Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the...

Area of Science:

• Infectious Disease Epidemiology
• Hospital Infection Control
• Environmental Microbiology

Background:

• Hospital construction is linked to infection rates, but renovation's impact on environmental decontamination and subsequent infection incidence is less understood.
• Vancomycin-resistant Enterococcus (VRE) poses a significant threat in healthcare settings, particularly for immunocompromised patients.

Purpose of the Study:

• To assess the effect of a hospital unit renovation, including surface replacement, on the incidence of hospital-acquired vancomycin-resistant Enterococcus (VRE) colonization.
• To investigate the role of environmental decontamination and strain dynamics in VRE transmission during and after renovation.

Main Methods:

• Retrospective clinical study involving molecular strain typing (multilocus sequence typing) and environmental cultures.
• Analysis of 536 hospital admissions for acute leukemia or stem-cell transplantation before, during, and after unit remodeling.
• Monitoring of VRE colonization rates and identification of environmental contamination sources.

Main Results:

• A significant decrease in VRE colonization rates was observed in the first year post-renovation (hazard ratio <0.23).
• Endemic VRE transmission was interrupted, with dominant pre-construction strains disappearing and novel strains emerging post-renovation.
• Environmental cultures identified contaminated surfaces frequently touched by personnel, suggesting a role in VRE transmission.

Conclusions:

• Unit reconstruction effectively interrupted endemic VRE transmission, demonstrating the impact of environmental changes.
• Resumption of VRE transmission with novel strains post-reopening underscores the importance of ongoing environmental monitoring and control.
• Contaminated environmental surfaces and shared equipment are critical factors in the endemic transmission of VRE.