Health Professionals Update – Vol. 19, No. 3
From:
Nicholas Brandon, MD, MA, MSc, CCFP, FRCPC, Associate Medical Officer of Health
In this issue
- New: Carbapenem-Resistant Enterobacterales (CRE) report
- Reminder: Carbapenemase-Producing Enterobacteriaceae (CPE) guidance and infection control measures
- Reminder: Requirements for reprocessing medical equipment
Key messages
- Public Health Ontario has released a new surveillance report about the current state of Carbapenem-resistant Enterobacterales (CRE) in Ontario.
- Carbapenemase-Producing Enterobacteriaceae (CPE) is a subset of CRE and is a reportable disease in Ontario; Peel region continues to experience high and increasing case counts of this disease.
- Implement infection control measures for CRE and CPE cases, including hand hygiene, use of gloves and gowns for direct care, thorough cleaning and disinfection of environmental surfaces and medical equipment.
- Ensure any reprocessing of reuseable medical equipment follows best practices and the manufacturer’s instructions for use.
New: Carbapenem-Resistant Enterobacterales (CRE) report
Carbapenem-resistant Enterobacterales (CRE) represent a broad range of bacteria that are resistant to carbapenem antibiotics. Carbapenem antibiotics are considered one of the last options for therapy against multi-drug-resistant gram-negative bacteria and resistance to these drugs severely limits treatment options.
According to Public Health Ontario’s new surveillance report, Peel region is identified as having one of the highest rates of CRE in the province. Across Ontario, CRE incidence more than doubled from 3.3 to 6.9 per 100,000 population between 2017 and 2024 and Peel is one of the major contributors to this increasing burden (8.3 cases per 100,000 population).
CRE cases are seen more commonly among older patients, those with comorbidities, and among those who have been hospitalized or admitted to intensive care units.
Reminder: Carbapenemase-Producing Enterobacteriaceae (CPE) Guidance and Infection Control Measures
Carbapenemase-producing Enterobacteriaceae (CPE), a subset of CRE, is reportable to public health under Ontario’s Health Protection and Promotion Act (HPPA).
Community transmission of CPE in Peel is increasing, marking a shift from cases associated with international travel or health care abroad.
CPE can present as an infection or as a colonization; both require appropriate infection prevention and control (IPAC) measures to prevent transmission to others, although treatment is only recommended for those exhibiting signs of infection. Transmission can occur through direct or indirect contact. Preventive IPAC measures include:
- Hand hygiene.
- Use of gowns and gloves for direct care.
- Thorough cleaning and disinfection of both environmental surfaces and medical equipment.
- Situating patients admitted to hospitals or congregate living settings in a private room with dedicated washroom and medical equipment.
Ask your patients with CPE to disclose their diagnosis if they are being treated in hospital or move into a congregate living setting. In doing so, IPAC measures can be initiated to prevent spread.
All cases of CPE are reportable to Public Health. To report a case, call Peel Public Health at 905-799-7700, toll-free 1-888-919-7800 or send lab results by fax to 289-801-0257.
Requirements for reprocessing medical equipment
“Reprocessing” multi-use medical equipment includes two mandatory steps: cleaning and disinfection (or sterilization). See Figure 1 for the minimum level of reprocessing required.
Ensure the following items are in place to minimize the risk of transmission of infection to patients (refer to the College of Physician and Surgeons of Ontario CPSO - Infection Prevention and Control for Clinical Office Practice):
- Cleaning, disinfection or sterilization methods and products are compatible with the medical equipment and devices.
- Manufacturer’s instructions for all medical equipment are available and easy for staff to access.
- Staff responsible for reprocessing have completed training appropriate to the volume and complexity of equipment being handled.
- Reuseable medical equipment and devices are fully cleaned before disinfection or sterilization.
- There are written procedures for cleaning and disinfection/sterilization near the reprocessing area.
- There is a dedicated reprocessing area that is separate from other clinical and non-clinical activities.
Figure 1. What level of reprocessing is needed for medical devices and equipment?
| Class | Use | Minimum Level of Reprocessing | Examples |
|---|---|---|---|
| Critical | Enters sterile body site, including the vascular system | Cleaning followed by sterilization |
|
| Semicritical | Comes in contact with nonintact skin or mucous membranes but does not penetrate them | Cleaning followed by high-level disinfection, sterilization is preferred |
|
| Noncritical | Touches only intact skin and not mucous membranes, or does not directly touch the patient | Cleaning followed by low-level disinfection (in some cases, cleaning alone is acceptable) |
|
Learn more about environmental cleaning and medical device reprocessing.
Contact us
The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.
More information:
For questions about this update, email healthprofessionals@peelregion.ca.