Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T22:53:53.906Z Has data issue: false hasContentIssue false
  • English
  • Français

Failure to Eradicate Vancomycin-Resistant Enterococci in a University Hospital and the Cost of Barrier Precautions

Published online by Cambridge University Press:  02 January 2015

Kwan Kew Lai ,
Anita L. Kelley ,
Zita S. Melvin ,
Paul P. Belliveau  and
Sally A. Fontecchio
Kwan Kew Lai*
Affiliation:
Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts Department of Infection Control, University of Massachusetts Medical Center, Worcester, Massachusetts
Anita L. Kelley
Affiliation:
Department of Infection Control, University of Massachusetts Medical Center, Worcester, Massachusetts
Zita S. Melvin
Affiliation:
Department of Infection Control, University of Massachusetts Medical Center, Worcester, Massachusetts
Paul P. Belliveau
Affiliation:
Department of Pharmacy, University of Massachusetts Medical Center, Worcester, Massachusetts
Sally A. Fontecchio
Affiliation:
Department of Infection Control, University of Massachusetts Medical Center, Worcester, Massachusetts
*
Division of Infectious Disease and Immunology, Department of Medicine, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the effect of infection control interventions on the incidence of vancomycin-resistant enterococci (VRE), the utility of pharyngeal cultures for surveillance for VRE colonization, and the cost of barrier precautions.

Design:

Evaluation of the occurrence of VRE infection or colonization, rates of vancomycin use, results of surveillance cultures before and after interventions, and the cost of increased barrier precautions.

Setting:

University of Massachusetts Medical Center, a 347-bed tertiary-care teaching hospital with eight intensive-care units, one burn unit, and one bone marrow transplant unit.

Participants:

Patients in the intensive-care units and staff who were involved with patients colonized or infected with VRE.

Methods:

Infection control interventions included placement of patients with VRE in private rooms, strict contact isolation, cohorting of patient and nursing staff, prohibiting of equipment sharing, and monitoring of compliance with the vancomycin restriction policy, with hand washing, and of the adequacy of environmental cleaning. Both rectal and pharyngeal cultures were obtained from patients at the beginning of the outbreak, and the utility of pharyngeal cultures was evaluated. The cost of barrier precautions was estimated by comparing the cost of glove and gown use before and after the outbreak began.

Results:

The interventions decreased the number of new cases of VRE, but total eradication of VRE was not achieved. Compliance with the room-cleaning protocol was 91% (141/155 observations). Hand washing following interaction with patients who were not in isolation was 51%, vs 100% for patients in isolation. Overall, handwashing compliance was 71% (319/449): 56% (130/231) for physicians and 86% (187/218) for nurses (P<.0001). The mean number of doses of vancomycin dispensed per 1,000 patient days decreased from 145 to 114 per 1,000 patient days (P<.001). Compliance with vancomycin-use guidelines was 85%. Forty-six (77%) of 60 surveillance rectal swabs yielded enterococci, as compared to only 4 (11%) of 36 pharyngeal cultures (P<.0001). Expenses on glove and gowns alone increased by over $11,000 per year since the epidemic began.

Conclusions:

Implementation of the various infection control measures did not eradicate VRE cases from the hospital. Rectal cultures were more useful than pharyngeal cultures for surveillance of VRE. Controlling VRE epidemics can be costly.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 9 , September 1998 , pp. 647 - 652
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Karanfil, LV, Murphy, M, Josephson, A, Gaynes, R, Mandel, L, Hill, BC, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.CrossRefGoogle Scholar
2. Rubin, LG, Tucci, V, Cerenado, E, Eliopoulos, G, Isenberg, HD. Van-comycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.CrossRefGoogle ScholarPubMed
3. Livornese, LL, Dias, J, Samel, C, Romanowski, B, Taylor, S, May, P, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus fae-cium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.CrossRefGoogle ScholarPubMed
4. Handwerger, S, Raucher, B, Altarac, D, Monka, J, Marchione, S, Singh, KV, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin and gentamicin. Clin Infect Dis 1993;16:750–755.CrossRefGoogle ScholarPubMed
5. Boyle, JF, Soumakis, SA, Rendo, A, Herrington, JA, Gianarkis, DG, Thurberg, BE, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993;31:1280–1285.CrossRefGoogle ScholarPubMed
6. Frieden, TR, Munsiff, SS, Low, DE, Willey, BM, Williams, G, Faur, Y, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76–79.CrossRefGoogle ScholarPubMed
7. Boyce, JM, Opal, SM, Chow, JW, Zervos, MJ, Potter-Bynoe, G, Sherman, CB, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.CrossRefGoogle ScholarPubMed
8. Montecalvo, MA, Gedris, C, Issah, A, et al. Outbreak of vancomycin-resistant Enterococcus faecalis in an adult oncology unit. In: Proceedings and abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; 1992; Washington, DC. Abstract 1169.Google Scholar
9. Glenn Morris, J, Shay, DK, Hebden, JN, McCarter, RJ, Perdue, BE, Jarvis, W, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.CrossRefGoogle Scholar
10. Dassey, DE, Lim, M, Mascola, L. Vancomycin-resistant Enterococcus faecium (VREF)—first outbreak in the Western USA. 35th Interscience Conference on Antimicrobial Agents and Chemotherapy; 09 1720, 1995; San Francisco, CA. Abstract J40.Google Scholar
11. Moreno, F, Grota, P, Crisp, C, Magnon, K, Melcher, GP, Jorgensen, JH, et al. Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium during its emergence in a city in southern Texas. Clin Infect Dis 1995;21:1234–1237.CrossRefGoogle Scholar
12. Centers for Disease Control and Prevention. Nosocomial enterococcus resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
13. National Committee for Clinical Laboratory Procedures. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 3rd ed. Villanova, PA: National Committee for Clinical Laboratory Standards; 1993.Google Scholar
14. National Committee for Clinical Laboratory Procedures. Performance Standards for Antimicrobial Disk Susceptibility Tests. 5th ed. Villanova, PA: National Committee for Clinical Laboratory Standards; 1993.Google Scholar
15. Woods, GL, Washington, JA. Antibacterial susceptibility tests: dilution and disk diffusion. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolen, RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: American Society for Microbiology; 1995:1327–1341.Google Scholar
16. De Lencastre, H, Couto, I, Santos, I, Melo-Cristino, J, Torres-Pereira, A, Tomaz, A. Methicillin-resistant Staphylococcus aureus disease in a Portuguese hospital: characterization of clonal types by a combination of DNA typing methods. Eur J Clin Microbiol Infect Dis 1994;13:64–73.CrossRefGoogle Scholar
17. Goering, RV. Molecular epidemiology of nosocomial infections: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595–600.CrossRefGoogle ScholarPubMed
18. Patterson, JE, Sanchez, RO, Hernandez, J, Grota, P, Rose, KA. Special organism isolation: attempting to bridge the gap. Infect Control Hosp Epidemiol 1994;15:335–338.CrossRefGoogle ScholarPubMed
19. Wright, W, Korb, S, Karabaic, M, Reynolds, L, Dunn, P, Hall, G, et al. Prospective study of the epidemiology of vancomycin-resistant entero-coccus (VRE) colonization among ICU patients. Fifth Annual Meeting of the Society for Healthcare Epidemiology of America; 04 2-4, 1995; San Diego, California. Abstract 14.Google Scholar
20. Landry, SL, Kaiser, DL, Wenzel, RP. Hospital stay and mortality attributed to nosocomial enterococcal bacteremia: a controlled study. Am J Infect Control 1989;17:323–329.CrossRefGoogle ScholarPubMed