Infection prevention and control policy implementation for CPE: A cross-sectional national survey of healthcare workers reveals knowledge gaps and sub-optimal practices.

BACKGROUND:In 2017, Ireland pioneered a unique response to the worsening epidemiology of carbapenemase-producing Enterobacterales (CPE), declaring a National Public Health Emergency. Subsequently, implementation in acute hospitals of CPE mitigation guidelines and policies focused on patient screening and outbreak management, often by healthcare workers (HCW) with limited background in infection prevention and control (IPC). CPE risks from sinks and drains remain inadequately controlled. AIMS:We compared CPE awareness, perceptions of the environments role in CPE transmission, and clinical handwashing sink liquid waste (LW) disposal practices between IPC and non-IPC HCWs in Ireland. METHODS:Between December 2022 and March 2023, HCWs employed in acute hospitals in Ireland from 2017-2022 were invited to participate anonymously in a 30-question digital-survey. FINDINGS:Responses (n=283) were received across several clinical disciplines of which 21.6% were/had worked in IPC-roles; 84.1% of whom reported no IPC-related learning needs. More IPC than non-IPC respondents perceived pathogen transmission risk from clean water plumbing (68.9% vs 39.2%; P<0.001) and waste/drainage plumbing (81.2% vs 43.7%; P<0.001). Among nursing and medical staff, only 5.6% of IPC respondents used clinical handwashing sinks (HWS) for LW disposal Vs 60% of non-IPC respondents (P<0.001). Witnessing colleagues routinely discard LW (including nutritional products, antimicrobials, patient body fluids) via clinical HWS was reported by a greater proportion of IPC Vs non-IPC-respondents (88.9% Vs 77.9%) CONCLUSIONS: Although, there is awareness of the built environment's role in pathogen-transmission, including CPE, familiarity with sink/water-related transmission was greater among IPC-HCWs. There may be opportunities to improve LW disposal practices through education targeting non-IPC HCWs.