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Control of Transmission of Vancomycin-Resistant Enterococcus faecium in a Long-Term–Care Facility

Published online by Cambridge University Press:  02 January 2015

Maxine Armstrong-Evans ,
Margaret Litt ,
Margaret A. McArthur ,
Barbara Willey ,
Darlene Cann ,
Susan Liska ,
Sidney Nusinowitz ,
Richard Gould ,
Anna Blacklock  and
Donald E. Low
...Show all authors
Maxine Armstrong-Evans
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
Margaret Litt
Affiliation:
Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada
Margaret A. McArthur
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
Barbara Willey
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
Darlene Cann
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
Susan Liska
Affiliation:
Barton Place Nursing Home, Toronto, Ontario, Canada
Sidney Nusinowitz
Affiliation:
Barton Place Nursing Home, Toronto, Ontario, Canada Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
Richard Gould
Affiliation:
City of Toronto Public Health Department, Toronto, Ontario, Canada
Anna Blacklock
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
Donald E. Low
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
Allison McGeer*
Affiliation:
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ottawa, Ontario, Canada
*
Room 1460, Department of Microbiology, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5
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Abstract

Objectives:

To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting.

Outbreak Investigation:

A strain of vancomycin-resistant Enterococcus faecium not previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain of E faecium.

Control Measures:

Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.

Outcome:

Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day X 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).

Conclusion:

VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 5 , May 1999 , pp. 312 - 317
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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