Infection control methods used to stall VRE spread
Clearly indicate status of patient on transfer
The following infection control measures were recommended to control the transmission of vancomycin-resistant enterococci in acute care facilities as part of a program implemented by a VRE task force in the Siouxland Health District. The recommendations for VRE-positive patients are summarized as follows:
Room assignment: Private room, when possible. Cohort with other VRE-positive patients if private room not available. May share a room with a VRE-negative roommate if appropriate criteria are met. [See box, p. 120.]
Barrier precautions: Place isolation supply cart outside of patient’s room whenever possible. Use clean, nonsterile gloves for direct patient care and contact with frequently touched surfaces. Use clean, nonsterile, impervious gown if substantial contact with patient or environment is anticipated, or if patient is incontinent or has diarrhea or uncontained drainage of body fluids.
Hand washing: Hand washing is crucial. Employees should wash hands with antimicrobial soap or waterless antiseptic gel for at least 15 seconds (30 seconds preferred), even after glove removal. Instruct patients to wash hands with antimicrobial soap after using the toilet, before eating, and before leaving the room. Verify patient’s ability to wash hands. If hand washing is inadequate, patient should use waterless antiseptic gel after washing hands. Visitors should be encouraged to wash their hands with an antimicrobial soap upon leaving the room.
Care of equipment: Non-disposable: Dedicate non-critical items (i.e., stethoscope, blood pressure cuff, thermometer) whenever possible. All items must be disinfected if reused for other patients. Disposable items soiled with body fluids (dressings, diapers, used gloves) should be tied in a plastic bag before being placed in the trash per institution protocol. Environmental surfaces should be clean and disinfected.
Transfer outside facility: The known VRE status of patient will be indicated verbally and written on transfer sheet. Facilities should establish a system for highlighting the records of infected or colonized patients in order to promptly identify and initiate precautions.
Screening: VRE screening on admission is recommended for patients transferred from acute care facilities outside the community. VRE screening on discharge is not recommended for patients dismissed to long-term care facilities who have been in acute care less than 72 hours and have not received antibiotic therapy. Patients screened before discharge and whose results are not final could be transferred to long-term care prior to final results.
Termination of precautions/isolation: Optimal requirements for termination are unknown. Patient should have VRE-negative results on at least three consecutive occasions (greater than one week apart). Cultures from multiple body sites suggested as criteria for removing patients from precautions include stool or rectal swabs, perineal area, axilla, umbilical, wound, foley catheter, and/or colostomy sites. Change in health status, administration of antibiotics, or signs and symptoms of infection may warrant re-establishing precautions.
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