Controlling
the Nosocomial Spread of
Vancomycin-Resistant Enterococcus (VRE) in an Acute Care
Facility
Gayle
H. Dasher, RN, MSN, CCRN
Director of Patient Care Services
Nancy Mendicino, RN, MPh, CIC
Infection Control Coordinator
Christus Santa Rosa Medical Center
Problem
A persistent increase
in suspected nosocomial transmission of VRE was noted. Existing
processes made it difficult for staff to determine if the
appropriate screening measures had occurred.
Evidence
The Infection Control
staff identified nine suspected nosocomial cases during
a 4-month period. This contributed to increased antibiotic
costs for infected patients. Identification of potential
reservoirs needed to be addressed.
Strategy
CSRMC began screening
patients on admission that had been identified as high-risk
for colonization with VRE.
Practice change
Patients identified
as high-risk were screened. "Special Contact care precautions
were initiated. Alerts were placed on the patient door and
chart to facilitate communication. If results were positive,
appropriate isolation procedures were initiated.
Evaluation
After initiating screening
in July, 2002, only 2 VRE-positive patients were identified
for the remainder of 2002. Additional costs (less than
$5.00) have been incurred due to testing, yet this offset
the potential antibiotic costs (approximately $5000).
50-60% of our high-risk patients are positive for VRE.
Recommendations
Increased awareness
has lead to a decrease in VRE transmission. Education
is a continuing issue particularly with regards to proper
screening techniques and identification of patients.
Reference
Arnold, M., Dempsey, J., Fishman, M., McAuley, P., Tibert,
C. & Vallande, N. (2002). The best hospital
practices for controlling methicillin-resistant
Staphylococcus aureus: On the cutting edge. Infection
Control and Hospital Epidemiology, 23(2),
69-76.
Farr, B. & Jarvis, W. (2002). Would active surveillance
cultures help control health-related methicillin-
resistant staphylococcus aureus infections? Infection
Control and Hospital Epidemiology, 23(2),
65-68.
Gaynes, R. (1997). Surveillance of nosocomial infections.
Infection Control and Hospital Epidemiology,
18(7), 6-13.
Rubin, R., Harrington, C., Poon, A., Dietrich, K., Greene,
J. & Moiduddin, A. (1999). The economic impact
of staphylococcus aureus infection in New York
City hospitals. Emerging Infectious Diseases,
5(1), 1-12.
Public health focus: Surveillance, prevention, and control
of nosocomial infections. MMWR Weekly,
41(42), 783-787.
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