1. Measuring and improving compliance with risk-factor based CPE admission screening
Siddharth Mookerjee,1 Kate Martin, 1 Itziar Atucha-Zambrano, 1 Rebecca Foley-Saeed,1 Tim Leak,1
Nadine Corbin,1 Tracey Galletly,1 Alison Holmes,1,2 Jonathan Otter,1 Kathleen Bamford1
1. Imperial College Healthcare NHS Trust; 2. Imperial College London.
 @jonotter
Introduction
Screening for carriage of carbapenemase-producing Enterobacteriaceae (CPE) is an important measure in preventing transmission.1
We implemented risk-factor based CPE admission screening in June 2015, using a modified version of the PHE Toolkit.2
Risk factors that trigger screening are overnight hospitalisation in the previous 12 months, and overseas residence.
Implementing CPE risk factor assessment and screening into the admission pathway has proved challenging operationally.
2. Methods
A ward in an acute NHS hospital Trust was selected for a quality improvement programme in collaboration with NHS Improvement to improve compliance with CPE admission screening.
CPE screening compliance was calculated by determining the number of admissions with overnight hospitalisation in our Trust in the past 12 months (denominator) and the number of patients who were screened within 24 hours of admission (the numerator).
The intervention to improve compliance began in April 2016 and included a range of measures involving staff and patient education, information and investigation of barriers co-developed with the ward team (see Figure).
Figure: Compliance with CPE admission screening, intervention ward. Annotated numbers refer to the interventions. 2
Intervention 1: initial discussions with between ward staff and IPC in April 2016.
Intervention 2: CPE posters and prompt cards in early May 2016.
Intervention 3: Review of CPE screening status at handover mid May 2016.
Intervention 4: Weekly discussion of CPE compliance figures on the weekly HCAI Taskforce call from June 2016. 3 4 1
3. Results
The rate of admission screening compliance increased from 56% prior to intervention 1 (71 of 126 admissions screened between Jun-15 and Mar-16) to 79% during the intervention phase (34 of 43 admissions screened) (p=0.21 using a Fisher’s exact test).
There is some evidence that the improvement on one ward ‘leaked’ to other wards in the same specialty, where compliance increased from 33% in July 2015 to 61% in July 2016 (p=0.111).
These figures do not capture patient refusals.
4. Discussion
An intervention based on raising staff and patient awareness of the need for risk factor based CPE screening increased compliance in a ward; although this increase was not statistically significant, the intervention was not powered for statistical significance.
Identifying patients colonised with CPE is vital for preventing ‘silent transmission’ of CPE.1
We have developed a communications strategy in orde to extend this successful intervention across all patients wards in the specialty, and then across the Trust to improve compliance with CPE admission screening.
References
Otter JA, Mutters NT, Tacconelli E, Gikas A, Holmes AH. Controversies in guidelines for the control of multidrug-resistant Gram-negative bacteria in EU countries. Clin Microbiol Infect 2015; 21:
Public Health England. Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae
Disclosures: JO is a consultant to Gama.