Vre Disease


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Vre Disease

Vre Disease

To reduce rates of VRE colonization/disease, Investigators from Austin Health in Melbourne, Australia and the University of Melbourne introduced a multimodal hospital-wide bleach-based cleaning program (BBCP) that included a new product (sodium hypochlorite 1000ppm detergent), new standardized (routine and detailed) cleaning practices and modified glove/gown protocols to rely on alcohol-based handrub and sleeveless aprons. Rates of VRE pre- and post-BBCP were compared.

Grayson, et al. report that patients in four high-risk wards (liver transplant, renal, ICU, hem/oncology) were screened on admission and weekly for rectal VRE colonization, and rates were compared pre-BBCP (Period A [6 mo] – Feb-July 2009) vs post-BBCP (Period B1 & B2 – Feb-July and Aug-Jan 2010/11). Rates of VRE bacteremia (per 100 patients blood cultured [100PBC]) and of urinary tract infection [UTI] were compared - Period A vs B1 & B2.

A 37 percent reduction in newly recognized VRE colonizations was observed post-BBCP (208/1,948 patients screened [Period A] vs. 181/2,129 [Period B1] vs. 143/2,141 [Period B2], p<0.0001), despite an increase in screening compliance (68.1% vs 74.6% vs 71.9%, p=0.061) and a stable rate of on-admission VRE colonization (38/1.461 [2.6%] vs. 44/1795 [2.5%] vs. 38/1,840 [2.1%], p=0.34). VRE bacteremia declined from 0.48/100PBC (14/2935) pre-BBCP to 0.08/100PBC (5/6194) during the 12-month post- BBCP (p=0.0002), with a reduction in UTI cases (24 [A] vs 19 [B1] vs. 17 [B2]).

The researchers conclude that BBCP was associated with a significant reduction in rates of both new VRE colonizations (37 percent decrease) and VRE disease. This approach potentially represents a new paradigm in the management of VRE. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland, June 29 through July 2, 2011.

Reference: ML Grayson, AA Mahony, EA Grabsch, DR Cameron, RD Martin, M Heland, M Petty and S Xie. Marked reductions in rates of vancomycin-resistant enterococci (VRE) colonization & disease associated with introduction of a routine hospital-wide bleach cleaning program. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6).

If the infection is associated with an invasive line, such as a Foley catheter or a PICC line, the line is often taken out to remove the source of infection.

Hand Hygiene is Key to Preventing Hospital Acquired Infections

As with all nosocomial infections (also known as hospital acquired infections or healthcare associated infections), consistent hand washing by healthcare workers, visitors, and patients is the single most important act of prevention.

Hands should be washed:

  • with soap and water
  • before and after gloves are donned
  • thoroughly for 20 seconds

The CDC states that alcohol-based hand sanitizers that have at least 60% alcohol are just as effective as washing with soap and water unless the hands are visibly soiled. Also, alcohol-based sanitizers are not effective for certain bacteria that form resilient spores, like C. diff.

Other Ways to Prevent VRE Infection

In addition to hand hygiene, maintaining cleanliness at bacterial points of entry is also vital.

  • It is very important for women to always wipe front to back after urinating. This decreases the chance that bacteria will be introduced into the urethra.
  • Decrease the amount of invasive lines. Remove Foley catheters, PICC lines, and IVs as soon as safely possible. Until then, keep the insertion sites as clean as possible. Perineal hygiene is especially important for people with Foley catheters.
  • Keep wounds and incisions clean.

References

Information for the Public About VRE

Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory

CDC.gov, "Put Your Hands Together" (accessed January 12, 2010)

Young-Bem Se, M.D., Hyoung-Joon Chun, M.D., et al. (2009). Incidence and risk factors of infection caused by vancomycin-resistant enterococcus colonization in neurosurgical intensive care unit patients. Journal of Korean Neurosurgical Society,46 (2), 123-129.

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