Carbapenem-resistant organisms (CRO)

Information for patients, relatives and visitors

        What are CRO?

        CRO stands for carbapenem-resistant organisms. These are groups of bacteria (germs) that produce carbapenemases (chemicals). These chemicals can destroy antibiotics called carbapenems. This makes the bacteria ʻresistantʼ to the antibiotic.
        Carbapenems are a powerful group of antibiotics that are often relied on for infections where treatment with other antibiotics has failed. So preventing the spread of CRO in our hospitals will make sure that these antibiotics continue to be available to treat infections in the future.
        CRO can live in the gut of humans and animals and they help us to digest food. In most cases CRO are harmless and cause no ill effects – this is called ʻcolonisationʼ. If the bacteria get into the body (for example, into the bloodstream or urinary tract), they can cause ʻinfectionʼ. This can happen if you are unwell or have a weakened immune system.

        How do we test for CRO?

        If you need a sample to be taken for testing, a member of your care team will discuss this with you. Normally a rectal swab is taken. A member of your care team will gently insert a swab a small distance into your rectum (bottom). Or, they may test a sample of faeces (poo). Some other samples may be needed, for example, a wound swab or urine sample.
        You should not experience any discomfort while samples or swabs are taken. Your privacy and dignity will be respected at all times when these samples are taken.
        All swabs and samples will be sent to the laboratory to see which bacteria grow and your care team will tell you the results. The results can take approximately one to three days.
        You may be cared for in a single room until the result of your test is known. This is to prevent the infection from spreading to other patients.

        What if the test for CRO is negative?

        This means that you are not colonised or infected with any CRO and no treatment or extra care precautions are necessary. If you are in a single room, you may be moved back to the main ward area.

        What if the test for CRO is positive?

        If you test positive for any CRO it means that you have the bacteria in your body. You may not show any symptoms (colonisation) or you may feel unwell and experience symptoms (infection). If your doctor thinks you are showing signs of infection he or she will prescribe a course of antibiotics.
        While you are in hospital the following will apply.
        • You will be cared for in a single room with your own toilet facilities.
        • Staff caring for you will wear personal protective equipment such as gloves and aprons to prevent spreading the bacteria to other patients.
        • It is very important that you wash your hands thoroughly with soap and water after visiting the toilet and before eating (staff will help you if you need them to).
        • It is very important that all healthcare staff and your visitors wash their hands with soap and water before entering and leaving your room.
        • You should avoid touching medical devices such as intravenous drips or catheters (if you have any).
        • You should avoid touching open wounds (if you have any).

        What is the treatment for CRO?

        If you test negative for CRO or are colonised with them, you will not receive any treatment. However, if you develop an infection caused by CRO, you may be given antibiotics to treat it.

        How do you get CRO?

        CRO can sometimes live in the gut of humans, so it can be difficult to say exactly how and where you got them.
        We do know that you are at increased risk of getting CRO if you have been in a hospital abroad, or in a UK hospital which has had patients colonised or infected with these bacteria.

        Are visitors allowed?

        CRO are not a problem for fit and healthy people, so family and friends are still encouraged to visit you.
        The general advice for hospital visitors is as follows.
        • Relatives, friends and other people who are feeling unwell should not visit you.
        • Visitors who have had a recent infection or illness should ask the nursing staff on the ward for advice before visiting.
        • Children and babies can be more vulnerable to infection and so should not visit.
        • Follow the instructions on the room door or from nursing staff before entering the room.
        • Visitors and relatives can still touch you (for example, hold your hands or give you a hug).
        • Visitors must wash their hands well with soap and water before entering and leaving your room to help prevent these bacteria from spreading to other people.

        What happens when I leave hospital?

        • If you are discharged from hospital with CRO, it should not affect you or your family home.
        • Staff from the hospital will tell your GP about your CRO condition when you are discharged from hospital.
        • Hand-washing is very important to prevent these bacteria spreading. So you must wash your hands well with soap and water after going to the toilet and before eating. Any people who are looking after you must also regularly wash their hands well to prevent spreading CRO to other people.
        • Staff caring for you in hospital may wear gloves and aprons when carrying out certain tasks. This is to prevent spreading CRO to other patients they are caring for. When you leave hospital, it is not necessary for your family members to wear aprons and gloves.
        • If you have any invasive medical devices, for example a urinary catheter, you should only touch these if instructed to clean them.
        • You should make sure your toilets and bathrooms are regularly cleaned with your usual household cleaning products.
        • You can continue with leisure and social activities as normal.
        • You should encourage visitors and relatives to wash their hands with soap and water.
        • Crockery, cutlery and so on can be washed as normal.
        • You can wash clothes and bed linen as normal at the hottest temperature suitable for the fabric. If laundry is soiled, it should be washed separately at 60°C. If friends or relatives are helping you with your laundry, it is important that they wash their hands with soap and water after handling the dirty laundry.

        What if I need to go back into hospital or go to hospital as an outpatient?

        If you are admitted back into hospital or go to hospital as an outpatient, it is important that you let the staff caring for you know that you have had a positive test for CRO in the past 12 months. This will make sure that you are tested again and receive the best care to reduce the risk of you developing a CRO infection. It might be helpful to take this leaflet with you to show the clinical team.

        Where can I get more information?

        If you would like more information, please speak to a member of the nursing or medical team caring for you, who may contact the local Infection Prevention and Control Team for you.
        Figure thumbnail fx3
        Figure thumbnail fx4