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Abstract
BACKGROUND/OBJECTIVES: The Special Care Nursery (SCN) notified Infection Control that two infants who had been transferred to a children's hospital were positive for Vancomycin-Resistant Enterococcus (VRE) upon admission screening. Active surveillance for enteric VRE was performed on the remaining SCN infants at our facility. METHODS: All infants in the SCN had stool sent for VRE culture. Observations were conducted to assess infection control practices. A multidisciplinary team was formed consisting of the Infection Control Practitioners, Medical Director of Infection Control, Chief Medical Officer, Medical Director of SCN, SCN nurse manager, SCN clinical nurse educator, Director of Women and Infant's Services, Housekeeping and Microbiology. Interventions consisted of immediate implementation of contact precautions, enhanced hand hygiene practices, cohorting of infants and nursing staff, and extensive cleaning of the SCN. Parents of VRE positive infants entered and left the SCN cohort area through a separate door. Education was provided to nursing staff, physicians and parents of SCN infants regarding modes of VRE transmission and means of prevention, hand hygiene, environmental contributions to VRE transmission, environmental cleanliness and cohorting measures. New admissions were geographically cohorted to a separate ancillary nursery until all VRE positive infants had been discharged home. RESULTS: Eight of the eleven (11) remaining SCN infants were positive for VRE by stool culture for a total of 10/13 (77%) VRE positive infants. After the interventions were implemented, no new cases of VRE were identified. Since the cluster, one hundred twelve (112) infants have been screened weekly during SCN admission and upon discharge home. To date, eighty-five (85) infants have been screened with at least one (1) stool culture, seventeen (17) received two (2) screens and ten (10) received three (3) screens. All screens have been negative for a statistically significant decrease in proportion of infants colonized with VRE admitted after the intervention (10/13 versus 0/112; p CONCLUSIONS: A multidisciplinary intervention consisting of active surveillance screening, cohorting, contact precautions, environmental cleaning and education resulted in rapidly abating this outbreak.
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