Elizabeth Bryce1, Jennifer Grant2, Sydney Scharf2, Linda Dempster3, Tim T Y Lau4, Felicia Laing3, Salomeh Shajari3, Leslie Forrester3. 1. Infection Prevention and Control, Vancouver Coastal Health, Vancouver, BC, Canada. Electronic address: elizabeth.bryce@vch.ca. 2. Infection Prevention and Control, Vancouver Coastal Health, Vancouver, BC, Canada. 3. Patient Safety and Quality, Vancouver Coastal Health, Vancouver, BC, Canada. 4. Pharmaceutical Sciences, Vancouver Coastal Health, Vancouver, BC, Canada.
Abstract
BACKGROUND: The use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed. METHODS: Routine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions. Cost avoidance and value-added benefits were monitored by the hospital finance department. VRE monitoring on these high-risk units and facility-wide comprehensive bacteremia surveillance continued as per established protocols. Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI) remained unchanged. RESULTS: VRE bacteremia rates did not increase with the change to the VRE risk-managed approach. The number of patients requiring VRE isolation in all areas of the hospital decreased from an average of 32 to 6 beds per day. Statistically significant reductions in CDI and MRSA rates were observed possibly related to the aggressive decluttering, equipment cleaning, and AMS program elements. CONCLUSION: A risk-managed approach to VRE can be implemented without adverse consequences and potentially with significant benefits to a facility.
BACKGROUND: The use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed. METHODS: Routine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions. Cost avoidance and value-added benefits were monitored by the hospital finance department. VRE monitoring on these high-risk units and facility-wide comprehensive bacteremia surveillance continued as per established protocols. Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI) remained unchanged. RESULTS: VRE bacteremia rates did not increase with the change to the VRE risk-managed approach. The number of patients requiring VRE isolation in all areas of the hospital decreased from an average of 32 to 6 beds per day. Statistically significant reductions in CDI and MRSA rates were observed possibly related to the aggressive decluttering, equipment cleaning, and AMS program elements. CONCLUSION: A risk-managed approach to VRE can be implemented without adverse consequences and potentially with significant benefits to a facility.
Authors: Irene K Louh; William G Greendyke; Emilia A Hermann; Karina W Davidson; Louise Falzon; David K Vawdrey; Jonathan A Shaffer; David P Calfee; E Yoko Furuya; Henry H Ting Journal: Infect Control Hosp Epidemiol Date: 2017-04 Impact factor: 3.254
Authors: Payal K Patel; M Todd Greene; Mary A M Rogers; David Ratz; Latoya Kuhn; Jennifer Davis; Sanjay Saint Journal: Am J Infect Control Date: 2018-03-13 Impact factor: 2.918
Authors: Geoffrey Taylor; Denise Gravel; Anne Matlow; Joanne Embree; Nicole LeSaux; Lynn Johnston; Kathryn N Suh; Michael John; John Embil; Elizabeth Henderson; Virginia Roth; Alice Wong Journal: Antimicrob Resist Infect Control Date: 2016-05-21 Impact factor: 4.887