Ward Contact Screening of carbapenemase-producing Enterobacterales – Do the Numbers Add Up?
Megan Gritt1, Denise Del Rosario-Kelly1, Pauline Bass1, Andrew Stewardson1, , 1Alfred Health, Melbourne, VIC, Australia
Introduction
The Victorian Guideline on carbapenemase-producing Enterobacterales (CPE) defines a Transmission Risk Area (TRA) as geographic area (e.g. ward) and time period where local CPE transmission occurred. Patients admitted to the designated TRA for ≥24 hours are ‘ward contacts’ and should be screened for CPE colonisation. We aimed to assess the frequency of case detection and the resource utilisation of this approach.
Method
We reviewed all TRAs at our health service, summarising actions taken, including tasks performed by non-Infection Prevention department staff, and presenting total number of ward contacts, screening numbers, and CPE-positive cases for each TRA.
Results
8069 ward contacts were identified across 22 TRAs at our health service since 2015, with a range of 35 to 1018 contacts per TRA. Of 4082 ward contacts who underwent screening, 20 (0.48%) were CPE-positive. Among the 20 CPE-positive ward contacts, 10 (50%) were unrelated to the bacterial isolate for their respective TRA, 8 (40%) were closely genetically related to the CPE isolates in 6 TRAs, and 2 (10%) cases are undergoing molecular characterisation. Of the 10 unrelated cases, 8 (80%) exhibited the same carbapenemase gene as the TRA isolate. Laboratory consumables amounted to approximately $15,103, with Infection Prevention staff investing approximately 200 hours in creating patient medical record alerts.
Conclusion
A small percentage of ward contacts screened for CPE colonisation during TRA management test positive for the outbreak isolate. Considering the costs involved, and impacts on bed management, and patient experience, a resource-efficient risk stratified approach may be appropriate.
Biography
Megan is an Infection Prevention Nurse Consultant and Aseptic Technique Coordinator at Alfred Health. She has a background in Infectious Diseases and is working towards a Masters of Public Health and Tropical Medicine, with an interest in antimicrobial resistance and emerging public health threats. Denise has been at Alfred Health for almost 20 years and is a Senior Infection Prevention Nurse Consultant. She has a background in neuroscience nursing and infection control nursing, and has an interest in data analytics and outbreak management of multi-resistant organisms.