Admissions restricted to Middlemore Hospital National Burns Centre
Counties Manukau Health is limiting the number of admissions to the National Burns Centre (NBC) at Middlemore Hospital following several cases of a highly unusual multi-drug resistant organism.
On 10 December 2017 one case of carbapenem-resistant organisms (CRO) was identified at the centre, most likely acquired from off-shore. (Carbapenems are a powerful group of antibiotics often relied on for infections where treatment with other antibiotics have failed.)
Vanessa Thornton, Acting Chief Medical Officer, says the multi-drug resistant organisms are often detected and managed in hospitalised patients, however this is quite a unique organism, believed to have been acquired overseas. It is of particular concern because of the vulnerability of burns patients.
“Despite infection control measures, on 9 January 2018 another patient in the burns/ICU care complex was found to be infected with the same organism, and a third patient identified on Saturday, 3 February.”
“Whilst this is not a concern for most of our patients or the visiting public, CROs can have serious implications for patients such as burns patients and we are taking all the necessary steps to ensure these cases are contained, managed and eliminated before they spread further,” she says.
“All three infected patients are in isolation and one theatre has been reserved for their exclusive use. Restricting the transfer of patients to the burns/ICU is a crucial step in eradicating these organisms,” says Dr Thornton.
“The burns, ICU and theatre teams have done an amazing job responding to this situation and continue to provide the best level of care to all our patients.”
As part of the National Burns Service strategy, Counties Manukau Health has contacted regional burns centres and is putting into action the agreed plan to manage patients in New Zealand, that have burns, in such situations.
“We are asking that patients be held in other burns centres until we are confident the risk is contained at the NBC. We are also considering options for transferring very serious burns cases, which would normally be treated at Counties Manukau Health, to locations in Australia. This would be on a case-by-case basis.”
Dr Thornton stresses that Middlemore Hospital has stringent measures in place to manage and eliminate the CROs and the majority of patients and the visiting public are not at any risk.
“Patient safety is paramount and these alternative arrangements are being put in place to ensure the protection of our most vulnerable burns patients.”
What are Carbapenem Resistant Organisms (CRO)?
Everyone has bacteria that live in the bowel that are generally harmless and can even help with digestion. Your immune system keeps them in check and prevents them from spreading elsewhere in the body. However, sometimes these bacteria can cause infections and in certain situations become antibiotic-resistant (this is where certain antibiotics no longer work against bacteria).
Some of these bugs can develop into Carbapenem Resistant Organisms (CRO) as they have become resistant to multiple antibiotics including the carbapenem antibiotics, which are usually the antibiotics of choice for very drug-resistant bowel bacteria. There are very few antibiotics which can treat infections with CRO, and in extreme cases no antibiotics are effective.
The majority of patients who are found to have CRO do not have symptoms and are known as carriers. Rarely, CRO can cause symptomatic infection such as urine, kidney or bloodstream infections in patients (such as burns patients and transplant recipients), and patients needing intensive care or while receiving chemotherapy.
How do people get CRO?
Patients who have already taken lots of antibiotics are more at risk of developing CRO. The reason for this is that the more bacteria are exposed to antibiotics, the more likely they will develop resistance.
CRO are more common in some countries than others.
CRO can be carried by patients, either harmlessly or if they are infected with it. It can spread between people through direct contact with each other or by touching items or surfaces that the person with CRO may have touched such as bed rails, toilets or equipment. As patients in hospital are much more vulnerable to infection, special precautions are required to prevent the spread of CRO between them.
Which patients are tested for CRO?
CRO is a very common bug in some countries. If a patient has been admitted to hospital in another country in the past 12 months and is being admitted to hospital in New Zealand, they should tell their doctor or nurse so that a CRO test can be done if deemed necessary. The test is not done routinely in all New Zealand hospitals.
How is the test done?
A swab taken from a patient’s rectum is the quickest and easiest way to check for CRO, as it is usually detected in the bowel. The swab will be put in a special sample container to send to the hospital laboratory.
The hospital laboratory will usually be able to rule out CRO within 3 days.
What is the risk associated with CRO?
The risk is to vulnerable patients while they are in hospital. Increased hygiene precautions will be taken and gowns and gloves will be used, as well as vigilant hand cleaning.
The risk to members of the public is minimal as long as good hygiene practices are used while visiting patients in hospital.
For further information, contact the Counties Manukau Health media line on 09 250 9857.