FUNCTION:  Surveillance, Prevention, Control of Infection

 

TITLE:  Vancomycin Resistant Enterococcus

_________________________________________________________________

 

PURPOSE:

 

To identify the control measures needed to prevent the spread of vancomycin

resistance due to VRE.

 

POLICY:

 

Definitions:

 

VRE: Vancomycin-Resistant Enterococci.  This organism has been reported by

the CDC to be significantly increasing in the U.S.  The CDC has identified

the serious risks from the spread of the microorganism due to limited

efficiency of treatment options and the possibility for the transfer of the

vancomycin-resistance to other microorganisms.

 

Colonization: Presence of VRE on tissue without patient symptoms or

clinical manifestations of illness or infection.

 

Infection: Invasion and multiplication of VRE in tissue with the

manifestation of clinical symptoms of infection such as increased white

blood cell count, fever, lesions, boils, and erythema.

 

1.   The laboratory will promptly report all newly identified confirmed and

     presumptive cases of VRE to the:

 

     a)   nursing unit if patient is still hospitalized (nursing staff

          will notify patient's physician)

     b)   patient's physician if patient has been discharged.

     c)   Infection Control Coordinator.

 

2.   The nursing unit will promptly notify the Infection Control Coordinator

     of all cases of VRE reported by the transferring hospital, the patient's

     physician, etc., which were cultured/identified prior to admission.

 

3.   The nursing unit will promptly initiate and maintain isolation

     precautions for all cases of VRE infection or colonization to include the

     following precautions:

 

     a)   private room

     b)   isolation supplies obtained (from C.S.) and stored in anteroom or

          cart outside the patient's room (if ante-room is not available,

          obtain isolation cart from C.S.)

     c)   signage on door - "sign B" according to hospital isolation policy

     d)   gloves and gowns put on before entering room and removed before

          leaving room

     e)   masks worn if VRE is found in respiratory system

     f)   gloves changed after any contact with patient's feces and all other

          infected body fluids.

     g)   wash hands with antiseptic soap after removal of gloves.

     h)   after removal of gowns and gloves and hand washing is completed,

          ensure that clothing and hands do not contact potentially

          contaminated items in patient's room.

     i)   dedicate the use of all patient care equipment whenever possible to

          the patient with VRE or the VRE cohort (e.g.  stethoscope,

          sphygomomanometer, thermometer, etc.).  All patient care items must

          be thoroughly disinfected with a hospital approved disinfectant

          before use by another patient.  Items must be bagged or throughly

          disinfected before leaving the patient's room.

 

4.   If the VRE patient had been in a semi-private room prior to

     identification of the VRE contact the Infection Control Coordinator

     promptly.

 

5.   The Infection Control Coordinator will request stool cultures or rectal

     swabs of all roommates of patients who are newly found to be infected or

     colonized with VRE.  If the roommates cannot be cultured, then isolation

     precautions for VRE will be initiated/maintained for the exposed

     roommates for the remainder of their hospitalization.

  

6.   Patients with VRE colonization or infection will remain in isolation

     until three cultures collected 5-7 days apart are free of VRE from the

     following sites:

 

     a)   stool or rectal swab;

     b)   open wounds, foley catheters, and/or colostomy sites if present; and

     c)   perineal area, axilla or umbilicus if clinically infected (having

          signs of infection).

 

7.   Notify any receiving agencies of the need for consistent hand washing and

     the appropriate use of gowns and gloves.

 

8.   Upon patient discharge or transfer to another room, notify housekeeping

     supervisor to ensure special room cleaning to include all potentially

     contaminated areas (e.g. door knobs, pulls on curtains/blinds, light

     switches, etc.) in addition to routine cleaning.