National Public Health Emergency Team on CPE publish situational analysis today
The National Public Health Emergency Team on Carbapenemase-producing Enterobacteriaceae (CPE) published their first situational analysis report today, 21 December 2017. The group also held their eighth meeting today.
The situational analysis report provides an overview of the information gathered via the National Public Health Emergency Team process to date. It includes background information, the key outputs achieved, gaps identified and resulting next steps. It also presents available national data on the levels of CPE screening taking place and the number of newly patients detected with CPE, an overview of governance arrangements at national and regional level and existing policies and procedures.
Figures from the National CPE Reference Laboratory are included in the report. There were 401 newly detected patients with CPE in the period from January to November 2017, this compares with 282 in 2016. This represents a 42% increase in the number of new patients detected. At this stage, it is not known if this increase is due to enhanced screening or an actual increase in the number of people with CPE. The most recent CPE screening data from the HSE’s Business Intelligence Unit is also included. It shows a total of 9,821 reported CPE screenings in October 2017 with differences across hospital groups suggesting variation in the implementation of the CPE screening requirements policy.
The main gaps identified to date relate to requirements for reporting of CPE colonisation, implementation of national requirements in particular for screening in acute hospitals and the timeliness of surveillance data. The report includes next steps to address the gaps.
The Chief Medical Officer and Chair of the Group, Dr Tony Holohan recognised that “the HSE have reviewed and strengthened their governance and implementation oversight arrangements since the National Public Health Emergency Team was convened” and added that “assuring that the required next steps are progressed will be a priority focus for the group in 2018”.
Expected outputs for 2018 include prompt progress towards effective screening for CPE across all hospital groups to make sure that the risk to patients is reduced, progress reports from the HSE’s Implementation Team, monthly CPE surveillance reports from the Health Protection Surveillance Centre, a report from the Expert Group on their review of the screening requirements and outbreak management plan and seeking assurance that the response plan is aligned to Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020.
The minutes of all previous meetings and related documents are published on a dedicated page on the Department of Health website.
Notes to the Editor
Public Health Emergency Plan to tackle CPE
What is CPE?
Carbapenemase Producing Enterobacteriaceae CPE (also referred to as carbapenem resistant Enterobacteriaceae (CRE)) is a superbug resistant to most or all antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity.
CPE are gram-negative bacteria that are carried in the gut and are resistant to most, and sometimes all, available antibiotics. CPE are an established threat to human health, particularly in hospital settings. They are shed in the faeces and transmitted by direct and indirect contact. A period of 4 weeks or more may elapse between that contact that results in acquisition of the organism and the time at which CPE becomes detectable in the faeces of the contact. More than half of all patients who develop blood stream infections with CPE die as a result of their infection.
CPE has been identified throughout the world in recent years. Ireland has seen an increase in the number of cases year on year. The number of cases almost doubled in 2016 and is estimated to increase by a further third in 2017. The spread of this superbug in hospitals can lead to the closure of beds, wards and units removing thereby, essential capacity to provide services, to admit patients from Emergency Departments and to address waiting lists effectively.
Public Health and microbiological advice indicates that the opportunity remains for effective interventions to be taken which can protect our patients, protect our hospital capacity from unplanned closures and ultimately lead to a halting or reduction in the spread of this superbug.
What is a public health emergency?
A public health emergency is described as any serious or unexpected event, due to an infectious disease, which causes, or threatens to cause, death or serious illness to large sections of the population, an individual region or a specific cohort of individuals and which will have a major impact on the normal functioning of the health system and on society in general.
What is the Public Health Emergency Plan?
The Department of Health’s National Health Emergency Plan is a plan for activation in the event of a national/large-scale public health emergency in the event of an infectious disease outbreak or similar health issue. The purpose of the plan is to assist all health agencies in the State to respond to a public health emergency in an integrated and co-ordinated manner.
The National Public Health Emergency Team was convened as a result of the activation of the Public Health Emergency Plan, on 25 October 2017, by the Minister for Health (Mr Simon Harris, T.D.) as a public health response to CPE in Ireland.
What is AMR?
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food handling encourage the further spread of AMR.
What is the National Action on Antimicrobial Resistance 2017-2020 (iNAP)?
Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to implement policies and actions to prevent, monitor and combat AMR across the health, agricultural and environmental sectors. Reducing the inappropriate use of antimicrobial medicines, as well as preventing infections and disease, is vital to stop the development and spread of resistant microorganisms.
It provides an overview for the health, agricultural and environmental sectors. It presents key strategic interventions for tackling antibmicrobial resistance in line with World Health Organisation (WHO) requirements across the three sectors. These interventions represent Ireland’s commitment to the development and implementation of a holistic, cross-sectoral ‘One Health’ approach to the problem of antimicrobial resistance.
What are healthcare-associated infections (HCAIs)?
A healthcare-associated infection (HCAI) is an infection that is acquired after contact with the healthcare services. This is most frequently after treatment in a hospital, but can also happen after treatment in outpatient clinics, nursing homes and other healthcare settings. Healthcare-associated infections that are picked up in hospital are also known as “hospital-acquired infections”.
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