Patient Information Sheet

Vancomycin-Resistant Enterococcus (VRE)

Enterococcus is a type of bacteria normally found in everyone’s gastrointestinal tract and sometimes in the vagina of females. Vancomycin resistance means that most antibiotics cannot kill this bacteria. Enterococcus can cause serious infections such as urinary tract infections, wound infections, or even infection of the blood. People who are likely to get vancomycin-resistant Enterococcus are those who:

• are very ill
• have been in the hospital a long time
• have a serious disease which harms the body’s ability to fight infection
• have had many antibiotics (medicine which fights bacteria)

Everyone normally has many different bacteria on their skin and inside their bodies. When bacteria are present and are not causing infection, this is called colonization. There are no symptoms with VRE colonization. VRE can colonize people for months to years. The only way to check for colonization is with a culture. It can be found in a stool culture or by a special cotton swab gently rubbed on the skin outside the rectum. Culture results are usually ready in two to three days.

People who are colonized or infected with VRE can spread it to other people. VRE also can be spread to objects and other surfaces in a room.

Isolation is used to help prevent the spread of this bacteria. At the University of Virginia Health System patients with VRE will be placed on contact precautions, which means:

• patients will have a private room
• visitors must also follow isolation precautions
• all hospital workers and visitors must remove their gowns and gloves, and wash their hands well after leaving the patient’s room
• patients on isolation precautions are asked to stay in their hospital rooms as much as possible. They should NOT go to common areas such as the patient dayroom, cafeteria, gift shop, or nurse’s station.
• for return visits to UVA outpatient clinics or the hospital, isolation precautions will be used until cultures show that the VRE is gone.

There is no "treatment" for getting rid of VRE completely, but it usually gets overgrown by normal bacteria within weeks to months after antibiotic therapy is stopped (one-half of patients become culture negative within two months of stopping antibiotics).

Once VRE patients leave the hospital and go home, they can return to their normal routine including going out in public because many activities in the community involve less risk for transmission and because the risk of VRE infection is low in healthy adults and children. Good handwashing by the patient and household members is necessary. No special cleaning of laundry or dishes is needed because the hot wash cycle reliably kills these bacteria and good soap and water washing of dishes followed by drying removes virtually all risk of spread.

Patients should tell anyone caring for them that they have VRE. This includes home health providers, nurses, therapists, doctor’s offices, and rescue squads.

Before stopping isolation, three cultures in a row must show that the bacteria is gone. These cultures can be done at least one week apart beginning about two months after the last positive culture, and are processed in the epidemiology lab at no charge to the patient. Patients who want to be cultured may contact Infection Control and ask to speak with the outpatient infection control nurse.

Source: University of Virginia Health System, Charlottesville.