Preventing the spread of vancomycin-resistant enterococci in a long-term care facility

Area of Science:

• Infectious Diseases
• Healthcare Epidemiology
• Microbiology

Background:

• Vancomycin-resistant enterococci (VRE) pose a significant challenge in healthcare settings.
• Long-term care facilities (LCFs) are vulnerable to VRE colonization due to resident demographics and potential for transmission from acute care facilities.
• High endemic rates of VRE in acute care facilities necessitate robust infection control measures in LCFs.

Purpose of the Study:

• To evaluate the effectiveness of infection control practices in preventing VRE transmission to LCF residents.
• To test the hypothesis that stringent infection control can halt VRE spread from an acute care setting.

Main Methods:

• A point prevalence study was conducted in a state-supported veterans nursing home and an affiliated acute care veterans hospital.
• Rectal colonization screening for VRE was performed on residents before transfer and upon admission.
• Interventions included contact isolation for colonized veterans and oral bacitracin to eliminate colonization.

Main Results:

• No new VRE colonization cases were identified among residents who were not already colonized upon admission.
• The study involved culturing 69 of 200 residents in 1996 and 130 of 230 residents in 1998.
• No significant differences were found in VRE colonization rates between residents who consented to culturing and those who did not, except for gender.

Conclusions:

• Adherence to infection control practices by LCF staff was associated with the absence of VRE transmission among residents.
• VRE colonization identified in an acute care patient should not preclude their acceptance into a nursing home, provided appropriate isolation and management protocols are in place.
• Effective infection control can mitigate the risk of VRE introduction and spread in long-term care settings.