Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

Abstract

<jats:p>INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p &lt; 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p &lt; 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.</jats:p>

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

“…While around the world, and even in other regions of Brazil, VRE outbreaks have been especially associated with E. faecium [5,6,7], in our city, outbreaks have been almost exclusively related to E. faecalis. Some non-published data from Porto Alegre demonstrated the sporadic occurrence of VRE infections/colonization from 2000 to 2009 in different health institutions of the city, but all were associated with E. faecalis.…”

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

“…There was also less VRE on health care worker hands (58). Escalating VRE cases in a Brazilian hospital prompted a range of activities, including emphasis on environmental cleaning, contact precautions, and the introduction of an educational program (59). Improvements in cleaning included use of bleach for bathroom surfaces and 70% alcohol for furniture and patient equipment.…”

“…Improvements in cleaning included use of bleach for bathroom surfaces and 70% alcohol for furniture and patient equipment. The overall package helped prevent dissemination of VRE throughout the hospital, including intensive care, with a decrease in acquisition rate from 1.49 to 0.33 (P Ͻ 0.001) (59). Bleachbased terminal cleaning was used for an earlier study to control VRE in a hemato-oncology unit, again as part of an intervention package (57).…”

A hospital-wide screening programme to control an outbreak of vancomycin-resistant enterococci in a large tertiary hospital in Hong Kong

“…[25][26][27] The association of environmental contamination and the occurrence of an outbreak has also been well established. 18,[28][29][30] The improvement in hand hygiene compliance from approximately 37% to 73% was remarkable. Several explanations are postulated: (1) the VRE Task Group escalated the need for urgent improvement.…”