Enterobacteriaceae is a family of bacteria (germs) that normally live in the bowel. E. coli is a well-known type of enterobacteriaceae.
Carbapenem antibiotics are generally used to treat these types of bacterial infections. However, carabapenem-resistant bacteria (CRE) have become resistant to these antibiotics.
Who is at an increased risk of getting a CRE infection?
Children in hospital who have:
- other health conditions that make them sick
- been in a hospital or care facility before
- been frequently treated with antibiotics
- weakened immune systems such as intensive care patients, or those in cancer or transplant wards
- recently travelled to countries where resistant bacteria are more common
- spent a large amount of time in hospitals overseas, particularly in Asia.
How is CRE spread?
CRE can be passed directly onto others via the hands of healthcare workers, visitors, carers, children or indirectly on equipment such as bed and cot rails, medical equipment, door handles and bathroom fixtures.
CRE infections are rare in Australia and patients often pick up the condition when they’ve had medical care overseas. CRE is found in patients in hospitals and clinics around the world and particularly in Greece, India and South‑East Asia.
Why is it important to identify CRE?
Healthy people do not usually get CRE infections. However, people may carry CRE in their bowel or in a wound without symptoms. This is called colonisation.
People who are colonised with CRE are at risk of getting a CRE infection if they have an operation or other hospital treatment. These infections need to be treated with different antibiotics to usual infections.
Infections caused by CRE are uncommon but are more difficult to treat. We do not want CRE to become widespread.
How is CRE diagnosed?
CRE can be detected in a microbiology laboratory from wound swabs or urine, faeces, blood, sputum or tissue samples.
How is CRE treated?
Most CRE infections can be treated with other antibiotics. Laboratory tests can determine which antibiotics will work.
If your child is colonised with CRE (i.e. they are carrying the germ in their body) but it’s not making them sick, then no treatment is needed. However, please advise health care workers about the CRE if your child is going to be treated or admitted to hospital.
What can you do to help prevent the spread of CRE?
While your child is in hospital, it’s very important that you, your child, hospital staff and visitors use excellent hand hygiene practices. This means using an alcohol-based hand rub or washing with soap/antiseptic and water to clean your hands. This needs to be completed frequently and thoroughly to reduce the risk of spreading of this germ. It is particularly important that you and your child perform hand hygiene after going to the toilet/changing nappies.
We recommend patients with CRE have their own bathroom while in hospital. This bathroom should not to be used by visitors.
When should you clean your hands?
Always clean your hands:
- before handling anything that goes in the mouth
- before preparing or eating food or drinks
- after going to the toilet or changing nappies
- after using a tissue or handkerchief
- after handling rubbish
- after handling dirty washing
- after coming into contact with an affected area (avoid touching wherever possible)
- before leaving a patient’s room.
Health care workers must clean their hands
It is very important that health care workers clean their hands with alcohol-based hand rub or soap/antiseptic and water before and after providing care for your child. If you don’t see them cleaning their hands it’s OK to ask “Have you cleaned your hands?” This is an important step in preventing spread of CRE and other resistant germs.
What other precautions are taken?
Our staff will use special precautions to stop the spread of CRE to other children. Your child may stay in a single room or share a room with a child with the same germ. Your child will be asked to stay in their room, unless they are receiving tests and treatment.
Our hospital staff will use gloves and gowns/aprons while caring for your child – this is commonly known as ‘contact precautions’. Hospital staff will do this to avoid spreading CRE to other children in the hospital.
If your child has CRE can they have visitors?
CRE can affect people who have certain long-term health problems. Please let the nursing staff know if someone who has a long-term health problem wants to visit you. They will need to be advised of the importance of hand hygiene to protect themselves and they may wish to discuss any risk to themselves with their treating doctor. Visitors should wash their hands after visiting your child, so that they do not spread this to others.
You and your visitors don’t usually need to wear gloves or gowns unless you or they will be visiting other people in the hospital.
Your child can receive visitors from the school and entertainment services if they are not able to leave their room or attend these areas in person. It may be suitable for you and your child to leave the hospital to visit the South Bank precinct or other areas.
What happens when you visit the hospital outpatient department or return to the hospital after discharge?
As there may be other children visiting the hospital who are at high risk of infection, precautions will be put in place when you visit all areas of the hospital. These may involve using a single room or allocating a time slot for appointments or procedures when there are fewer patients. Please let staff know that CRE precautions are required. The hospital patient information system (our patient database) should also have a record that CRE precautions are needed.
Do I have to tell the school, pre-school/kindergarten, other parents, sports groups or camps?
No. The risk to others outside a hospital environment is very low. Regular hand washing is the most important factor in preventing the spread of CRE.
Can the CRE be cleared?
Some children can be cleared of CRE. This depends on the use of antibiotics, if they have any drains/tubes or devices and if they have any ongoing health conditions. Your child’s care team or the infection control nurses will be able to advise you.
Infection Management and Prevention Service
Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 4145 (nurses)
t: 07 3068 1558 (administration)
t: 07 3068 1111 (general enquiries)
In an emergency, always call 000.
If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.
National Health and Medical Research Council (NHMRC) www.nhmrc.gov.au
Australian Commission on Safety and Quality in Health Care (ACSQHC) www.safetyandquality.gov.au
NHMRC. 2010. Australian Guidelines for the Prevention and Control of Infection in Healthcare. www.nhmrc.gov.au
Hand Hygiene Australia. 2008. Health Care Associated Infections. www.hha.org.au/ForConsumers/FactSheets.aspx#HCAI
Centres for Disease Control and Prevention. 2015. Carbapenem-resistant Enterobacteriaceae in healthcare setting. http://www.cdc.gov/HAI/organisms/cre/