Control of vancomycin-resistant enterococci in a hospital: a five-year experience in a Taiwanese teaching hospital.

In order to prevent transmission of hospital-acquired vancomycin-resistant enterococci (VRE), the infection control team (ICT) of the National Taiwan University Hospital (NTUH) introduced practical guidelines from January 1997 to June 2000. All patients at NTUH found to be infected or colonized with VRE were placed in strict contact and cohort isolation. Surveillance cultures were obtained from other patients in close proximity in order to determine any spread of VRE. If identified, these patients were also placed in contact and cohort isolation, and their isolates were subjected to antimicrobial susceptibility testing and molecular typing by pulsed-field gel electrophoresis. During this period, 20 patients were found to have VRE. Based on typing results, there were three occasions where the same VRE strain had spread between index patients and roommates or patients staying in neighbouring rooms. No further spread occurred after applying strict contact isolation for these patients. The hospital-acquired VRE infection rate was around 0.03 to 0.09 per 1000 discharges during the intervention period. After July 2000, however, members of the ICT did not actively monitor or implement any interventions to control VRE. The rate then increased to 0.20 per 1000 discharges in 2001. This study suggests that interventions for the control of VRE, based on the guidelines from the Hospital Infection Control Practice Advisory Committee, are effective for control of VRE spread. Failure to adhere to these guidelines may result in an increase in hospital-acquired VRE.