CPE: Are you ready for the new super bug hitting your ED?

Jo-Anne McShane1, Dr Andrew  Maclean1,2, Leanne  Houston4, Helen Marquand4, Madeleine Smith1, A/Prof Mary O’Reilly2,3

1Emergency Department, Box Hill Hospital, Eastern Health, Box Hill , Australia, 2Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Box Hill, Australia, 3Department of Infectious Diseases, Eastern Health, Box Hill, Australia, 4Infection Prevention and Control, Eastern Health, Box Hill, Australia


This study aimed was to determine if patients who were at risk of Carbapenemase-producing Enterobacteriaceae (CPE) were isolated and screened correctly in the Emergency Department.


Carbapenemase-producing Enterobacteriaceae (CPE)  is the latest ‘superbug’ on the scene of multi-resistant organisms (MRO’s)  is already endemic in America, India and China. The key factor in reducing the spread of CPE in Australia is the surveillance, screening and management of those at risk.  Emergency Department admissions account for a significant number of potentially CPE colonised patients and provide an opportunity for screening and implementation of transmission based precautions to prevent transmission within the hospital setting.  In response to recommendations regarding CPE screening and pre-emptive isolation in the DHHS (Victoria) guideline on Carbapenemase- resistant Enterobacteriaceae (2015), questions about an overnight stay in a hospital overseas within the last  year were added to the ED triage process. Patients  who said yes were classified as a CPE risk 2 and isolation and screening was required during their Emergency visit.


A retrospective e-audit from March 2016 to March 2017 (using Symphony, the electronic Emergency Department Information System) with a filter capturing a CPE risk factor of 2 was data matched with the Infection Prevention and Control (IPAC) units spread sheets and Pathology’s CPE database. Data collected:  presenting complaint, discharge status, CPE risk, data source, specimen collection and isolation of patients. Data was entered into Excel and analysed using IBM SPSS v22 .


Throughout the audit process it was discovered there was significant issues affecting the ability to isolate and screen at risk CPE patients including communication, resources, knowledge deficits and technology issues.


Pre-emptive isolation and screening of patients with CPE risk factors in the Emergency Department is an important initiative in identifying  and containing  CPE within the health service.


Medtronic Infection Control Scholarship


Jo-Anne is an enthusiastic Emergency Nurse with 20 yrs experience in Australian and overseas Emergency Departments. Jo-Anne is currently a research nurse at Box Hill Emergency Department and is particularly enthusiatic about Infection Prevention and Control practise and research.