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Vancomycin-resistant enterococci outbreak in an intensive care unit: prevention and control
Critical Carevolume 11, Article number: P33 (2007)
Infection caused by vancomycin-resistant enterococci (VRE) is associated with high morbidity and mortality rates; it poses a serious threat, in particular, to critically ill patients. It generates high costs and challenges infection control programs. An important component of VRE control is the identification of colonized patients. Since December 2001 we have monitored patients in high-risk units, who would be most susceptible for acquiring VRE. Contact precautions are implemented for VRE-colonized or VRE-infected patients.
To describe an outbreak of VRE in an adult ICU with 30 beds from a 450-bed tertiary care, private hospital.
A monthly surveillance for VRE was performed in patients considered at risk for acquiring VRE in high-risk areas (adult ICU and semi-ICU). Patients with hospitalization longer than 30 days were screened for the presence of VRE by the collection and culture of stools or perirectal swab. In September 2005 we detected an increase in the number of colonized and infected patients with VRE, and we expanded the VRE surveillance to every 15 days. The positive samples were characterized for antimicrobial susceptibility followed by pulsed-field gel electrophoresis.
Nine of 231 patients (3.9% of screened patients) were VRE-positive between August and November 2005. The samples were plated on chromogenic agar medium and all suspected VRE were confirmed by manual and automated methods. Pulsed-field gel electrophoresis identified four different patterns. One pattern ('B') was found in five different patients and another one ('C') in two different patients, suggesting a clone dissemination. The other two patterns were isolated in one patient each. All patients with a positive stool were followed until three negative results, collected with an interval of 1 week or when they had been discharged. At the same time, revision of the basic procedure such as dealing with materials and equipments, training, an informative leaflet though the web, and visits in the unit were performed in order to provide education and orientation to the staff. There was a reduction in the number of new cases of VRE after all measures, and the outbreak was considered controlled in December 2005.
The active surveillance program among high-risk patients resulted in the complete control of the VRE outbreak at our institution.