A Multipronged Approach to Vancomycin-Resistant Enterococcus Control in an Acute-Care Setting

Abstract

BACKGROUND: Between March 1998 and October 1998, an increase in nosocomial vancomycin-resistant Enterococcus (VRE) was seen (1.80–1.98/1,000 patient days). During that time education was provided to physicians and patient-care staff regarding early detection of VRE and transmission prevention. The VRE rate did not decrease; therefore a comprehensive program was developed. METHODS: Initial interventions were targeted at ensuring that all VRE policies/procedures were in place and closely adhered to by staff. Efforts also included increased use of barrier precautions for known VRE and high-risk patients. Further analysis of data revealed that most VRE was isolated from urinary tract infections (UTIs) and from stool cultures. Endoscopes were cultured to rule out cross contamination (all cultures were negative). A silver-alloy/hydrogel–coated Foley catheter was evaluated in an effort to reduce UTIs. The final measures instituted were active culture screening, annual education on VRE policies/procedures, and provision of waterless hand foam at each door in patient-care areas. RESULTS: Use of silver-alloy–coated Foley catheters resulted in a 52% decrease in catheter-associated UTIs and a drop on the VRE rate to 0.0–0.87/1,000 patient days. Multivariate regression analysis revealed 84% of the variance in VRE transmission rates can be explained by the introduction of silver-coated urinary catheters, waterless hand foam, and active patient screening. VRE rates have remained constant at 0.0/1,000 patient days with only one exception since August 2000. CONCLUSION: While compliance with established procedures is important, we found that a more aggressive, multipronged approach to control and prevent VRE was the only way to significantly reduce our infection rate.