We all need to know about CPO

Carbapenemase-producing organism (CPO) is a collective term that refers to a group of bacteria that have become resistant to many antibiotics, including our last line of defence antibiotics called carbapenems.

Along with many other health services, Western Health has seen a rise in CPO cases since late 2023. Currently CPO is in 5 of our wards and unfortunately for the first time in our Western Health history some internal transmission has occurred. This is a notifiable event and our Infectious Diseases and Infection Prevention teams have been working with the Department of Health.

An Incident Management Team has been established to oversee the rapid implementation of short-term measures to decrease the risk of further internal transmission.

In addition, we’re asking all staff to continue adhering to standard infection prevention practices to help us stop the spread,

About CPO
Some people carry CPO in their gut and remain healthy but if the CPO moves from the gut to another part of the body, they may develop an infection and require treatment. The CPO produce an enzyme called carbapenemase that makes the antibiotic no longer effective in fighting infections, resulting in limited treatment options and often death.

CPO infections are rare in Australia and are usually associated with overseas hospital admissions or healthcare, particularly in parts of Europe, North America, the Middle East and Asia. Groups at increased risk of acquiring CPO include:

• people have had prolonged admissions to hospitals
• people who have received medical care or aged care overseas in the previous 12 months
• people who have been treated with multiple or repeated courses of antibiotics
• people with a weakened immune system or underling long-term medical conditions
• people with an indwelling medical device such as a urinary catheter.

What can I do?
Essentially, we just need all of our staff to adhere to standard infection prevention practices. Please be cognisant that every action that you do will impact on whether CPO is contained or spread – depending on how you do it!

Top tips for positively impacting on our ability to contain CPO:

• Screening: Finding CPO on people who carry CPO is essential to stop any spread. This is why we have an infection prevention infectious risk screening questionnaire in our EMR to be done on admission for all our patients – it is essential that this is done as early as possible, preferrably at the entry point (usually Emergency Department, Urgent Care Centres or Day Surgery Units). If someone has a history of being in an overseas hospital, having a procedure or being in a residential care facility in the last 12 months, a specimen to look for CPO (either a stool sample or a rectal swab) must be collected, patient isolated in single room, own bathroom. CPO High Risk alert placed, and Infection Prevention notified.
• Handover: as CPO is relatively new to Australia, there may be some staff that are not aware of what it is, and how serious it is. Please ensure that if a patient has CPO, or is a contact of CPO cases it is included in each handover to ensure that staff make good, informed decisions on how they practice. Check the infectious risk alerts to see why patients are in Contact precautions.
• Isolation: Contact transmission-based precautions are used in addition to standard precautions to prevent the spread of CPO. Contact precautions need to be followed, including wearing gloves and a gown before entering the room of a CPO patient, and taking them off prior to exiting. Patients with CPO are the highest priority for single rooms; however Infectious Diseases and Infection Prevention may approve cohorting of patients with the same strain of CPO.
• No equipment or devices to enter and exit rooms: Shared equipment and devices (including WOWs, vital signs machines, glucometers, and stethoscopes) can be the greatest spreaders of infection across hospitals. Nothing should be routinely entering and exiting rooms being used to isolate a patient with CPO. Western Health has recently moved to using disposable equipment and dedicated devices for use with all patients with CPO. Room computers should be used to avoid contaminated WoWs entering rooms.
• Carefully cleaning and disinfecting rooms: rooms need to be regularly cleaned and disinfected. CPO rooms also get ultra-violet marker testing to validate the cleaning effectiveness. Anything that does need to leave the room needs to be thoroughly cleaned and disinfected. Make sure that simple easy slip-ups don’t occur, like putting contaminated meal-trays on clean PPE trolleys.
• Shared patient equipment: if shared patient equipment must be used, it must be cleaned after each use. Small pieces of equipment must be cleaned using the disinfectant wipes, ensuring all surfaces are cleaned. Large pieces of equipment such as lifting hoists should be cleaned with Actichlor (chlorine based) product with microfibre cloths.
• Hand hygiene:ensure you undertake the 5 moments of hand hygiene and that there is alcoholic hand rub present at every bed side and point of care. Gloves should be removed, hand hygiene performed and gloves redonned when moving from contaminated area to clean area. Hand hygiene must be performed immediately before donning gloves, and immediately after removing gloves. Gloves should always be put on immediately prior to touching the patient in the room or cubicle, not outside the room. Gloves should not be kept on PPE trolley’s but inside the room to avoid cross contamination of gloves. Review Using gloves appropriately in healthcare (vimeo.com)
• Careful staff allocation: where possible, try to allocate staff that are caring for patient(s) with CPO so that they are not caring for patients without CPO to decrease the risk of transmission.
• Antimicrobial stewardship: This is the range of activities that reduces the unnecessary and inappropriate use of antibiotics to prevent and contain antimicrobial resistance. Antibiotics should only be dispensed and administered if they have the necessary approvals from our Infectious Diseases clinicians.
• Patient hand hygiene: patients will have hand wipes added to their meal trays to encourage hand hygiene prior to eating, to avoid oral ingestion of organisms from their environment. Please encourage patients to use the wipes before eating. Also remind patients to wash their hands after using the bathroom and to use the hand rubs if they ambulate around the ward or go out to the café’s on exiting and returning to their room.