Stool management techniques prevent VRE

James F. Marx, RN, MS, CIC, an infection control consultant based in San Diego, makes these recommendations to long-term care facilities concerning stool management in patients with vancomycin-resistant enterococci (VRE):

Rectal thermometers: Avoid the use of electronic rectal thermometers, if possible. Dedicate one electronic thermometer for rectal use only and ensure it is disinfected between uses. Outbreaks of VRE have been linked to probes. Use glass thermometers that have been cleaned and disinfected between uses or use a tympanic thermometer.

Cleaning the bedpan/commode: Establish a regular cleaning schedule. The bedpan should be disinfected after each bowel movement.

Brief (diaper) use and disposal: For disposable diapers, place them in plastic bags, not on the floor, bedstand, or bed. Dispose of plastic bags in regular waste containers. For reusable diapers, consider using disposables. If they are reused, rinse diapers only in an area designated for that purpose. Never rinse them in a semiprivate sink, toilet, or bathtub.

Incontinence management: Initiate a bowel/bladder program according to facility policy. Use barriers (gloves and gowns) when appropriate. Hand washing after glove removal is required.

"Accidents" in the hallway: Provide prompt cleanup with an appropriate disinfectant that is approved by the U.S. Environmental Protection Agency (EPA).

Behaviors that involve stool: Treat them as inappropriate. Facilities may need to segregate residents by using a private room and restricting group activities and dining.

Bowel diversion: Empty colostomy bags in the toilet. Do not rinse them in the sink. Bags should not be rinsed in semiprivate bathrooms.

Use of barriers: Use according to standard precautions.

Selection of soap: Use antibacterial soap in rooms with residents identified with enteric pathogens or poor hygiene.

Selection of disinfectant: Use an EPA-approved disinfectant that is effective against VRE. Clostridium difficile may require stabilized chlorine solution.

Laundry and waste: Contain stool and other body fluids in a plastic bag. Use red bags only if fluid blood is visible.

Room cleaning: Routine cleaning procedures are adequate. Use recommended disinfectant.

Visitors: Provide education about barrier protection to health care workers. Use barriers for direct care activities. Reinforce hand washing.

Rectal procedures and medications: Single-use disposable gloves and hand washing after procedures are necessary.

Activities and dining: Allow regular socialization and dining, provided the resident has good hygiene.