Evaluation of patient-held carbapenemase-producing Enterobacteriaceae (CPE) alert card

Poole, K; George, Ryan; Shryane, Theresa; Shankar, K; Cawthorne, Julie; Worsley, M.A.; Savage, N; Scott, Janine; Welfare, William

doi:10.1016/j.jhin.2015.10.008

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…This can, for example, be done by sharing information about the colonisation status of patients between healthcare institutions, through centralised registers [22] or by patient held cards [23], alerting hospitals to take appropriate action to prevent onward transmission and saving money from unnecessary repeated screening. Regional coordination may also aid effective contact tracing in outbreaks that span multiple institutions.…”

Section: Discussionmentioning

confidence: 99%

The relative importance of large problems far away versus small problems closer to home: insights into limiting the spread of antimicrobial resistance in England

Donker

Henderson

Hopkins

et al. 2017

BMC Med

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BackgroundTo combat the spread of antimicrobial resistance (AMR), hospitals are advised to screen high-risk patients for carriage of antibiotic-resistant bacteria on admission. This often includes patients previously admitted to hospitals with a high AMR prevalence. However, the ability of such a strategy to identify introductions (and hence prevent onward transmission) is unclear, as it depends on AMR prevalence in each hospital, the number of patients moving between hospitals, and the number of hospitals considered ‘high risk’.MethodsWe tracked patient movements using data from the National Health Service of England Hospital Episode Statistics and estimated differences in regional AMR prevalences using, as an exemplar, data collected through the national reference laboratory service of Public Health England on carbapenemase-producing Enterobacteriaceae (CPE) from 2008 to 2014. Combining these datasets, we calculated expected CPE introductions into hospitals from across the hospital network to assess the effectiveness of admission screening based on defining high-prevalence hospitals as high risk.ResultsBased on numbers of exchanged patients, the English hospital network can be divided into 14 referral regions. England saw a sharp increase in numbers of CPE isolates referred to the national reference laboratory over 7 years, from 26 isolates in 2008 to 1649 in 2014. Large regional differences in numbers of confirmed CPE isolates overlapped with regional structuring of patient movements between hospitals. However, despite these large differences in prevalence between regions, we estimated that hospitals received only a small proportion (1.8%) of CPE-colonised patients from hospitals outside their own region, which decreased over time.ConclusionsIn contrast to the focus on import screening based on assigning a few hospitals as ‘high risk’, patient transfers between hospitals with small AMR problems in the same region often pose a larger absolute threat than patient transfers from hospitals in other regions with large problems, even if the prevalence in other regions is orders of magnitude higher. Because the difference in numbers of exchanged patients, between and within regions, was mostly larger than the difference in CPE prevalence, it would be more effective for hospitals to focus on their own populations or region to inform control efforts rather than focussing on problems elsewhere.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0844-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The relative importance of large problems far away versus small problems closer to home: insights into limiting the spread of antimicrobial resistance in England

Donker

Henderson

Hopkins

et al. 2017

BMC Med

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“…These cards facilitate patient-centered decision-making by providing case-speci c information and have the potential to expedite referrals to tertiary healthcare centers. Medical alert cards, developed for both adult [9,11,18] and pediatric [13,15] patients, have demonstrated their ability to enhance patient management by providing concise, patient-speci c information [9,[19][20][21][22][23].This readily accessible information proves especially crucial in critical situations, ensuring timely and appropriate patient care [18]. Our study corroborated these ndings, with 94% of respondents acknowledging the utility of these cards in formulating optimal diagnostic and treatment strategies based on unique patient characteristics and procedure-related considerations.…”

Section: Discussionmentioning

confidence: 99%

Medical Alert Cards for Patients with Antegrade Continence Enemas (ACEs): A Useful Tool to Increase Awareness

Bokova,

Elhalaby,

Martin-McLain

et al. 2024

Preprint

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Purpose Antegrade continence enema (ACE) procedure, a surgical intervention creating colonic access, demands a physician’s nuanced understanding of the procedure, channel type, tubes utilized, and regimen. This study introduces an instrument to enhance healthcare providers' and caregivers’ familiarity with ACE procedures. Methods Medical Alert Cards encompassed (1) contact details, (2) ACE-related information, (3) emergency referral indications, and (4) patient-specific data. A single-institution survey appraising the cards’ efficacy was disseminated among providers and caregivers. Results Among 17 providers, the majority (65%) being attendings, 94% affirmed the cards’ utility in elucidating individual patient features. Content coherence was acknowledged by providers (88%) and caregivers (100%), with a readability score of 8 (IQR 7–10). The layout was approved by 88% of respondents, and 55% stated that the cards would inform their personalized management approach. Providers appreciated the clarity of contact details (94%) finding it advantageous for patient referral (18%). Proposed enhancements encompassed adding tube-related information, readability improvement, and visual presentation of the channel. Of the 2 caregivers, all reported their intention to carry the physical card for presentation at medical facilities. Conclusions Medical Alert Cards can increase healthcare providers’ and caregivers’ understanding of ACE procedures, facilitating management, and ensuring patient referral to specialized centers.

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“…Although preventing further introductions of CPE is not effective for CPE endemic hospitals, the effects of patient sharing between hospitals still need to be taken into account in the design of control efforts. In particular, information sharing about a patient's CPE colonisation status, either through centralised systems or patient-held information [11], could prove essential for a timely response when these known colonised patients are admitted to another hospital. Actively tracking the admissions of CPE positive patients may reduce the need to test all patients coming from other hospitals, thus reducing unnecessary screening and isolation, and freeing up resources.…”

Section: Discussionmentioning

confidence: 99%

When do big problems far away become smaller than the problems closer to home

Donker

Hopkins

et al. 2019

Preprint

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Infection prevention and control strategies aimed at reducing the occurrence of Carbapenemase-Producing Enterobacteriaceae (CPE) and other antimicrobial-resistant organisms often include advice about screening patients coming from hospitals with a known resistance problem, to prevent introductions into new hospitals by shared patients. We argue that, despite being an efficient method of identifying cases, admission screening for introduction prevention is only effective if the absolute number of imported cases from other hospitals outnumbers the cases coming from the hospital's own patient population, and therefore is only a feasible control strategy during the start of an epidemic. When determining whether import screening is still advisable, we therefore need to be continuously reminded of how Father Ted so eloquently summarised the principles of perspective: "These are small, but the ones out there are far away". The increasing threat of CPEAn increasing number of control strategies against Carbapenemase-Producing Enterobacteriaceae (CPE) and other antimicrobial-resistant organisms include a focus on coordinating control efforts among hospitals nationally [1] or regionally [2,3]. The need for coordinated control stems from the fact that no single hospital is completely segregated from others: they are all connected by the patients they share, thus creating one large national hospital network. For numerous reasons, some patients need to receive care in different hospitals, for instance because the necessary treatment is not available in the original hospital, or because care can be offered more efficiently elsewhere. These shared patients offer the opportunity for CPE and other organisms to be transmitted from one hospital to another.Patient sharing between hospitals has a strong regional tendency [4], driven by movement patterns to and from large tertiary care centres, such as university hospitals. Often, multiple general hospitals refer patients to the same tertiary care centre for advanced care, connecting all hospitals served by this centre into a single group. These groups tend to fall into clear geographical regions, because referral choice is related to the geographical distance between hospitals. Within these regions, hospitals can quickly share each other's CPE problem(s), with an outbreak in one hospital easily spreading to the others.By coordinating infection prevention and control efforts among hospitals that are easily affected by each other's CPE problems, any outbreak can be approached as a problem of all hospitals combined, avoiding any hospitals being caught off-guard by CPE-positive patients. An example of such a coordinated national response, which included central reporting of detected colonised and infected individuals, contained an outbreak of CPE in Israel after local, single hospital-based interventions had failed [5]. Although the described response was expensive and relied on strict compliance with testing and isolation guidelines in all hospitals, it does show the clear benefit of coo...

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Evaluation of patient-held carbapenemase-producing Enterobacteriaceae (CPE) alert card

Cited by 5 publications

References 5 publications

The relative importance of large problems far away versus small problems closer to home: insights into limiting the spread of antimicrobial resistance in England

The relative importance of large problems far away versus small problems closer to home: insights into limiting the spread of antimicrobial resistance in England

Medical Alert Cards for Patients with Antegrade Continence Enemas (ACEs): A Useful Tool to Increase Awareness

When do big problems far away become smaller than the problems closer to home

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