Guidelines for health care providers in New Zealand acute and residential care facilities
Antimicrobial resistance (AMR) is a growing threat globally and to the entire New Zealand population, because it hinders our ability to manage infections. It has been estimated that Carbapenemase-producing Enterobacteriaceae (CPE) have the greatest potential to contribute to the overall problem of antimicrobial resistance.
CPE is the newest in a long line of ‘superbugs’ and are a particular problem in hospital settings. CPE are (typically) resistant to nearly all known antibiotics; they increase patient morbidity and mortality and have the potential to spread and act as a reservoir of resistant genes for transmission to other organisms.
While CPE are not currently considered to be endemic in either New Zealand healthcare facilities or the wider community, their transmission here is considered to be evolving rapidly, with the window of opportunity to minimise the risk of spread in healthcare facilities likely to be narrow.
In New Zealand, the rate of CPE carriage and infection has increased sharply in recent years, and while until very recently nearly all CPE have been imported from overseas, there is now evidence of secondary spread in the community and in health care facilities. Patients at highest risk would be those most reliant on antibiotics for survival, including those in intensive care units; those undergoing treatment for cancers; those undergoing bone marrow and solid organ transplantation; those with complex urological problems; and those undergoing major surgery.
This Guideline is intended for health care providers. It sets out recommendations, requirements and response actions for the prevention, management, including outbreak response measures and control of health care-associated infections due to CPE in healthcare facilities in New Zealand. Section one of the Guideline includes background information, roles and responsibilities and epidemiology of CPE. Section two provides an operational framework for health care workers managing CPE and outbreak response measures.