Infection-Control Measures Reduce Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

Abstract

Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals. To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting. Prospective cohort study. Adult oncology inpatient unit. 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices. Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed. VRE infection rates, VRE colonization rates, and changes in antimicrobial use. During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced. Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.