Elimination of vancomycin-resistant enterococci from a neonatal intensive care unit following an outbreak

Area of Science:

• Infectious Diseases
• Microbiology
• Healthcare Epidemiology

Background:

• Neonatal intensive care units (NICUs) are vulnerable to multidrug-resistant organism outbreaks.
• Vancomycin-resistant enterococci (VRE) pose a significant threat due to limited treatment options.
• An outbreak of VRE in 2005 necessitated a review of surveillance and control strategies.

Observation:

• An outbreak of vanA type Enterococcus faecium affected 11 of 18 patients in a NICU, causing bloodstream infections and meningitis.
• Enhanced contact isolation, cohorting, environmental decontamination, and unit closure controlled the initial outbreak.
• Weekly surveillance cultures detected VRE faecal carriage in two patients one year post-outbreak.

Findings:

• The implemented surveillance policy was crucial in identifying VRE carriers.
• Early and intensive intervention following surveillance detection led to the eradication of VRE from the NICU.
• No further VRE cases occurred in the NICU for over two and a half years post-intervention.

Implications:

• Routine surveillance for VRE in high-risk settings like NICUs is highly effective.
• Prompt intervention based on surveillance data can prevent VRE transmission and maintain a VRE-free environment.
• This approach demonstrates the utility of proactive screening in managing hospital-acquired infections.