Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 28;14(1):38.
doi: 10.1186/s13756-025-01554-1.

Impact of standard precautions and unrestricted movements of carbapenemase-producing Enterobacterales (CPE) carriers on CPE transmission in a nursing home in Singapore: a prospective cohort study

Kyaw Zaw Linn  1   2 , Xiaowei Huan  1   2 , Pei Yun Hon  2 , Sharifah Farhanah Syed Husen  2 , Natascha May Thevasagayam  2 , Oon Tek Ng  1   2   3   4 , Shawn Vasoo  4   5   6 , Moi Lin Ling  7 , Dale Fisher  6   8 , Kalisvar Marimuthu  9   10   11   12
Affiliations

Impact of standard precautions and unrestricted movements of carbapenemase-producing Enterobacterales (CPE) carriers on CPE transmission in a nursing home in Singapore: a prospective cohort study

Kyaw Zaw Linn et al. Antimicrob Resist Infect Control. .

Abstract

Background: In 2018, Singapore's National Infection Prevention & Control Committee (NIPC) recommended standard precautions and unrestricted movements for CPE carriers in nursing homes.

Objective: This study investigates the short-term impact of this intervention on CPE transmission in a nursing home in Singapore.

Methods: We conducted a prospective cohort study between 1st April and 11th July 2019 in a 255-bedded nursing home in Singapore. Stool samples from residents and environmental samples from sink strainers in the residents' bedrooms, bathrooms, and lavatories, and shower drain traps in bathrooms were collected at baseline, week 2, week 8, and week 12 and tested for CPE. We performed whole genomic sequencing (WGS) to find out if there was any bacterial or plasmid linkage among the residents and between the residents and environment.

Results: A total of 32 residents, including six known CPE carriers, were recruited and completed the three-month follow-up visits. Of the six known CPE carriers, five tested negative for CPE, while one consistently tested positive for CPE throughout the study. Of the 28 sink strainers, six (21.43%) were positive for CPE. CPE was not detected in any shower drain trap throughout the study. Only one resident acquired CPE at week 12. WGS analysis of available CPE isolates showed no bacterial or plasmid linkage between residents or between residents and the environment.

Conclusions: Standard precautions and unrestricted movement of CPE carriers may be sufficient to control CPE transmission in the nursing home setting. Larger studies with more extensive environmental sampling and longer follow-up periods are needed to confirm this.

Keywords: CPE; CRE; Carbapenem-resistant Enterobacterales; Carbapenemase-producing Enterobacterales; Long-term care facility; Standard precaution.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the National Healthcare Group Domain Specific Review Board (2018/00439) before initiation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Recruitment and follow-up of subjects
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Weterings V, Zhou K, Rossen JW, et al. An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread. Eur J Clin Microbiol Infect Dis. 2015;34:1647–55. - PubMed
    1. Legeay C, Hue R, Berton C, et al. Control strategy for carbapenemase-producing Enterobacteriaceae in nursing homes: perspectives inspired from three outbreaks. J Hosp Infect. 2019;101:183–7. - PubMed
    1. CPE Expert Group. Guidance relating to Carbapenemase Producing Enterobacterales (CPE) for Long- Term Care Facilities for Older People.
    1. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. - PubMed
    1. Magiorakos AP, Burns K, Rodriguez Bano J, et al. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European centre for disease prevention and control. Antimicrob Resist Infect Control. 2017;6:113. - PMC - PubMed

MeSH terms