Infection Control Manual, VRE Infection Control Policy

VRE Infection Control Policy
	Introduction
	Epidemiology
	VRE Prevention & Control
	Reservoirs
	Inpatient Control Measures Identification Contact Precautions Patient Care Equipment Patient Transport Cleaning/Disinfection Antibiotic Usage
	Discharge/Transfer/Home Care
	Outpatient Control Measures
	Discontinuation of Isolation Precautions
	Surveillance/Outbreak Control
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Yale New Haven Hospital
QISS
GB 325
New Haven, CT
06504 USA

Dr. Jeff Topal
688-4634


Introduction

Enterococci are a normal part of the human gastrointestinal and vaginal flora. Although not especially virulent, enterococci have become the second most common nosocomial pathogen and are the third leading cause of nosocomial bloodstream infections. Enterococci are intrinisically resistant to many common antibiotics. Effective therapy is generally limited to penicillins (ampicillin) and glycopeptides (vancomycin). In 1988, vancomycin resistance was first reported in enterococci in the United States. Since that time, vancomycin-resistant enterococci (VRE) have become a significant nosocomial pathogen. The percentage of VRE in nosocomial non-ICU enterococcal infections has risen from 0.3% in 1990 to 15.4% in 1997; the magnitude of the rise of VRE in the ICU is even greater with the percentage of nosocomial enterococci reported as VRE increasing from 0.4% to 23.2% in the same time period.

Given the intrinsic resistance of enterococci to most antibiotics, the addition of vancomycin resistance has meant many infections have become untreatable. Even with the use of second and thirdline antibiotics, the outcome from VRE infections is often very poor. Additionally, the attributable mortality of patients with VRE bacteremia has been reported at 36.3% as compared to 16.4% for patients with vancomycin sensitive enterococcal infections.

Finally, with the rise of VRE, the emergence of vancomycin resistance in S. aureus and S. epidermidis has become a public health concern. The genes for vancomycin resistance have been transferred in-vitro from enterococci to staphylococci. Thus, the control of VRE is crucial to prevent the emergence of untreatable staphylococcal infections.

Last modified: December 20, 2000.