An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England

C M Coope; N Q Verlander; A Schneider; S Hopkins; W Welfare; A P Johnson; B Patel; I Oliver

doi:10.1016/j.jhin.2018.03.007

An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England

J Hosp Infect. 2018 Aug;99(4):381-389. doi: 10.1016/j.jhin.2018.03.007. Epub 2018 Mar 9.

Authors

C M Coope¹, N Q Verlander², A Schneider³, S Hopkins², W Welfare², A P Johnson², B Patel², I Oliver⁴

Affiliations

¹ NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, UK; University of Bristol, Bristol, UK. Electronic address: caroline.coope@phe.gov.uk.
² Public Health England, UK.
³ NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; University College London, London, UK.
⁴ NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, UK; University of Bristol, Bristol, UK.

PMID: 29530741
DOI: 10.1016/j.jhin.2018.03.007

Abstract

Background: Following hospital outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), Public Health England published a toolkit in December 2013 to promote the early detection, management, and control of CPE colonization and infection in acute hospital settings.

Aim: To examine awareness, uptake, implementation and usefulness of the CPE toolkit and identify potential barriers and facilitators to its adoption in order to inform future guidance.

Methods: A cross-sectional survey of National Health Service (NHS) acute trusts was conducted in May 2016. Descriptive analysis and multivariable regression models were conducted, and narrative responses were analysed thematically and informed using behaviour change theory.

Findings: Most (92%) acute trusts had a written CPE plan. Fewer (75%) reported consistent compliance with screening and isolation of CPE risk patients. Lower prioritization and weaker senior management support for CPE prevention were associated with poorer compliance. Awareness of the CPE toolkit was high and all trusts with patients infected or colonized with CPE had used the toolkit either as provided (32%), or to inform (65%) their own local CPE plan. Despite this, many respondents (80%) did not believe that the CPE toolkit guidance offered an effective means to prevent CPE or was practical to follow.

Conclusion: CPE prevention and control requires robust IPC measures. Successful implementation can be hindered by a complex set of factors related to their practical execution, insufficient resources and a lack of confidence in the effectiveness of the guidance. Future CPE guidance would benefit from substantive user involvement, processes for ongoing feedback, and regular guidance updates.

Keywords: Carbapenemase-producing Enterobacteriaceae; Guidance; Hospitals; Infection prevention and control; NHS acute trusts; Screening.

MeSH terms

Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
Cross-Sectional Studies
Disease Management*
England
Enterobacteriaceae Infections / diagnosis*
Enterobacteriaceae Infections / drug therapy
Enterobacteriaceae Infections / prevention & control*
Guideline Adherence
Health Services Research*
Hospitals
Humans
Infection Control / methods*