The Prevention and Control of Carbapenemase-Producing Enterobacterales (CPE) in Ontario, Canada
Year: 2020
Type: dissertation
Study design: Observational Study
Abstract: Carbapenemase-producing Enterobacterales (CPE) are an important threat to human health. CPE spread appears to occur primarily in healthcare facilities, and transmission is usually patient-to-patient but can sometimes be from contaminated hospital drains to patients. The extent to which community transmission occurs is unknown. This thesis aimed to inform CPE infection prevention and control (IPAC) measures in Ontario, Canada. First, we surveyed all acute care hospitals in Ontario to determine whether their CPE IPAC practices were in accordance with provincial guidelines. Only 60% of hospitals screened patients with prior healthcare abroad or high-risk travel on admission, despite guidelines recommending this. Even fewer hospitals (20%) screened patients with prior hospitalization in Canada on admission, possibly because guidelines do not recommend this despite recent evidence revealing considerable local CPE transmission. Second, we cultured all hospital drains previously exposed to inpatients with CPE at ten hospitals in Southern Ontario (N=1,209) and used whole-genome sequencing to determine whether drain CPE could be linked to patient exposure. Drain contamination was uncommon (53, 4%) but dispersed across 7 (70%) hospitals, and only 4 CPE-contaminated drains could be linked to prior patient exposure. This suggested contamination of drains by prior room occupants whose CPE was undetected, further highlighting insufficient patient screening practices. Finally, we examined risk of CPE household transmission. Of 177 household contacts, only 5 (3%) were detected as colonized due to confirmed or probable household transmission, suggesting little community transmission. Given that screening is cost-effective in low prevalence populations, household contacts of known CPE cases should be included in hospital admission screening programs. In summary, this thesis revealed an urgent need for methods to improve uptake of provincial guidelines for CPE prevention and control in Ontario hospitals, particularly with respect to admission screening. This thesis also shone a light on aspects of provincial guidelines that require updating, such as recommendations for admission screening to include patients with prior hospitalization in Canada and household contacts of known cases. We should continue to focus our IPAC efforts for CPE in healthcare facilities, where most transmission appears to occur, as opposed to the community.
Source: TSpace (University of Toronto)
Author: Alainna Jamal
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3142464647