Scottish hospitals at risk of new 'superbug' outbreak, experts warn

Scottish hospitals are at risk of an outbreak of a new potentially deadly superbug unless attitudes towards screening change, according to health experts.

Rates of antibiotic-resistant bacteria carbapenemase producing enterobacteriaceae (CPE) in Scotland are relatively low compared to other parts of Europe, the US, India and Africa.

But a study by researchers at Glasgow Caledonian University (GCU) found there is a lack of awareness among health professionals and the public about the threat of CPE.

More than 30% of nurses questioned in a nationwide survey were unaware of the emerging risk of CPE and the same proportion thought taking rectal swabs from patients, the best screening method, was unacceptable.

In the 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 and the acceptability of rectal swabs.

Lead study author Professor Kay Currie, GCU School of Health and Life Sciences associate dean, research, 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.''

The bacteria lives harmlessly in the gut in healthy people but can be extremely dangerous if it gets into the bloodstream, urine or surgical wounds and causes an infection.

Half of nurses surveyed 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.

Almost 70% of nurses questioned in the survey thought members of the public would be embarrassed by a rectal swab and 74% said they would ask patients to do the test themselves despite the fact this method may be unreliable.

The majority of members of the public surveyed strongly agreed providing a rectal swab was acceptable, contrary to nurses' perceptions.

More than 80% of members of the public said they knew about the growing problem of drug-resistant bacteria but only 23% had heard of CPE.

As a result of the research, 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.

Professor Jacqui Reilly, Lead consultant for healthcare associated infection, antimicrobial resistance and infection control at Health Protection Scotland (HPS), 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.

"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.

"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.''

The research has been published in the BMC journal Antimicrobial Resistance and Infection Control.

A Scottish Government spokesman added: "We welcome this new research from Glasgow Caledonian University as antibiotic resistance is one of the greatest threats to our healthcare system.

"Findings from this research has informed the infection prevention work within the Chief Nursing Officer's 'Excellence in Care' approach.

"A new National Clinical Risk Assessment (CRA) which identifies individuals most at risk of carrying multi drug resistant bacteria has been developed and tested.

"Using a person centred approach, early identification of bacteria prompts correct treatment and management of these patients."