Survey indicates lack of nurse awareness of new ‘superbug’

They warned that Scottish hospitals were at risk of a new potentially deadly superbug outbreak, unless attitudes changed towards screening.

“We really want to try to stop it becoming endemic in our hospitals because it’s extremely difficult to treat and get rid of”

Kay Currie

At the moment, rates of antibiotic-resistant bacteria Carbapenemase Producing Enterobacteriaceae (CPE) in Scotland are relatively low compared to other parts of Europe, US, India and Africa.

The World Health Organization has identified CPE as a growing challenge in the fight against antibiotic-resistant infections with predictions of worldwide epidemics.

The UK has been hit by isolated outbreaks, particularly in Manchester hospitals where they are struggling to get rid of the bacteria with fears it may still be living in sink drains.

However, researchers at Glasgow Caledonian University said they had found a “disturbing” lack of education and awareness among health professionals and the public about the threat of CPE.

A team from the university’s Safeguarding Health through Infection Prevention (SHIP) group has carried out the first study of its kind into the acceptability and perceptions of CPE screening.

“HPS will use these findings to inform further development of the CPE screening programme”

Jacqui Reilly

In a nationwide survey, 450 nursing staff from all Scottish health board areas and 261 members of the public were asked a series of questions to find out what they knew about CPE.

They were also asked about their views on the acceptability of rectal swabs, which is the best way to detect the bacteria and recommended by international guidelines for all patients deemed at risk.

More than 30% of nurses surveyed were unaware of the emerging risk of CPE and the same number thought that taking rectal swabs from patients was unacceptable.

Almost 70% of nurses quizzed in the survey thought the public would be embarrassed by a rectal swab and around 74% said they would ask patients to do it themselves, despite it being unreliable.

Half of nurses who responded said they had not been informed about their hospital’s policy and procedures for CPE screening and less than 50% felt the consequences of CPE to their patients were so severe that screening was a priority.

When the public were asked about CPE, more than 80% said they knew about the growing problem of drug-resistant bacteria but only 23% had heard of CPE.

However, contrary to nurses’ perceptions, the majority of the general public strongly agreed that providing a rectal swab was acceptable, said the researchers.

They highlighted that their findings – published in the journal Antimicrobial Resistance and Infection Control – had informed national action to boost heightened awareness of CPE and screening.

NHS Education for Scotland is developing new online educational resources for nurses to help them understand that the public are not as embarrassed by the rectal swab test as they think.

Lead study author Professor Kay Currie said: “This is very important research because it will be used to educate nurses and raise awareness among the general public, which will increase uptake of screening and help prevent an outbreak of this very dangerous resistant bacteria in the UK.

“CPE is a growing threat to our healthcare system and we really want to try to stop it becoming endemic in our hospitals because it’s extremely difficult to treat and get rid of once it takes hold,” she said.

Glasgow Caledonian University

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Jacqui Reilly

Professor Jacqui Reilly, lead consultant on healthcare associated infection, antimicrobial resistance, infection control and decontamination at Health Protection Scotland, said: “Antibiotic resistance is one of the greatest threats to our healthcare system.

“Early identification of those patients coming into hospitals who may be at risk of getting an infection, such as one caused by CPE, is critical to stopping the onward transmission of these infections to other patients,” she said.

Professor Reilly said: “This study demonstrates the importance of ensuring any screening programme, for the identification and prevention of these infections, is based on an understanding of the important public health principle of acceptability.”

She added: “HPS will use these findings to inform further development of the CPE screening programme, in order to ensure we make it easy for staff and patients to do the right thing to protect health.”