Fraser Health declares outbreak of deadly ‘superbug’ at British Columbia hospital

A British Columbia hospital that has been battling overcrowding for years is the site of a rare outbreak of a deadly superbug known to be highly fatal when spread to people with weak immune systems.

Fraser Health announced an outbreak of Carbapenemase-Producing Enterobacteriaceae (CPE) in a medical unit at the Royal Columbian Hospital, in New Westminster.

"Infection prevention and control measures are already in place; however, because of sustained transmission of the bacteria on this unit, we are now declaring an outbreak and have implemented further measures," Fraser Health stated in a recent announcement.

You are forgiven for not recognizing Carbapenemase-Producing Enterobacteriaceae. It isn't a household name like C. difficile or other hospital-spread infections, though the superbug has been spotted in Canadian hospitals in recent years. They are believed to be brought in from areas of the world where it is more common.

"It was inevitable that we would see this in British Columbia, in particular in Fraser Health," said Dr. Elizabeth Brodkin, Fraser Health's medical director for infection prevention and control. "These bacteria have been emerging worldwide for over a decade, in various parts of the world. In Fraser Health we serve communities with strong ties to parts of the world where this has become endemic."

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Fraser Health says CPE come from a common family of bacteria found in human intestines. Most people who carry CPE are colonized but not infected, meaning they carry the bacteria around without getting sick or showing symptoms.

The major concerns comes when the bacteria is transmitted to another person. Those who are already sick are most likely to become infected by the bacteria.

According to a recent infectious disease update, CPE have developed resistance to many antibiotics and can transfer resistance to other bacteria in the body. Severe infections of CPE may cause death in up to 50 per cent of cases.

CPE is transmitted by direct contact, but it can also survive on surfaces and equipment. Efforts to contain the bacteria at Royal Columbia, through thorough hand washing and cleaning, have been unsuccessful, leading to the need for stronger measures.

All of this makes health units particularly susceptible. Indeed, Fraser Health says the bacteria were most likely brought to B.C. by patients who had travelled to endemic areas such as South Asia, the U.S. and Greece.

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To combat the spread of CPE, officials at Royal Columbian have separated patients known to be colonized and provided dedicated staff and equipment. Those treating CPE patients will wear gowns and gloves, even while providing basic care.

“We have been preparing for increased cases of CPE for some time and have adopted aggressive infection control protocols to detect and isolate these cases in our hospitals,” said Brodkin.

Exacerbating the problem, however, is how many patients stream through the halls of Royal Columbian. Its emergency room is one of the busiest in the country, with more than 67,000 patient visits annually. Twice in recent years, the hospital has been forced to establish makeshift emergency rooms in the hallways, the lobby, and even the in-house Tim Hortons location, in order to accommodate the influx of patients.

In 2012, Royal Columbian was the site of a C. difficile outbreak. Shortly afterward, the government issued a directive to Fraser Health demanding reductions in the frequency of hallway care, a decrease in infection rates and quicker turnaround for patients.

It isn’t clear how many patients have been infected by CPE. The Globe and Mail reported last month that Fraser Health counted 41 CPE-carrying patients in the second-half of 2013, a number they referred to as a “cluster.”

Fraser Health says recovery efforts already appear to be working, although it will be weeks before the outbreak could be declared over. In the meantime, patients and visitors are being urged to stay away from the site. For now, the fewer people at the frequently-overcrowded hospital, the better.