SHEA guidelines address education, surveillance

The recommendations of the Society of Hospital Epidemiology of America (SHEA) regarding reducing vancomycin-resistant enterococci (VRE) in long-term-care (LTC) facilities are summarized as follows: 1

o Employee education about basic infection control and VRE is essential to any effort to control resistant organisms. Particular emphasis on the importance of colonization and the role of the environment is needed.

o Surveillance cultures of rectal swabs and wounds for VRE may be appropriate if an outbreak of infection appears to be under way. Otherwise, surveillance cultures are unlikely to be cost-effective and are not recommended.

o When a patient who is infected or colonized with VRE is transferred to an LTC facility from an acute-care facility, information on the VRE should be provided to the receiving institution.

o Recommendations for isolation in LTC for patients colonized or infected with VRE are:

• A private room should be given, if possible. If patients must share rooms, it is acceptable to place with another patient a VRE patient who is continent of stool, has no diarrhea, and doesn’t have an open wound infect ed or colonized with VRE.

• Gloves are required before contact with colonized or infected patients, their secretions, or the inanimate environment in the room.

• Gowns are required if it is expected that the health care worker’s clothing will have material contact with patients, the patients’ secretions, or with environmental surfaces.

• Patients transport should be limited to situations required for medical care and precautions continued while patients are outside their rooms.

• Patient care equipment should be dedicated, if possible, to a single patient, or cleaned and disinfected between patients.

• Vancomycin use should be prudent, and regular monitoring of antibiotic use is appropriate in LTC facilities.

Reference

1. Society for Healthcare Epidemiology of America Committee on Long-Term Care. Vancomycin-resistant enterococci in long-term-care facilities. Infect Control Hosp Epidemiol 1998; 19:521-525.