What is CPE?    

Enterobacterales are a type of bacteria that normally live in the human gut and do not usually cause any issues. Sometimes they can cause infection if they enter other parts of the body such as the bladder, wounds or the bloodstream.

Carbapenemase Producing Enterobacterales (CPE) are types of these bacteria that are resistant to many antibiotics, including carbapenem antibiotics such as meropenem. These antibiotics are usually used to treat serious infections, which means infections caused by CPE can be more difficult to treat.

Many people carry CPE without becoming unwell, this is called colonisation. Infection occurs when the bacteria cause symptoms or illness. If an infection develops, treatment will be guided by specialist healthcare teams and microbiology advice.

How does CPE spread?

CPE can spread from one person to another if hands are not washed thoroughly after using the toilet or before eating. It can also spread through contact with contaminated equipment or environmental surfaces such as commodes, tables, chairs and door handles.

CPE is found more commonly in some hospitals in the UK and abroad. People who have received healthcare in these hospitals may have acquired CPE through contact with contaminated environments or other people carrying the bacteria

Who is at risk of CPE?

Individuals can be more likely to carry CPE if they:

• have received certain antibiotics, particularly carbapenem antibiotics
• have been a hospital inpatient in the UK or abroad
• receive regular healthcare treatment such as chemotherapy or dialysis
• Have had contact with a patient know to carry CPE.

How will I know if I have CPE?

Healthcare staff may assess whether you need testing for CPE.

Tests may include:

• a rectal swab (a swab taken from your bottom)
• a stool sample
• samples from wounds or medical devices if applicable.    

What actions will be taken if I have CPE?

If you have CPE the healthcare team looking after you will assess the safest place for your care.

If you have symptoms of infection, we may care for you in a single room with your own toilet facilities where possible. If this is not available, we will make alternative arrangements, such as providing a dedicated commode.

If you are carrying CPE but do not have any symptoms, you may still be able to use shared ward facilities and communal areas following assessment by the nursing staff.

To help prevent the spread of CPE, staff may wear personal protective equipment (PPE), such as gloves and aprons, when providing your care. This is a routine precaution used to protect all patients and reduce the risk of germs spreading within healthcare settings. Staff will also clean their hands before and after caring for you.

These precautions are not a reflection of your illness or personal hygiene. They are standard infection prevention measures used to keep you, other patients, visitors and staff safe.

Your healthcare team will discuss any precautions with you and answer any questions you may have.

Can I still have visitors?

Yes, you can still have visitors.

Kent Community Health NHS Foundation Trust (KCHFT) asks all visitors to use the alcohol hand sanitiser as they arrive to our inpatient areas or departments. Your visitors do not need to wear aprons or gloves unless they are assisting with your care (such as helping you dress or shower). They will need to wash their hands with soap and water before they leave your room and avoid visiting other people in hospital after they have been with you.

What actions should I take if I have CPE?

Good hand hygiene is the most important thing you can do:

• washing hands with soap and water after using the toilet
• washing hands before eating
• washing hands after touching wounds or medical devices. (full stop added)

Having CPE should not delay your discharge from hospital if you are otherwise fit to leave.

At home

No special cleaning of your home is required and your clothes can be washed as normal.

If healthcare staff visit you at home:

• they may schedule visits according to local infection prevention arrangements.
• they will follow appropriate infection prevention measures.
• any equipment used will be cleaned appropriately.

Do I need to tell anyone if I have CPE?

Your CPE status will be recorded in your healthcare records and shared with relevant healthcare professionals involved in your care. This helps to make sure appropriate precautions are taken during future healthcare visits, admissions, or transfers. Some hospitals provide a CPE card which you can show to other healthcare professionals.

Please tell healthcare professionals caring for you that you have previously been identified as carrying CPE. This is so they can take the appropriate steps to look after you.

When should I seek medical advice?

Most people who carry CPE do not become unwell. However, if you develop any of the following symptoms, please contact your GP, NHS 111, or the healthcare team involved in your care:

• a high temperature (fever) or feeling feverish
• new or worsening diarrhoea
• pain or a burning sensation when passing urine
• needing to pass urine more often than usual
• redness, swelling, pain, or discharge from a wound
• feeling generally unwell, weak, or unusually tired
• confusion or any sudden change in your condition.

Seeking advice early can help ensure that any infection is identified and treated promptly.

When should I seek urgent help?

Seek urgent medical attention by contacting NHS 111 or calling 999 in an emergency if you experience:

• severe weakness or collapse
• difficulty breathing
• signs of sepsis (a serious reaction to infection), such as:
  • A very high or very low temperature
  • A fast heartbeat
  • Rapid breathing
  • New confusion or difficulty staying alert.

If you are concerned that you or someone you care for is becoming seriously unwell, do not delay in seeking medical help.

What should I do if I have further questions?

If you have any questions, please speak to the team looking after you to answer your questions, or you can ask them to contact infection prevention and control colleagues, who can also assist.