Early identification and management of CPE risk in the Emergency Department

Ms Jo-anne Mcshane1, Dr Andrew  Maclean1,2, Mrs Leanne Houston4, Mrs Helen Marquand4, Ms Madeleine Smith1, A/Prof Mary O’Reilly2,3

1Emergency Department,  Eastern Health, Box Hill, Australia,

2Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Box Hill, Australia,

3Department of Infectious Diseases, Eastern Health, Box Hill, Australia,

4Infection Prevention and Control, Eastern Health, Box Hill, Australia

 

Aim

This study aimed  to determine if patients who at risk of being colonised or infected with Carbapenemase-producing Enterobacteriaceae (CPE) were screened and isolated correctly in the Emergency Department (ED) following a pre-emptive assessment of risk factors at triage.

Background

Key factors in reducing the spread of CPE are surveillance, screening and management of those at risk.  ED presentations provide an opportunity for screening and implementation of transmission based precautions (TBP) to prevent transmission within the hospital setting.

Methods

A retrospective e-audit from April 2016 to March 2017 capturing CPE risk factors was data matched with the Infection Prevention and Control (IPAC) and Pathology’s CPE databases. Data collected:  presenting complaint, discharge status, CPE risk, data source, specimen collection and isolation of patients. Data was entered into Excel and analysed using IBM SPSS v22 .

Results

Of the 65,491 patient presentations in the audit period, 281 (0.43%) patient presentations met the CPE risk criteria requiring isolation and screening with 14.2% of these screened for CPE. Of these, 11% of patients were screened in the ED for CPE, and 30.6% were isolated using appropriate  TBP.

Of more concern, 31.7% (n=89) of at risk patients were admitted to hospital via ED, with 73% (n=65) of these patients not tested or isolated on the ward. Communication, resources, knowledge deficits and technology issues were identified throughout the audit process.

Conclusion

Pre-emptive isolation and screening of patients with CPE risk factors in the ED is an innovative infection prevention strategy.

Funding

Medtronic Infection Control Scholarship


Biography:

Jo-Anne is a passionate advocator  for Infection Prevention and Control in the Emergency Department. Jo-Anne’s interest was sparked when she  became a Hand Hygiene auditor and IPAC liaison  nurse over 8yrs ago . She  spent a  year  working in a IPAC unit before returning to ED to save lives and stamp out disease.