What is it and why are we concerned?
Enterococci are gram-positive cocci closely related to streptococci that are inherently resistant to many antibiotics, and which acquire resistance readily. Vancomycin is increasingly used to treat serious enterococcal infections.
In 1986, resistance to vancomycin by enterococci was first reported.
Since then, the incidence of VRE has been increasing at an alarming
rate. There is no effective therapy available at the present time for
treating infections with VRE. Consequently transmission of this organism
in the hospital setting would be disastrous.
How is it spread?
Enterococci are normally found in the bowel and female genital tract. They have been shown to persist in the environment for long periods of time (up to 7 days) on hands, gloves, equipment and environmental surfaces such as bedrails, telephones, stethoscopes, etc.
Cross - infection has been attributed to rectal thermometers, bedpans, washer - disinfector machines and fluidized microsphere beds.
Transmission occurs directly via the hands of healthcare workers or
indirectly from contact with contaminated environmental surfaces and
patient - care equipment.
Prevention of Transmission
A single case of VRE must be treated as an Infection Control emergency. Control measures include a private room, gloves and gown for all patient contact, dedicated patient equipment, the use of antiseptic soap, and enhanced cleaning of the room. These measures should continue for the duration of hospitalization.
Gloves and gown must be discarded before leaving the room. Gloves should be changed between sites (eg. after contact with stool). Hands must be thoroughly washed (longer than 30 seconds) with antiseptic soap after removing gloves and upon leaving the room. Care must be taken not to recontaminate hands.
Environmental contamination should be avoided when disposing of linen and garbage. All surfaces should be cleaned daily (eg. doorknobs, countertops, bedrails) with hospital disinfectant. Terminal cleaning of the room should include walls and curtains.
Transport of patient out of the room should be limited to essential
tests. Affected sites should be covered and the wheelchair/stretcher
disinfected after use.
To date, treatment options for VRE infection are limited. Colonization may persist indefinitely, however there is usually spontaneous clearing after antibiotics and invasive procedures are withdrawn.