthy that they have recommenced ESBL screening. They added that patients who are identified as CPE positive “are a priority for a single room”.
LAST RESORT: Superbug investigation
Do you want to know why his dangerous superbug is continuing to spread in Irish hospitals and why control measures are not always being implemented?
Through Noteworthy, we want to do an in-depth investigation into this issue and identify the impact CPE is having on patients and hospitals.
Here’s how to help support this proposal>
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