Carbapenemase-producing organisms

The planning, prevention and control of CPOs requires effective infection prevention and control and antimicrobial stewardship programs that are consistent with local needs and the requirements of the National Safety and Quality Health Service (NSQHS) Standards.

All health service organisations should have a governance framework and plan for responding to CPOs. This framework should consider:

• Effective patient screening processes that include a system for screening and identification of patients at risk of CPOs on admission
• Systems that detect and manage clusters or outbreaks of CPOs, including accurate and efficient methods of testing and processes for epidemiological evaluation
• An outbreak action plan
• Education for clinical and non-clinical staff on CPO management and standard and transmission-based precautions
• An alert system in place for patients colonised or infected with a CPO
• Processes for microbiology laboratories to allow timely notification to infection prevention and control of a CPO infection.

Health service organisations should follow relevant state and territory policies for CPO screening and surveillance. 

Patients with the following risk factors should be screened for CPOs on admission to hospital:

• Direct transfer from an overseas hospital
• A contact of a suspected or confirmed CPO case
• History of admission to an overseas health or aged care facility
• Recent hospitalisation in a hospital with a known CPO outbreak. 

Screening requirements for CPOs will vary depending on the organism and clinical situation. For more information on screening, refer to relevant state or territory policy.

Patients who test positive for a CPO infection or colonisation should have an alert placed in their healthcare record for easy identification. 

CPE screening

Refer to Section 2 of the Recommendations for the Control of CPE for specific information on CPE screening.

States and territories have different CPO surveillance requirements and CPOs are also monitored nationally via CARAlert. For data on CPOs, see AURA 2023 and CARAlert annual reports and data updates. Every health service organisation, state and territory should select an appropriate active CPO surveillance strategy to identify CPO cases and contacts (for example, individuals who have had a recent hospitalisation in an endemic CPO setting or outbreak). Active surveillance of CPOs is recommended during outbreak situations and follow-up of contacts of cases.

CPOs can be spread from person to person through direct contact with contaminated hands, equipment, and environmental surfaces. Standard and contact precautions should be implemented when managing patients with suspected or confirmed CPO infection or colonisation. The key elements of applying contact precautions are:

• Use of appropriate personal protective equipment, such as aprons, gowns, and gloves
• Patient placement (e.g. single room cohorting)

Minimising patient movement.

Lower risk settings

Healthcare workers in sub-acute, community, primary health care or long-term care facilities, such as aged care homes, should perform a risk assessment to determine whether transmission-based precautions can be modified to allow people with a CPO to engage in group activities or settings. The risk assessment should consider the acuity of other individuals, the setting, and the CPO case’s individual risk factors. 

The Aged Care Infection Prevention and Control Guide provides more information on the management of multidrug-resistant organisms in aged care settings.

CPOs are easily spread from contact with contaminated environmental surfaces and equipment. 

Health service organisations should have environmental cleaning and disinfection policies and procedures that include guidance for the management of the environment where there is a suspected or confirmed CPO case. These policies and procedures should include:

• Product selection and method of use
• Frequency of cleaning and disinfection for the patient’s room/area and bathroom, including frequently touched surfaces
• Reprocessing shared medical equipment such as blood pressure cuffs (if unable to use dedicated patient equipment for those suspected or confirmed with a CPO)
• Discharge cleaning and disinfection requirements

Processes to monitor and audit cleaning according to relevant state or territory policies or procedures.

Disinfection

Cleaning the environment where there is a suspected or confirmed CPO case should involve: 

A 2-step clean	a physical clean using a detergent followed by disinfection with an Australian Register of Therapeutic Goods (ARTG)-listed hospital-grade disinfectant with specific claims of bactericidal activity against the CPO or a chlorine-based product, such as sodium hypochlorite, where indicated for use; or
A 2-in-1 clean	a physical clean using a combined detergent and ARTG-listed hospital-grade disinfectant with specific claims of bactericidal activity against the CPO or a chlorine-based product, where indicated for use

• Further information on environmental cleaning

There is a lack of high-quality evidence to support clearance of CPOs. Clearance should only be considered in accordance with the relevant state and territory policies, and in consultation with experts in clinical microbiology, infectious diseases, public health or infection prevention and control. A variety of factors should be considered, including recent microbiological results.

Staff education is important for preventing and controlling the spread of CPO infections. Education helps staff to understand and follow infection prevention and control requirements, support antimicrobial stewardship, and enhance reporting and clinical communication. Education should also highlight state or territory policies for reporting breaches in infection prevention and control practice and CPO screening requirements to promote a culture of safety and quality.

Patient education can also help prevent the spread of CPOs. Health service organisations can:

• Promote personal hygiene, including hand hygiene
• Encourage reporting of symptoms and accurate patient history, including recent overseas hospital admissions,
• Encourage adherence to antimicrobial treatment. 

The Commission has developed a suite of fact sheets for patients and visitors about infection prevention and control, and common and emerging healthcare-associated infections.