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Deadly bacteria spread by hospital sinks of ‘grave concern’

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A growing number of cases of a bloodstream infection dubbed the “nightmare bacteria” should be of increasing concern for the health service, nurse infection control experts have warned.

Around 60 patients treated at Central Manchester University Hospitals NHS Foundation Trust since 2009 have died from infections linked to carbapenemase-producing enterobacteriaceae (CPE) that are extremely hard to treat.

“We know the number of cases are increasing in the UK and worldwide”

Neil Wigglesworth

Meanwhile, a 10-month outbreak across Imperial College Healthcare NHS Trust cost £1m, covering deep cleaning, ward closures, special training for nurses and expensive drugs.

Overall, reports of CPE bacteria, of which 40-50% of those infected die, have risen more than five-fold across England in the last five years, according to the Bureau of Investigative Journalism.

Freedom of Information requests made by the bureau reveal at least 81 people infected with CPE have died since 2009 at 66 NHS trusts in England – though CPE may not have been the direct cause.

The real figure is almost certain to be much higher, according to the bureau, because many trusts did not respond to its request for information or were unable to supply complete data.

Alongside Manchester and London, there have been confirmed outbreaks in Liverpool, Leeds, Sheffield, Birmingham, Nottingham, Colchester, Edinburgh and Belfast.

“It should absolutely be mandatory for trusts to report this”

Val Edwards-Jones

In a report – published earlier this month – the bureau contended that CPE was more dangerous than MRSA, but it was currently not mandatory for trusts to inform Public Health England about cases.

Val Edwards-Jones, emeritus professor of microbiology at Manchester Metropolitan University, said: “It should absolutely be mandatory for trusts to report this.”

Poorly-designed sinks that allow contaminated water to splash back out of drains are thought to have played a major role in the Manchester outbreak, noted the bureau in its report.

In Manchester, new cleaning methods were used on all sinks and hand basins, and wards and rooms were swabbed regularly for CPE, which the trust said successfully controlled the outbreak.

“Infection prevention and control will always be a high priority for the trust and is central to our patient safety agenda,” said Cheryl Lenney, the trust’s chief nurse. “We are continuing our efforts to control the spread of CPE and all other organisms.”

“We are continuing our efforts to control the spread of CPE and all other organisms”

Cheryl Lenney

CPE refers to a group of bacteria that has acquired the ability to fight off whole classes of antibiotics, including carbapenems – seen as a last resort for serious infections resistant to all other drugs.

CPE bacteria can live in the gut without causing any harm but can lead to serious infections if they get into wounds, lungs, urine or the bloodstream.

In February the World Health Organization named carbapenem resistant bugs as a “critical priority” for which new antibiotics were urgently needed.

Dr Neil Wigglesworth, president of the Infection Prevention Society and a nurse by background, told Nursing Times that CPE was of “grave concern”.

Infection Prevention Society

Deadly bacteria spread by hospital sinks of ‘grave concern’

Neil Wigglesworth

“We know the number of cases are increasing in the UK and worldwide as a result of over use and reliance on antibiotics,” he said.

“Control depends on early identification though screening and preventing spread between patients through high quality infection prevention precautions, including single room isolation when in hospital,” said Dr Wigglesworth.

“If healthcare professionals practice good infection prevention it reduces the need for antibiotics and therefore the risk to patient safety,” he noted.

He added: “We encourage trusts and other healthcare providers to ensure infection prevention and control teams are adequately resourced to meet this challenge and involve them when considering structural changes – such as replacing sinks – to reduce the risk.”

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