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What is a preoperative assessment?

If your Consultant has recommended surgery, the preoperative assessment lets us check your fitness for anaesthetic and for your procedure. It also identifies any special needs you might have.

You’ll be contacted by our Surgical Bookings team to book your preoperative assessment as soon as an appointment is available. Once agreed, an appointment confirmation will be sent to you.

Nursing staff in outpatients at Benenden Hospital

What happens during my preoperative assessment?

You’ll meet a member of the nursing team who’ll carry out any tests you need. Depending on your procedure, you may have also been booked in for an anaesthetic review on the same day or this may be requested during your preoperative assessment.

I have a question about my preoperative assessment

What should I bring to my preoperative assessment?

Please bring your completed health screening questionnaire to your preoperative assessment.

If you’ve ever had any tests or scans relating to cardiology, nephrology (renal medicine), neurology, endocrinology, haematology or respiratory medicine, you should bring details of these with you to your appointment. This should include copies of any letters, test results or reports that you have.

You should also bring details of any prescription medicines that you’re taking, either a copy of your green (GP) repeat prescription form or the actual medicines in their original packets. 

It’s very important that you bring this information with you as we’ll use it to make sure that it’s safe for you to have surgery and anaesthesia.

I have a question about Section 20 of the health screening questionnaire

Section 20 refers to colonisation or infected with Carbapenemase – producing Enterobacteriacaea or CPE. The guide below will help you to complete this part of the form.

What does 'carbapenemase – producing Enterobacteriaceae' mean?

Enterobacteriaceae are bacteria that usually live harmlessly in the gut of humans. This is called ‘colonisation’ (a person is said to be a ‘carrier’). However, if the bacteria get into the wrong place, such as the bladder or bloodstream they can cause infection. Carbapenems are one of the most powerful types of antibiotics. Carbapenemases are enzymes (chemicals), made by some strains of these bacteria, which allow them to destroy carbapenem antibiotics and so the bacteria are said to be resistant to the antibiotics.

Why does carbapenem resistance matter?

Carbapenem antibiotics can only be given in hospital directly into the bloodstream. Until now, doctors have relied on them to successfully treat certain ‘difficult’ infections when other antibiotics have failed to do so. In a hospital, where there are many vulnerable patients, spread of resistant bacteria can cause problems.

If a person is a carrier of carbapenem-resistant Enterobacteriaceae, they do not need to be treated. However, if the bacteria have caused an infection then antibiotics will be required.

How will I know if I am at risk of being a carrier or having an infection?

Your doctor or nurse may suspect you are a carrier if you have been in a hospital abroad, or in a UK hospital that has had patients carrying these bacteria, or if you have been in contact with a carrier elsewhere. If any of these apply to you, screening will be arranged for you and you will be accommodated in a single room with your own toilet facilities at least until the results are known.

How will I be screened for Carbapenemase-producing Enterobacteriaceae?

Screening usually entails taking a rectal swab by inserting it just inside your rectum (bottom). Alternatively, you may be asked to provide a sample of faeces. The sample will be sent to the laboratory and you will normally be informed of the result within 2 – 3 days. If the result is negative, the doctors may wish to check that a further 2 samples are negative. If all results are negative no further actions are required.

Advice for patients who have a positive result

What happens if the result is positive?

If the result is positive, do ask your doctor or nurse to explain this to you in more detail. You will be accommodated in a single room whilst in hospital. If you have an infection, you will need to have antibiotics. However, if there are no signs of infection and you are simply ‘carrying’ the bacteria, no treatment is required.

How can the spread of carbapenemase-producing Enterobacteriaceae be prevented?

Accommodating you in a single room helps to prevent spread of the bacteria. Healthcare workers should clean their hands regularly. They will use gloves and aprons when caring for you. The most important measure for you to take is to wash your hands well with soap and water, especially after going to the toilet. You should avoid touching medical devices (if you have any) such as your urinary catheter tube and your intravenous drip, particularly at the point where it is inserted into the body or skin. Visitors will be asked to clean their hands on entering and leaving the room.

What about when I go home?

Whilst there is a chance that you may still be a carrier when you go home quite often this will go away with time. No special measures or treatment are required; any infection will have been treated prior to your discharge. You should carry on as normal, maintaining good hand hygiene. If you have any concerns you may wish to contact your GP for advice.

Before you leave hospital, you will be given a letter or a card, advising that you have had an infection or have been/are colonised with carbapenemase-producing Enterobacteriaceae. This will be useful for the future and it is important that you make health care staff aware of it. Should you or a member of your household be admitted to hospital, you should let the hospital staff know that you are or have been a carrier and show them the letter/card.

Where can I find more information?

If you would like any further information please speak to a member of your care staff, who may also contact the Infection Prevention and Control Team for you. The Public Health England website is another source of information.

When will I know the results of my preoperative assessment?

The Preoperative Assessment office will notify the clinical teams if there are any issues. They’ll only be in contact with you if there’s a problem.

What happens after my preoperative assessment?

The Preoperative Assessment team will liaise with your GP, Consultant and the Surgical Bookings team to ensure that it’s safe for you to have your procedure. How long you have to wait will depend on theatre and Consultant availability. Our team will contact you by phone as soon as they can.