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Outbreak of vancomycin-resistant enterococci in a burn unit.

P S Falk1, J Winnike, C Woodmansee

  • 1Department of Internal Medicine, University of Texas Medical Branch at Galveston, 77555-0835, USA.

Infection Control and Hospital Epidemiology
|September 23, 2000
PubMed
Summary
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A vancomycin-resistant enterococci (VRE) outbreak in a burn intensive care unit was traced to a single clone and eradicated using aggressive decontamination and isolation. Recurrence highlighted the need for meticulous environmental cleaning to prevent VRE spread.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Epidemiology

Background:

  • Vancomycin-resistant enterococci (VRE) pose a significant threat in healthcare settings, particularly in intensive care units.
  • Burn intensive care units (BICUs) are vulnerable to healthcare-associated infections due to the compromised skin barrier and prolonged patient stays.

Purpose of the Study:

  • To investigate the epidemiology and implement control measures for a vancomycin-resistant enterococci (VRE) outbreak in a burn intensive care unit (BICU).
  • To identify risk factors associated with VRE acquisition and determine effective eradication strategies.

Main Methods:

  • Conducted epidemiological investigations including patient and environmental cultures, healthcare worker hand hygiene monitoring, and pulsed-field gel electrophoresis (PFGE) for isolate typing.

Related Experiment Videos

  • Performed a case-control study to identify independent risk factors for VRE acquisition.
  • Implemented barrier isolation and aggressive environmental decontamination protocols.

    • Main Results:

    • A 13-month outbreak involving 21 patients with VRE colonization and 4 with bacteremia was caused by a single VRE clone.
    • Diarrhea and antacid administration were identified as independent risk factors for VRE acquisition.
    • Despite initial eradication, the outbreak recurred from a contaminated electrocardiogram lead, emphasizing persistent environmental reservoirs.

    Conclusions:

    • A single clone of VRE caused the protracted outbreak in the BICU.
    • Recrudescence of the outbreak underscored the importance of identifying and eliminating subtle environmental contamination sources.
    • Aggressive environmental decontamination and barrier isolation were effective in eradicating VRE from the burn patient population.