When you are back home
Why you may be screened for CPE after hospital treatment abroad, and what it means
A hospital at home may ask where else you have been a patient. Here’s what the named guidelines say about that question, what may follow on admission, and which papers are worth carrying. It is general information, not medical advice.
Guidelines in England, Ireland, Ontario and New South Wales set out admission questions about recent hospital care. England’s and Ireland’s cover a stay in any hospital, at home or abroad, and Ontario’s counts a facility in the United States as outside Canada. A hospital that follows them may have you screened for CPE after hospital treatment abroad, by a rectal swab or a stool sample. CPE stands for carbapenemase-producing Enterobacterales, bacteria that can live in the gut.
Being colonised means the bacteria are present without making you ill. The guidelines treat that as different from infection, while noting that colonisation can lead to infection.
Hospitals apply these texts through their own policies and local risk assessment, so what happens to you may differ. Your own clinician can tell you what applies to you.
Medically reviewed
Reviewed by Dr Gunjan Patel, MBBS, registered with the Gujarat Medical Council (G-65059). Last reviewed 26 September 2026. Reviewed for accuracy only. This page is general information, not advice about your own case, and Dr Gunjan Patel does not diagnose, prescribe or treat.
Why you are asked
The question covers any recent hospital stay, at home or abroad.
The lists are about time spent in hospital, wherever it happened. England’s framework states it for hospital trusts. England’s UKHSA framework (September 2022) says patients likely to stay in hospital overnight who were inpatients in any hospital, in the UK or abroad, in the last 12 months should be strongly considered for screening on admission.
UK Health Security Agency, Framework of actions to contain carbapenemase-producing Enterobacterales, September 2022, section 2.3.1 Checked 2026-09-26.
Each acute trust makes its own risk assessment. We found no later version or withdrawal notice on GOV.UK in September 2026. The list also includes multiple hospital treatments, such as dialysis.
Ireland’s list, further down, is worded the same way, and Ontario’s checklist also asks separately about ordinary stays in any facility.
The texts give their reasons in different words. Someone can carry these bacteria without symptoms, and a carrier can bring them into another hospital. England’s UKHSA framework (September 2022) recommends active screening to minimise transmission from patients who carry CPE, and its patient text says it can be difficult to say when or where a person picked the bacteria up.
UK Health Security Agency, Framework of actions to contain carbapenemase-producing Enterobacterales, September 2022, section 2.2 and Appendix J Checked 2026-09-26.
The bacteria can live harmlessly in the gut. Other aims include reducing the chance that carriers develop infection and helping ensure antibiotics are appropriate.
The wording quoted here asks about a history of hospital care and says nothing about the quality of any hospital. Whether your own stay meets a particular hospital’s trigger is a question for its admitting team.
On admission
Four things a hospital may do, in an order we have put together from the guidelines.
No single guideline sets out these four in this order. Where a text says should or must, that is a line to the hospital, not a promise about you.
A question comes first, as part of the admission process: have you been in hospital lately, at home or abroad, and when? If you are being assessed before an operation, ask whether the same question applies at that visit.
A sample may follow, if your history matches the hospital’s policy. England’s UKHSA framework (September 2022) names a rectal swab, taken by gently inserting a swab into the rectum, as the most sensitive specimen for detecting carriage, with a stool specimen if a swab is not feasible or acceptable. Consent wording differs between the texts. Ireland’s HSE guidance (version 1.1, 29 September 2025) says CPE testing is performed on the basis that people are entitled to decline, and that verbal consent for a rectal swab should be obtained beforehand. Scotland’s toolkit and the New South Wales guideline, quoted further down, word it differently, and the England, Ontario and CDC texts we read give none. Ask the clinician taking the sample what applies at your hospital.
UK Health Security Agency, Framework of actions to contain carbapenemase-producing Enterobacterales, September 2022, section 2.5 Checked 2026-09-26.
It adds a wound swab or, if catheterised, a urine sample. Guidance for hospitals, not a description of what any one patient is asked to do.
Guideline text for hospitals in Ireland, not advice to any patient and not a statement of the law. Ask your own clinician what applies in your hospital.
Precautions may apply while a result is awaited, and a single room is only one of them. England’s UKHSA framework (September 2022) describes pre-emptive isolation while a result is awaited as usually not feasible for lack of single rooms, and says standard and contact precautions should be used in a shared bay when none is free.
UK Health Security Agency, Framework of actions to contain carbapenemase-producing Enterobacterales, September 2022, page 15 and section 4.4 Checked 2026-09-26.
Local risk assessment decides who has priority for a single room, and screened inpatients should be in a single room with en-suite facilities where possible.
A note may go on your record. England’s UKHSA framework (September 2022) says CPE status, positive or negative, should be recorded on the discharge summary or transfer documents if a patient was screened during their admission.
UK Health Security Agency, Framework of actions to contain carbapenemase-producing Enterobacterales, September 2022, Box 1 on page 12 and page 15 Checked 2026-09-26.
This is what a hospital records, not what a patient should bring.
If a result comes back positive
Colonised is the guidelines’ word for carrying bacteria without being ill.
This page describes what the texts say, and what any one result means for you is a question for your own clinician. England’s framework gives the definition and keeps a qualifier beside it. England’s UKHSA framework (September 2022) defines colonisation as micro-organisms living harmlessly on the skin or in the bowel with no signs or symptoms of infection, and says colonisation usually precedes infection and increases the risk of developing infection.
Ireland’s guidance draws the same line and says what follows for treatment. Ireland’s HSE guidance (version 1.1, 29 September 2025) says a colonised person is not infected but may later develop infection, and that people colonised with no clinical evidence of infection should in general not be treated with antibiotics.
It also says the organism may spread to others, and that knowing the result may help choose antibiotic treatment if serious infection develops.
For life at home after a positive result, England’s framework includes model text that hospitals can adapt. England’s UKHSA model patient text (Appendix J, September 2022) says a person may still carry CPE at home, that this quite often goes away with time, and that no special measures or treatment are required at home.
UK Health Security Agency, Framework of actions to contain carbapenemase-producing Enterobacterales, September 2022, Appendix J Checked 2026-09-26.
A template for hospitals to adapt, aimed at patients who have tested positive, not a UKHSA leaflet. It says a patient can ask for a letter or card recording the result, and that carriage may last from a few days to indefinitely.
The guidelines, place by place
Where each text draws its line, and how firmly it is worded.
Each entry gives its own verb. England’s and the CDC’s advise, Ireland’s and New South Wales’s say must for parts of what they cover, Scotland’s calls screening mandatory, and Ontario’s gives instructions. Each hospital still applies them through its own policy and risk assessment.
MRSA is a separate question in England, with separate guidance. We found no overseas trigger in England’s 2014 national MRSA screening guidance, which recommends screening patients admitted to high-risk specialties, including orthopaedics and trauma, and patients previously found to have MRSA. A later guide for operations supplements it. NHS England’s GIRFT guide to preoperative MRSA screening (May 2025) says patients on an elective surgical pathway should be screened for surgery in a high-risk specialty, surgery that inserts prosthetic material, or higher risk of carriage, with examples of higher risk including recently admitted to hospital within the last year. That wording names no country, so a stay in hospital abroad within the last year could meet it, although the guide does not mention abroad. An operation in a high-risk specialty, or one that inserts prosthetic material, may lead to a swab whatever your history.
We read all 35 pages and searched for abroad, overseas, travel and similar wording, with no match. GOV.UK shows no later change or withdrawal notice. This is a finding about one document, and local policies may differ.
It names no country and has no abroad or overseas wording, so it does not say whether a stay abroad counts. It supplements the 2014 guidance, and a local team may decide a low-risk procedure needs no screening.
Scotland words it more firmly. Scotland’s CPE toolkit (version 1.4, June 2022) lists, for the 12 months before admission, an inpatient stay in a hospital outside Scotland, which takes in England, or holiday dialysis outside Scotland, as a risk factor for a suspected case. In that text a suspected case is identified by history alone, not by symptoms.
It says a suspected case should be immediately isolated in a single room while samples are tested, describes screening in Scotland’s NHS boards as a mandatory policy requirement, and says consent should be sought first and patients are free to decline. We did not confirm whether a newer version exists.
For Ireland, the guidance puts a duty on hospitals. Ireland’s HSE guidance (version 1.1, 29 September 2025) says facilities must adopt targeted or universal admission screening for CPE, guided by local risk assessment, and lists among its risk criteria for the last 12 months a stay in any hospital in Ireland or abroad and treatments or procedures at a hospital or clinic abroad. The consent wording is in the second step above.
The guidance says Table 1 was adapted from England’s UKHSA framework. Comparing the two lists, the clinic treatments and procedures abroad are Ireland’s addition, which is our comparison. It covers CPE only.
Ontario’s is the only text we read that puts MRSA (meticillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococci) on the same overseas question. Public Health Ontario’s checklist (June 2024) asks about time in a health care facility outside Canada, including the United States, in the previous 12 months, and for a yes says to start contact precautions in a private room and test for MRSA, VRE and CPE. The national CPE guidance sits alongside it. Canada’s national CPE guidance (June 2026) lists hospitalisation outside Canada within the past 12 months first among its key risk factors for screening, and says its measures should not be regarded as rigid standards.
Public Health Ontario, Antibiotic Resistant Organism (ARO) Risk Factor-Based Screening Guidance for All Health Care Settings: Screening Checklists, published June 2024 Checked 2026-09-26.
Ontario guidance, not national. It also asks about any admission or stay of more than 12 hours in any facility, has a section on Candida auris, and says its use is the responsibility of the user.
Public Health Agency of Canada, Carbapenemase-producing Enterobacterales (CPE) infection prevention and control in Canadian healthcare settings, published June 2026 Checked 2026-09-26.
It recommends rectal screening at admission assessment for patients with a risk factor, and does not supersede provincial, territorial or local policy.
We read one state guideline for Australia, so other states may differ. NSW Health’s guideline GL2025_010 (26 June 2025) tells NSW Health organisations that the in-patient admission process must include questions to identify patients needing screening, sends a patient who had care in a health care or aged care facility outside Australia in the last 12 months to CPE screening, and says screening should be discussed with the patient.
NSW guidance, not national. Discussed with is not consent or a right to decline, and the guideline gives no consent wording for adults.
The CDC pages we read advise health care facilities in the United States, and we found no national requirement. We did not read state or hospital policies, so what a US hospital does depends on the hospital. CDC’s page on preventing multidrug-resistant organisms (reviewed April 2024) advises health care facilities to ask patients at admission about recent hospitalisation or procedures outside the U.S. and to screen those with that history, and advises everyone to tell their provider about recent health care in another country. CDC’s carbapenem-resistant Enterobacterales page for healthcare providers (December 2025) advises assessing patients at admission for overnight hospitalisation or an invasive procedure in another country in the last 6 months, and says those with that history should be screened and placed in pre-emptive isolation.
US Centers for Disease Control and Prevention, Preventing MDROs: What Can Be Done, page last reviewed 15 April 2024 Checked 2026-09-26.
It names carbapenemase-producing organisms and Candida auris and gives no look-back period. We read an archived copy from 6 August 2026 and matched it to the live page through a summarising tool, because cdc.gov refused our automated requests.
US Centers for Disease Control and Prevention, Carbapenem-resistant Enterobacterales (CRE) Infection Control, page last updated 17 December 2025 Checked 2026-09-26.
The other CDC page gives no look-back period, and most other texts here use 12 months, so the periods are not merged. Read from the same archived copy and matched through a summarising tool.
For the UAE we have a gap to state. No text found on admission screening after hospital care abroad in the Abu Dhabi and Dubai health authority material we read, and we did not read federal Ministry of Health and Prevention material for this question. A hospital there may still have its own policy.
Absence noted after reading Abu Dhabi and Dubai health authority infection control material and searching for federal Ministry of Health and Prevention guidance, September 2026 Checked 2026-09-26.
Absence from our search is not proof that no policy exists, and a hospital may set one that is not public. Abu Dhabi’s 2007 infection control policy, revised 2009, requires each facility to have an infection control programme.
What we did not read: other Canadian provinces and Australian states, US state and hospital policies, any current national text for Wales or Northern Ireland, and any individual hospital’s own policy. Several of the texts above are some years old, and a newer edition may exist.
Papers
Documents worth having in your hand when you are admitted.
This list is ours, and none of the guidelines we read lists papers for a patient to bring after care abroad.
- The discharge summary from the overseas hospital
- The operative note, if you had an operation
- Implant details, such as the make and model of a joint or a device
- A medicines list, showing what you were given in hospital and what you were sent home with
- The dates you were in hospital, and the country
- Any culture or screening result the overseas hospital gave you
- One plain sentence, on paper or on your phone, saying where and when you were in hospital
The nearest the texts come is England’s model patient text, which mentions a letter or card recording a positive result, and the CDC page, which asks you to tell your provider about care abroad. Ask your own clinician what your hospital wants. The medicines list above raises a border question of its own, which the rules on carrying medicines to India and bringing them home takes country by country.
Dates matter because most of the texts on this page count back a fixed number of months, and the number differs between them. If you are unsure whether a sample was taken abroad, the overseas hospital is the place to ask, ideally before you leave it, while its team can still be reached.
About the handover pack
What we do with papers, and what we leave to your clinicians.
For people who go ahead with full case management, the ninety days of care coordination already deal in documents. Before you fly, we build a written handover for your own doctor: what was done, what was implanted or used, what to watch for and who to contact. The ninety days of aftercare are part of full case management.
The limits, stated plainly. We do not test anyone, we do not interpret a result and we do not advise you on one. What a result means for you stays with your own clinicians. We do not diagnose, prescribe or treat. The handover pack does not currently include microbiology or antibiotic records, so a culture or screening result is something to ask the overseas hospital for. We can help you work out who to ask and what to hand your own doctor. If you arranged your care another way, we cannot build a handover afterwards, and we do not sell the ninety days on their own.
If you are still planning care, the free 30 minute consultation is where to ask what a handover would hold for your case and what it would leave out. It takes thirty minutes, carries no obligation, and we say plainly whether we are the right people for you.
Questions
What people ask when a hospital asks about their stay abroad.
Is this the same as an MRSA swab?
Not as a rule of its own. We found no overseas trigger in England’s 2014 national MRSA guidance. A May 2025 NHS England guide for operations lists a hospital admission within the last year, without naming a country, among its examples of higher risk. Ontario’s checklist puts MRSA, VRE and CPE on the same question about care outside Canada. If a nurse mentions a swab, ask which organism it is for.
What if a discharge summary is all I brought home?
None of the guidelines we read lists papers for a patient to bring after care abroad, so we cannot say what your hospital will want. Bring the summary with the country and dates written beside it, and tell your own hospital what you could not get.
Does being asked say something about the hospital or country where I was treated?
The wording quoted on this page does not say so. It asks about a history of hospital care, and England’s and Ireland’s lists put a stay at home on the same line as a stay abroad. What a hospital does with your answer is its own decision, by local risk assessment.
Ask what a handover would hold, and what it would leave out.
If you are still planning care, the free 30 minute consultation is where to ask that. Once you are home, the aftercare page says the ninety days cannot be bought on their own, and the guide to what happens if something goes wrong says we can help you work out who to contact and what to hand them. We cannot tell you what your own hospital will do. Please do not send records or scans until we have spoken.