Risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (CPE) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer

The risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (CPE) is based on two systematic reviews – on the risk factors for patient colonisation or infection with CPE and on the effectiveness of infection control measures to stop the spread of CPE within healthcare institutions. In addition, a group of ten experts on infectious diseases and control provided their expert opinion on the systematic reviews. Patient transfer between healthcare facilities, in particular cross border transfer of patients, is a risk factor for the spread of resistance to last line antibiotics bacteria, concludes the report. For highly resistant bacteria, like CPE, the risk is heightened when patients are transferred from, or have received previous medical care in areas with high rates of resistance. The infection control measures, found effective in the risk assessment are: a) active surveillance (active screening of all cross-border patients on admission and a prompt laboratory detection); b) additional precautions for CPE-positive patients (e.g. contact  precautions, such as wearing of disposable gloves and gown, and isolation measures); c) cohort nursing by a separate, dedicated team for all suspected and positive CPE patients. Additional suggestions from ECDC are for countries to perform active surveillance on any patient transferred across borders upon admission to a hospital or other healthcare facility; to develop national guidance for how to stop the spread of CPE and to actively report cases of CPE to public health authorities.