# 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

## TL;DR

This study examines how standard precautions and allowing free movement of CPE carriers affects the spread of CPE in a Singapore nursing home.

## Contribution

The study provides evidence that standard precautions may be sufficient to control CPE transmission in nursing homes.

## Key findings

- Only one resident acquired CPE during the study period.
- Environmental sampling found CPE in sink strainers but not in shower drain traps.
- Whole genomic sequencing found no bacterial or plasmid linkage between residents or the environment.

## Abstract

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

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

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.

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.

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.

The online version contains supplementary material available at 10.1186/s13756-025-01554-1.