Diagnostics
with an additional €153,000 in infrastructure improvements (approx. £133,584).3
When wards close A separate
outbreak at University Hospitals of Leicester cost £350,000-400,000 for enhanced infection control measures alone.4
due to outbreaks, ripple effects cascade throughout the entire healthcare system. Research indicates that managing patients with carbapenem-resistant organisms costs more than double that of treating patients with sensitive organisms: £49,537 compared to £19,299.5
Implementing UKHSA guidance: practical considerations The UK Health Security Agency has issued guidance recommending that healthcare facilities implement active admission screening for the most common CPE types in areas of high prevalence.6
The guidance identifies five
priority patient groups who have in the previous 12 months: been identified as CPE positive; been an inpatient in any UK or foreign hospital; had multiple hospital treatments (eg, those who are dialysis-dependent); had a known epidemiological link to a CPE carrier; been admitted to augmented care or high-risk units. Translating guidance into practice presents significant challenges. Healthcare providers must conduct local risk assessments based on regional prevalence, patient populations, and connections to other facilities. Risk definitions vary substantially between institutions. Patients recently hospitalised overseas or transferred from facilities with known high CPE prevalence clearly merit screening. However, hospitals must make difficult decisions about resource allocation, determining which patients require pre-emptive isolation while awaiting results and managing testing when isolation capacity is limited. The challenge intensifies because screening identifies colonisation rather than treating it. Positive CPE screening does not trigger
antibiotic therapy; patients remain colonised, potentially for months or years. Screening serves to inform infection control measures and guide treatment decisions should infection subsequently develop.
The rationale for targeting common Carbapenemase types UKHSA guidance focuses on the common carbapenemase types based on manageability and public health strategy. Surveillance systems monitor the complete antimicrobial resistance landscape, including rare variants. However, practical screening programmes focusing on the most prevalent types enable healthcare facilities to capture the majority of cases while maintaining feasible workflows and costs. This focus does not neglect other carbapenemases. Culture-based methods continue identifying unusual resistance mechanisms. Epidemiological surveillance helps predict
emerging threats. Similar to anticipating influenza strains moving between hemispheres, CPE variants can be tracked as they spread from regions with high rates of specific carbapenemases. Identifying a particular CPE strain circulating in South Asia, for example,
combined with knowledge of significant travel between that region and the UK, enables anticipation and preparation for its arrival.
The strategic advantage of rapid molecular testing Time proves critical in CPE management. Rapid identification of colonised patients enables swift implementation of appropriate isolation measures or, equally important, rules out colonisation to avoid unnecessary isolation. Traditional culture-based testing requires
24-72 hours to yield results. During this period, patients often remain in isolation pending results. This creates cascading consequences: beds remain blocked, elective procedures may face delays, and studies demonstrate that isolated patients sometimes receive less frequent nursing care.7
Molecular testing offers
a fundamentally different approach. Rather than growing organisms and awaiting bacterial reproduction, molecular methods identify DNA or RNA directly. Results become available within hours rather than days. The practical implications prove substantial. Consider a patient admitted for urgent surgery with risk factors for CPE colonisation. Rapid molecular testing potentially clears them for the procedure the same day. Culture-based testing might delay surgery for days, increasing not only healthcare costs but also patient anxiety and risk of complications from delayed treatment. When isolation capacity is limited - as
it frequently is - rapid testing allows more intelligent resource allocation. One study demonstrated that molecular testing reduced mean bed-loss days from 22.8 to 9 days per month compared to culture-based screening.8 Another reported potential cost savings of £462 per patient for a five-day hospital stay.9
These
represent not merely financial considerations but improved patient flow, reduced delays in care, and better overall healthcare delivery.
30
www.clinicalservicesjournal.com I May 2026
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