The Health Service Executive (HSE) has begun writing to hundreds of patients who were not told they had come into contact with other patients carrying a highly antibiotic-resistant superbug.
The delay in informing people who were exposed to others carrying the CPE bug while in hospital may cause them to be "very upset and disappointed", the head of the HSE has warned the Department of Health.
Existing communications processes did not adequately address “prompt communication” with patients who had left hospital before it was known they had been exposed to CPE, according to acting HSE director-general John Connaughton.
This could mean a long delay before they were informed, or “they may not be informed at all” unless they were readmitted to the same hospital, he says in a letter seen by The Irish Times.
A “catch-up” process is needed to inform patients who had not been previously informed, he says, but this has the “potential to cause upset to patients and the wider public”.
"Although we are taking care to ensure clear and appropriate communication and to provide patients with access to appropriate care and support after they are informed, we must anticipate that some people may be very upset and disappointed," the letter to Department of Health secretary-general Jim Breslin states.
Difficult to kill
About 2,000 people in Ireland carry Carbapenemase Producing Enterobacteriaceae (CPE), the newest in a long line of bacteria that are extremely difficult to kill with antibiotics. The bug was "an associate factor" in the deaths of eight patients in University Hospital Limerick, according to a report published last month.
People who carry CPE are said to be “colonised” by the bug and have no symptoms. About five to 10 per cent may develop a CPE infection, usually when they are very ill.
The bug is spread person-to-person or through contact with contaminated surfaces. About one in 20 patients who come in contact with carriers will themselves be colonised by CPE, and one in 400 runs the risk of a serious, invasive infection. It is more likely to spread where patients are not accommodated in single rooms, as happens in at least five hospitals.
The issue has arisen with patients who left hospital before being identified as a CPE contact. The HSE says they are at very low risk of harm but acknowledges there has been a “communications gap” in telling them about their exposure.
It also admits the delay in communicating with these patients has been a concern for infection-prevention staff “for some time”.
“Some patients have said and written to hospitals to say how unhappy they were that they only found out about this when they came back into hospital weeks or months later,” according to the briefing notes prepared for Mr Breslin.
Least worry
The reason why hospitals did not get in touch with affected patients was due to a concern about how to get in touch with them in a way that caused the least worry, the note says.
This changed after CPE was declared a public health emergency in October 2017. Patient groups represented on the expert group established to handle the emergency demanded that people be given the information even if it caused upset.
Hospital groups have been left to make their own arrangements for contacting patients, usually by letter, and offering them testing and support.
This process is under way and at various stages across the hospital groups, according to a HSE spokeswoman. Asked how many people are affected, she said hospitals were working on the lists of CPE contacts, so an exact figure on the number of people who will be written to was not yet available.
Prof Martin Cormican, HSE lead for antimicrobial resistance and infection control, pointed out only a small number of the people who are CPE contacts will carry CPE. "For most of those patients who do carry CPE it will live harmlessly in the gut along with the many other gut bugs we all carry. However, the information that they are CPE contacts is important if they have to go back into hospital in the future."
Last year, 433 new cases of CPE were reported.
