Patient call bells awaken Canada to threat of VRE

Patient call bells" used to contact nurses apparently fueled the first nosocomial outbreak of vancomycin-resistant enterococci (VRE) in Canada in 1995, investigators report.

"This outbreak served as a wake-up call to the hospital infection control practitioners in Canada that VRE is here, and we have to be prepared to deal with it," says Lee Lior, MD, a field epidemiologist with Health Canada’s Laboratory Centre for Disease Control (LCDC) in Ottawa, Ontario.

Call bells — push-button plastic bulb devices that are attached to a cord and sit in the patient’s bed — apparently served as an environmental reservoir for VRE, she says. Four patient call bells were found to be VRE-contaminated, as well as bathroom areas and bed rails.

"VRE is very hardy in the environment and survives well on all types of surfaces," Lior says. "The call bell can often be overlooked, and certainly not cleaned with a diligence as other surfaces. Many of these patients had diarrhea or fecal incontinence. Certainly the situation is such that you could have possible easy contamination of the call bell itself."

The outbreak began in the summer of 1995 at the Toronto Hospital, beginning with two patients in a renal ward and spreading to 40 additional patients by mid-November. Of the 42 patients, 41 were colonized and one was infected with VRE. While investigators could not determine through chart review if the outbreak began with a transferred patient, Lior reports patients with VRE were more likely to have had three or more hospital admissions in the past year.

Infection control practices included isolation of identified patients, temporary closure of the affected unit to new admissions, use of gown and gloves at room entry, use of dedicated thermometers and sphygmomanometers and other medical equipment, and additional hand-washing facilities for patients, staff, and visitors. Extensive environmental cleaning was conducted, and cracked or broken call bells were replaced. Recommendations for prudent use of vancomycin and judicious use of antibiotics were reinforced to the medical staff. In the ensuing months, colonized patients were either discharged or reintegrated within the general hospital population, though patients with poor hygiene or diarrhea were isolated. The measures ended the outbreak successfully, Lior says.