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CPE Transmission in Hospitals March 30, 2023
CloroxPro CA

CPE Transmission in Hospitals

Carbapenemase-Producing Enterobacteriaceae (CPE) is the collective name for a family of microorganisms that have high levels of resistance to antibiotics.1 CPEs are a major infection control concern for healthcare facilities.2-5 Limiting the spread is essential since only a few last-line antibiotics are effective against antimicrobial resistant organisms (AROs) such as CPE.2,3

CPE can be spread from one person to another by unwashed hands or from contact with soiled equipment and surfaces2 

Current challenges

In Canada, it is estimated that antimicrobial resistance caused 5,400 deaths and cost the healthcare system $1.4 billion in 2018.2 The CDC and the WHO have classified CPE as one of the most urgent antimicrobial-resistance threats due the hard-to-treat or untreatable infections from CPE bacteria that are contracted among patients in medical facilities.6

Colonization of CPE

  • Most people who carry CPE don’t have symptoms, so screening and testing is required to identify those colonized with CPE.4
  • A person with CPE can carry it in their bowels for months to years.4
  • Recent travel and hospitalization abroad are important risk factors of CPE acquistion.7

Direct and indirect transmission

  • CPE can be transmitted by touching contaminated surfaces or from person to person via unclean hands.4
  • A recent study found the presence of CPE in sinks and drains, revealing another potential source of transmission of CPE.8

Limited therapies available

  • Some Enterobacteriaceae are resistant to nearly all antibiotics, including carbapenems, which are often considered the antibiotics of last resort.9

Some options that are active against CPE are often highly toxic with unproven efficacy.3

One third of all patients with CPE in southern Ontario did not have a history of travel abroad in the year prior to their CPE detection – but had a history of exposure to Canadian healthcare.10

What can be done to curb CPE transmission?

Some ways to help curb CPE transmission in healthcare facilities include the following:

Laboratory Testing/Active Screening Programs

  • Screening programs allow hospitals to identify those who were roommates with patients positive for CPE; patients admitted directly from a hospital in another country; patients with a history of hospital admission in another country; and patients who previously tested positive for CPE.2,9 A recent survey found that 73% of hospitals in Ontario reported having a screening program for CPE.2

Routine Practices

  • Routine practices for all clinical care, including the use of hand hygiene, and cleaning/disinfection of all shared equipment, can help to reduce the risk of CPE transmission.9,11

Infection control precautions

  • When CPE are identified, use infection control precautions such as ensuring that people with CPE are in private hospital rooms, dedicated use of equipment where possible, wearing gowns and gloves when caring for them, and washing hands before and after providing care to them.12

Contact Precautions

  • Follow proper contact precautions when putting on and removing gowns and gloves.13

Environmental cleaning and disinfection

  • All horizontal and frequently touched surfaces should be cleaned at least twice daily and when soiled, using hospital-grade cleaners and disinfectants.
  • Follow the terminal cleaning protocol for cleaning the patient’s room following discharge, transfer or discontinuation of contact precautions.9


  • Report cases of CPE to the Infection Prevention and Control as per the healthcare facilities policies and regulations.9

Public Health Ontario can provide Infection Control expertise and support in the event of a CPE outbreak.11

Coordination of infection control measures and surveillance can help to prevent transmission of CPE.10,14

CloroxPro® has a range of products with Health Canada-approved claims against CPE

A number of Clorox Healthcare™ products, including Clorox Healthcare™ Bleach Germicidal Wipes (DIN 02465671),  Clorox Healthcare™ Germicidal Disinfecting Cleaner (DIN 02469278), Clorox Healthcare™ Fuzion® Cleaner Disinfectant (DIN 02459744), Clorox Healthcare™ Hydrogen Peroxide Cleaner Disinfectant  Wipes (DIN 02406225) and Clorox Healthcare™ VersaSure™ Alcohol-Free Cleaner Disinfectant Wipes (DIN 02473151) have proven efficacy against common CPE in up to 2 minutes or less, with some as little as 30 seconds.15

Learn more about the products with claims against CPE in the CloroxPro® portfolio.


  1. CloroxPro® Canada. Carbapenemase-Producing Enterobacteriaceae. Accessed October 13, 2022.
  2. Ontario Agency for Health Protection and Promotion (Public Health Ontario); Institute for Quality Management in Healthcare. Antimicrobial resistance in common hospital pathogens in Ontario: annual laboratory and hospital survey report 2019. Toronto, ON: Queen’s Printer for Ontario; 2021.
  3. Ontario Public Health. Carbapenemase Producing Enterobacteriaceae. Accessed August 10, 2022.
  4. Windsor-Essex County Health Unit. Carbapenemase-producing Enterobacteriaceae (CPE). Accessed August 10, 2022.
  5. Public Health Ontario. Surveillence report: Carbapenemase-producing Enterobacteriaceae in Ontario, May 1, 2018 – April 30, 2019. . Accessed August 10, 2022.
  6. Kohler, Philipp P et al. Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada. Emerging infectious diseases vol. 24,9 (2018): 1674-1682. doi:10.3201/eid2409.180164
  7. Public Health Ontario. Frequently asked questions: Carbapenemase-producing Enterobacteriaceae. Accessed October 13, 2022.
  8. Jamal et al. Carbapenemase-producing Enterobacterales in hospital drains in Southern Ontario, Canada. Journal of Hospital Infection 106(4):820-827.
  9. Government of Canada. Guidance: Infection Prevention and Control Measures for Healthcare Workers in All Healthcare Settings. Accessed August 10, 2022.
  10. Jamal AJ et al. Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae (CPE) in acute-care hospital in Ontario, Canada. Infection Control and Hospital Epidemiology 2019:40:1006-1012.
  11. Ontario Ministry of Health. Carbapenemase-producing Enterobacteriaceae in Ontario, May 1, 2018 – April 30, 2019 Accessed August 10, 2022.
  12. Mayo Clinic. CRE bacteria: What you need to know. Accessed August 10, 2022.
  13. Ontario Public Health. Recommended steps: Putting on Personal Protective Equipment (PPE). . Accessed August 11, 2022.
  14. Canadian Communicable Disease Report. Nosocomial infection surveillance 2020;46(5). Accessed August 10, 2022.
  15. CloroxPro® Canada. Pathogens & Infection Prevention Info: Carbapenemase-producing Enterobacteriaceae (CPE). Accessed August 10, 2022.