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Management of vancomycin-resistant Enterococcus faecium in Dutch healthcare institutes: a nationwide survey
M Mulder1, K E W Vendrik2, S A M van Kessel2
1Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, The Netherlands.
Background:
Vancomycin-resistant Enterococcus faecium (VREfm) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VREfm management are available. Most available guidelines are written towards the hospital setting and only few on long-term care facilities (LTCFs). Moreover, not all aspects of VREfm management are covered, recommendations differ and the level of compliance to these guidelines is unknown. The aim of this study was to get insight into the routine VREfm policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures.
Methods:
Online questionnaires were sent to representatives of Dutch hospitals and LTCFs. The questionnaire included questions regarding the definition of VRE, screening, diagnostics, patient isolation, cleaning procedures, VREfm clearance and VREfm outbreaks.
Findings:
The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VREfm outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VREfm screening versus 50% of the LTCFs. VREfm-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VREfm-positive patients are in place in 84% of the hospitals and in 51% of LTCFs. The details of these measures differ substantially between healthcare facilities.
Conclusion:
This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VREfm management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VREfm data on a regional/national level.
Insights
Vancomycin-resistant Enterococcus faecium (VREfm) management varies across Dutch hospitals and long-term care facilities. Standard procedures exist but differ significantly, impacting data comparability and infection control.
Area of Science:
- Infectious Diseases
- Public Health
- Healthcare Management
Background:
- Vancomycin-resistant Enterococcus faecium (VREfm) poses an outbreak risk in healthcare settings.
- Existing Dutch guidelines for VREfm management primarily target hospitals, with limited focus on long-term care facilities (LTCFs).
- Current VREfm management policies lack uniformity and compliance data is unknown.
Purpose of the Study:
- To assess current VREfm screening, diagnostic, and infection control policies in Dutch healthcare facilities.
- To identify variations in VREfm management practices between hospitals and LTCFs.
Main Methods:
- Online questionnaires were distributed to Dutch hospitals and LTCFs.
- Data collected covered VREfm definition, screening, diagnostics, isolation, cleaning, clearance, and outbreak management.
Main Results:
- 61 hospitals and 57 LTCFs participated, with high response rates.
- Hospitals reported more VREfm outbreaks than LTCFs.
- VREfm screening (87% vs 50%), patient isolation (98% vs 83%), and clear labeling protocols (84% vs 51%) were more common in hospitals than LTCFs, with substantial variations in details.
Conclusions:
- Most Dutch hospitals and some LTCFs have VREfm management procedures, but comprehensiveness and details vary.
- Standardization of VREfm policies is needed for improved regional/national data comparability and infection control.
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