Visitor restrictions at University Hospital Limerick are likely to continue while the hospital battles an ongoing outbreak of CPE, Carbapenemase Producing Enterobacterales).
There have been 21 new positive cases detected since June linked to this current outbreak. There are currently three CPE-positive inpatients at University Hospital Limerick and all necessary infection prevention and control measures are in place to manage this current outbreak. All cases detected since June relate to patients colonised with and not infected with CPE.
Until further notice only one visitor per patient is allowed and during visiting hours (2pm to 4pm and 6pm to 9pm) only. Members of the public are reminded not to bring children on visits anywhere in the hospital. Parents visiting children are unaffected by the restrictions but are advised not to bring siblings.
With high volumes continuing to present to UHL, these restrictions, while regrettable for patients and their loved ones, have been deemed necessary in the interests of patient care. All infection control measures are in place and every effort is being made to manage the situation with CPE-positive patients and CPE contacts being isolated and cohorted as appropriate.
A number of measures have been taken to deal with the current outbreak. These include
- twice weekly incident meetings convened for all affected areas
- isolation of all positive patients with strict high level contact precautions
- all CPE contacts are screened for a period of 28 days with four negative swabs. These patients are isolated/cohorted with contact precautions
- extensive environmental cleaning and hydrogen peroxide decontamination is underway
CPE is recognised as being endemic in the MidWest Region and UL Hospitals Group has developed comprehensive control measures to deal with Multi-Drug Resistant Organisms.
UL Hospitals Group is proactive in screening patients for CPE in line with national and international best practice and guidance. This helps identify at risk colonised patients asymptomatically carrying CPE, allowing for the appropriate control measures to be put in place. Screening protocols that have been in place at UHL for a number of years have been the template for the development of the national screening policy for the National Public Health Emergency Team on CPE.
There has been strengthened governance in relation to CPE across the UL Hospital Group including the establishment of a CPE Strategic Committee. Information on CPE is shared with senior management and clinicians and escalated nationally through the appropriate channels.
CPE are a group of antibiotic resistant bacteria that are becoming more common all over the world, especially in hospitals. The term CRE (Carbapenem Resistant Enterobacteriaceae) has also often been used to mean much the same thing as CPE.
The first case in Ireland of CPE was detected in University Hospital Limerick in February 2009. The microbiology team at the hospital raised an alert at the time by telling colleagues in other hospitals of this new problem.
Since then CPE has become more and more common in Ireland and several different kinds of CPE have appeared around the country.
This has become such a problem that the Minister for Health, Simon Harris, established the National Public Health Emergency Team, as a public health response to the CPE/CRE threat in October 2017.
CPE are able to resist the killing effect of a very important group of antibiotics known as carbapenems. This means infection caused by CPE is harder to treat. CPE are carried in the gut.
They are often resistant to a lot of other antibiotics as well as being resistant to meropenem. They are shed in the faeces and spread to other people through contact with hands, surfaces and other things that are contaminated.
Most people who pick up CPE get no symptoms and no illness because the CPE stays in their gut. This is called CPE colonisation or CPE carriage. About 1 in 20 people who carry CPE develop infection at some time
CPE can spread from people that carry it to other people. We know that at the moment most CPE spread happens in hospitals. CPE spread can easily happen below the radar which is why hospitals are testing patients for CPE.
Most of the people who are carrying and shedding CPE are not sick with CPE.