Recently, in the US, there has been an increase in occurrences of infections caused by enterococi bacteria. These bacteria have developed resistance to treatment with vancomycin (vancomycin-resistant enterococci or 'VRE'). Besides, being resistant to vancomycin, they also seem to withstand treatment with other drugs, and may also transfer their resistance-providing genes to other bacteria (such as Staphylococcus aureus).
Hospitals and healthcare organizations need to take certain precautions to prevent spread. Various sections of the hospital need to cooperate. Some of the issues that need to be looked into include careful use of vancomycin, training and creating awareness amongst the healthcare workers, prompt detection of VRE using appropriate clinical and diagnostic tools, and providing infection-control interventions. The main aim of these interventions is to prevent spread of VRE to the hospital staff, residents, visitors or the general public; allow individuals with VRE to visit hospitals freely and seek treatment services; and to prevent spread of vancomycin resistance to other bacteria.
- The hospital through cooperation with various sections should develop a detailed plan to screen, prevent and treat VRE cases.
- All the healthcare workers in the long-term care department should be provided instructions and training on ways of reducing VRE cases.
- Vancomycin should be administrated only when absolutely required, as its use becomes a risk factor for developing the infection.
- Transmission of the bacteria from one individual to another should be prevented using infection-control interventions.
- For hand washing, a strong antiseptic solution should be utilized.
- Individuals, who come in contact with a person infected or harboring VRE, should wash their hands immediately. VRE cases should also wash their hands with an antiseptic especially after using the toilet.
- Healthcare workers coming in contact with infected people or contaminated items should use gloves, mouth-masks and even cover gowns.
- After contact with contaminated surfaces, appropriate hand washing should be followed.
- Rooms suspected to be contaminated, should be cleaned thoroughly every day using a standard disinfectant.
- Medical equipment used on a VRE case should be thoroughly cleaned and appropriately disinfected before being utilized on another patient.
- Appropriate room-mate selection is required to prevent transmission of VRE infections. VRE cases should ideally be given a separate room. However, if this is not possible, they could share a room with another VRE case or an individual not at a risk of developing VRE infection. Special precautions should be taken in VRE cases who suffer from incontinence or who do not maintain proper personal hygiene.
- An individual with VRE need not be isolated during group activities provided appropriate personal hygiene measures are being taken.
- Extra precautions have to be taken by the hospital when more than 3 VRE cases are reported within a 3 month period.
- The Local Health Authorities have to be reported when any laboratory sample containing Vancomycin-resistant Staphylococcus aureus is detected.
- CDC (2001). Recommendations for Preventing the Spread of Vancomycin Resistance Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC).
- CommunityHealth Administration (2006). Guidelines for the Prevention and Control of Vancomycin-Resistant Enterococci (VRE) in Long Term Care Facilities. Retrieved November 22, 2006, from Maryland Department of Health & Mental Hygiene.
- Medline Plus (1999). Vancomycin (Systemic). Retrieved November 21, 2006.
- Sanderson, R. (2000). Vancomycin-Resistant Enterococci (VRE). Retrieved November 21, 2006.
- State of South Dakota (2006). Guidelines for Prevention and Contorl of Vancomycin Resistant Enterococci (VRE) in Long Term Care Facilities. Retrieved November 21, 2006.