1. Detecting and managing CPE outbreaks: seek and you shall find
Tracey Galletly,1 Eimear Brannigan1, Siddharth Mookerjee1, Frances Davies1, Alison Holmes1,2, Jonathan Otter1
Imperial College Healthcare NHS Trust; 2. Imperial College London.
 @jonotter
2. Methods
CPE screening was performed using chromogenic agar, with each confirmed by PCR locally sent to the reference laboratory for VNTR genotyping.2
An outbreak was defined as two of more cases of CPE with the same VNTR type with epidemiological links.
We report the number of outbreaks of CPE since implementing enhanced CPE screening in June 2015.
Introduction
Carbapenemase-producing Enterobacteriaceae (CPE) have begun to cause outbreaks in the UK.1
From June 2015, our hospitals began risk-factor based CPE screening of all admissions, universal screening in high-risk specialties, weekly screening in wards where known carriers were present, and contact tracing around newly detected carriers.
We explore whether increases in CPE screening resulted in the detection of further outbreaks.
Figure: The number of new cases of CPE each month
3. Results
The Trust experienced 5 separate outbreaks of CPE first in the 15/16 financial year. (Figure)
55/72 (76%) of these patients were first identified by screening specimens.
Only 1 CPE outbreak had been identified in the Trust previously (in 2013).
Control measures included: an emphasis on high-quality hand hygiene, cleaning of equipment and ward environment including hydrogen peroxide vapour (HPV) decontamination of patient rooms at the time of transfer or discharge of case patients, and continued screening.
All outbreaks have been controlled.
4. Discussion
We experienced two separate outbreaks of K. pneumoniae NDM, and K. pneumoniae OXA-48, which was a confusing message for staff!
We believe that enhanced screening for CPE has resulted in the detection of CPE outbreaks that would otherwise have gone undetected.
Controlling these outbreaks has led to several challenges, including compliance with admission screening, staff education, and limited single rooms.
We expect to detect more outbreaks of CPE as our screening programme continues.  
References
1. Public Health England (2013). Acute trust toolkit for the early detection, management and control of carbapenemase- producing Enterobacteriaceae.
2. Health Protection Agency (2010). Advice on Carbapenemase Producers: Recognition, infection control and treatment.
Disclosures: JO is a consultant to Gama.