Table 1 Schematic representation of a suggested screening approach

Active surveillance of high-risk unplanned admissions

Risk assess patients based on epidemiological history

Pre-emptively isolate highest-risk patients

If screening results are positive:

 • Use molecular or immunochromatographic testing to identify resistance mechanisms where necessary

 • Negative results may be used to de-escalate isolation

To rapidly determine carriage status and requirements for isolation:

For CPE negative cases:

 • Improve patient flow

 • Retain bed capacity

 • Prevent unnecessary isolation protocols or empirical treatment

For CPE positive cases:

 • Instigate infection control procedures

 • Prevent transmission and outbreaks

 • Consider clinical impact if infection present e.g., alteration to empiric therapy pending further results

Pre-admission screening for high-risk elective patients

Risk assess patients based on epidemiological history

Determine whether there is a need to isolate patients or to establish cohorts

If results are positive:

 • Further risk assessment for the procedure required based on probability of post operative infection

 • Risk assess whether targeted prophylactic and/or empiric antibiotic therapy indicated

Consider, if:

 • The procedure is imminent, and results are needed urgently;

 • There is a lack of laboratory resources or staffing for culture-based methods.

Regular screening of patients on high-risk units

Use as a sentinel surveillance method in addition to other screening strategies, and protect highest risk settings.

If results are positive:

 • Isolate positive high-risk patients to avoid transmission of CPE

Consider, if:

 • There is a lack of laboratory resources or staffing for culture-based methods.

Screening of contacts of known cases

If results are positive:

 • Urgent identification and isolation of known contacts

 • Instigate infection control cleaning protocols

Yes– the faster turnaround time is important for preventing further transmission, and retaining resources and beds in large outbreaks.