VRE foiled by aggressive action

Ostrowsky BE, Trick We, Sohn AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001; 344:1,427-33.

Aggressive infection control measures, including heightened screening and isolation of infected patients, virtually eliminated vancomycin-resistant enterococci (VRE) that was spreading throughout health care facilities in the Midwest.

A model for action

"In an era of emerging antimicrobial resistance when many facilities are abandoning efforts to control transmission, especially of [VRE] and methicillin-resistant Staphylococcus aureus, this comprehensive, communitywide health care effort should be viewed as a model for action," the authors report.

"Our data show that comprehensive efforts to identify and isolate patients who are colonized with [VRE] an reduce the transmission of these strains and even eradicate them," they write.

In late 1996, VRE was detected in the Siouxland region of Iowa, Nebraska, and South Dakota. A task force was created, and in 1997, the assistance of the Centers for Disease Control and Prevention was sought in assessing the prevalence of VRE in the region’s facilities and implementing recommendations for screening, infection control, and education at all 32 health care facilities in the region.

The infection control intervention was evaluated in October 1998 and October 1999. Perianal-swab samples were obtained from 1,954 of 2,196 eligible patients (89%) in 1998 and 1,820 of 2,049 eligible patients (89%) in 1999. The overall prevalence of VRE at 30 facilities that participated in all three years of the study decreased from 2.2% in 1997 to 1.4 % in 1998 and to 0.5% in 1999.

Aggressive screening policies are crucial

The number of facilities that had had at least one patient with VRE declined from 15 in 1997 to 10 in 1998 to five in 1999. At both acute care and long-term care facilities, the risk factors for colonization with VRE were prior hospitalization and treatment with antimicrobial agents.

One of the key interventions was aggressive screening policies, which included screening patients at high risk, such as those undergoing hemodialysis or in intensive care units; screening patients on wards where clusters of colonization of infection with VRE had occurred; and screening all patients before they were discharged to a long-term care facility.