Trust hope to declare infection outbreak over next week

Frimley Health Foundation Trust has seen outbreaks of carbapenemase-producing enterobacterales at both its Frimley Park and Wexham Park sites, starting in the middle of last year, it has emerged. In total, it identified 94 new CPE cases in 2023–24 — 75 at Wexham Park and 19 at Frimley Park. This compares with just 20 in total in 2022–23.

It commissioned an internal review which was completed earlier this year.

It said on Friday morning the review had that of four patients who died with multiple health issues, including CPE infection, the CPE was “not directly associated with their deaths”.

The last case of CPE colonisation was identified on 10 June and the trust hopes to “close” the outbreak on Monday, 28 days after this, if no linked cases have been identified. 

CPE bacteria are resistant to many antibiotics, including carbapenems, which are broad-spectrum drugs used to treat serious infections. CPE infections pose a particular risk to vulnerable patients and can spread rapidly in hospitals. There has been increasing concern about them in the UK, with reporting requirements increasing and screening and testing of patients stepping up.

At Wexham Park, an outbreak in the middle of last year affected multiple wards — including one with cancer patients and others with elderly frail patients — and was linked to issues in the water and drainage systems.

“The working hypothesis for the outbreak was association with site drains,” according to the infection prevention and control annual report in this week’s board papers. The organisms are known to travel in biofilms through drainage systems and can colonise other water outlets. Between 30 per cent and 80 per cent of the sinks at Wexham Park were thought to have been colonised by CPE.

“Inappropriate use of hand wash basins for disposal of fluids such as drinks and washbowl water, and antimicrobials excreted in wastewater into drains, increases the likelihood of biofilm development and selective pressure in favour of resistant bacteria,” the report continues.

The outbreak at Frimley Park was smaller — which is thought to have been caused by a patient moving from another infected hospital — and CPE was not found in its drains. 

The trust’s report recommends a number of changes, such as removing sinks from high risk areas including ITU and oncology; reducing the number of sinks in new builds and refurbishments and putting them further than two metres from patients; redesigning showers so patients’ feet don’t touch drain outlets and not using them for patients with open wounds; and using alcohol-based hand sanitiser after washing hands.

The trust says work has been completed in the areas which contain patients at highest risk and ongoing work continues across the trust to reduce the risk of exposure to waste water as the potential source of CPE. 

The report also calls for the UK Health Security Agency to consider a change in national screening recommendations to improve protection. At the end of 2023, the trust introduced screening on admission and discharge for inpatients at Wexham Park, which continued until April.

Updated at 8am on 5 July after the trust responded to queries.

Updated Friday 12 July at 17.40 when the trust confirmed it had been unable to close down the outbreak. 

It said: ”We have seen a significant reduction in CPE cases since we identified the outbreak in June 2023. In line with standard outbreak management and the need for no linked cases within a 28 day period, the outbreak currently remains formally open with the last linked colonisation case identified on 5 July through our enhanced screen process. This means that the patient is not infected or unwell but is carrying the same bacteria that was identified in the trust last year. We are continuing to implement appropriate infection prevention and control measures to manage potential transmission risks effectively and ensure patient safety.”