Veronica Weterings1, Anita van Oosten2, Ellen Nieuwkoop3, Jolande Nelson3, Andreas Voss4, Bas Wintermans2,5, Joris van Lieshout2, Jan Kluytmans6,7,8, Jacobien Veenemans2,5. 1. Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands. vweterings@amphia.nl. 2. Department of Infection Control, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands. 3. Department of Infection Control, Elisabeth-TweeSteden Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands. 4. Department of Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. 5. Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands. 6. Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands. 7. Microvida Laboratory for Microbiology, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands. 8. Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
Abstract
BACKGROUND: The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014-February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as 'VRE suspected'. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak. METHODS: After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing 'VRE suspected' label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak. RESULTS: Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected. CONCLUSION: We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.
BACKGROUND: The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014-February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as 'VRE suspected'. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak. METHODS: After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing 'VRE suspected' label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak. RESULTS: Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected. CONCLUSION: We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.
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