The National Public Health Emergency Team on Carbapenemase-producing Enterobacteriaceae (CPE) held their twelfth meeting today, 08th February 2018.
Items discussed included publication of the Health Protection Surveillance Centre (HPSC) CPE surveillance report, the latest figures from the National CPE Reference Laboratory and an update on HSE communications plans.
The National Public Health Emergency Team welcomed the publication of the HPSC CPE surveillance report on 07 February. Data showed that the number of patients with newly confirmed CPE increased to 435 in 2017 from 282 in 2016. There were 15 invasive CPE infections notified in 2017 in comparison to 14 in 2016. The number of reported CPE outbreak events was 15 in 2017 in comparison to five in 2016. The report also included data on the number of CPE screens performed by acute hospitals and quantity of meropenem dispensed. The full report is available on the HPSC website and will be published on a monthly basis going forward.
The latest figures from the National CPE Reference Laboratory were presented to the group. In the two-week period from 22nd January to 4th February 2018 a total of six new patients with CPE were detected.
The HSE provided an update on their strategic communications programme of work in relation to healthcare-associated infections (HCAI) and antimicrobial resistance (AMR). This includes the Under the Weather information campaign and a central repository of information for the public and healthcare workers on a dedicated section of their website, www.hse.ie/hcai.
The minutes of all previous meetings and related documents are published on the dedicated webpage on the Department of Health website.
Carbapenemase Producing Enterobacteriaceae CPE (also referred to as carbapenem resistant Enterobacteriaceae (CRE)) is a superbug resistant to most or all antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity.
CPE are gram-negative bacteria that are carried in the gut and are resistant to most, and sometimes all, available antibiotics. CPE are an established threat to human health, particularly in hospital settings. They are shed in the faeces and transmitted by direct and indirect contact. A period of 4 weeks or more may elapse between that contact that results in acquisition of the organism and the time at which CPE becomes detectable in the faeces of the contact. More than half of all patients who develop blood stream infections with CPE die as a result of their infection.
CPE has been identified throughout the world in recent years. Ireland has seen an increase in the number of cases year on year. The number of cases almost doubled in 2016 and is estimated to increase by a further third in 2017. The spread of this superbug in hospitals can lead to the closure of beds, wards and units removing thereby, essential capacity to provide services, to admit patients from Emergency Departments and to address waiting lists effectively.
Public Health and microbiological advice indicates that the opportunity remains for effective interventions to be taken which can protect our patients, protect our hospital capacity from unplanned closures and ultimately lead to a halting or reduction in the spread of this superbug.
A public health emergency is described as any serious or unexpected event, due to an infectious disease, which causes, or threatens to cause, death or serious illness to large sections of the population, an individual region or a specific cohort of individuals and which will have a major impact on the normal functioning of the health system and on society in general.
The Department of Health’s National Health Emergency Plan is a plan for activation in the event of a national/large-scale public health emergency in the event of an infectious disease outbreak or similar health issue. The purpose of the plan is to assist all health agencies in the State to respond to a public health emergency in an integrated and co-ordinated manner.
The National Public Health Emergency Team was convened as a result of the activation of the Public Health Emergency Plan, on 25 October 2017, by the Minister for Health (Mr Simon Harris TD) as a public health response to CPE in Ireland.
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food handling encourage the further spread of AMR.
Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to implement policies and actions to prevent, monitor and combat AMR across the health, agricultural and environmental sectors. Reducing the inappropriate use of antimicrobial medicines, as well as preventing infections and disease, is vital to stop the development and spread of resistant microorganisms.
It provides an overview for the health, agricultural and environmental sectors. It presents key strategic interventions for tackling antibmicrobial resistance in line with World Health Organisation (WHO) requirements across the three sectors. These interventions represent Ireland’s commitment to the development and implementation of a holistic, cross-sectoral ‘One Health’ approach to the problem of antimicrobial resistance.
A healthcare-associated infection (HCAI) is an infection that is acquired after contact with the healthcare services. This is most frequently after treatment in a hospital, but can also happen after treatment in outpatient clinics, nursing homes and other healthcare settings. Healthcare-associated infections that are picked up in hospital are also known as “hospital-acquired infections”.