A successfully shortened outbreak of vancomycin-resistant Enterococcus faecium in a secondary care hospital in Sweden

Outbreaks of vancomycin-resistant Enterococcus faecium (VRE) are often difficult to contain. In this study, we developed and implemented a set of control measures, which resulted in a relatively limited outbreak in a secondary care hospital in Sweden.

VRE screening was performed by rapid polymerase chain reaction (PCR) on fecal swabs, reported within 1-3 h. Vancomycin-resistant isolates PCR-positive for the vanA/vanB gene were further analyzed with whole-genome sequencing (WGS). Cleaning efficiency was evaluated directly after cleaning by using adenosine triphosphate (ATP) swabs, detecting organic live material. The hospital management appointed a task force consisting of experts in infectious diseases, microbiology, hospital hygiene, cleaning and representatives of the affected unit.

A total of 22 VRE-positive patients were identified, of which 12 isolates belonged to the same clone (ST 203) in a surgical ward. VRE screening by PCR shortened the turnaround time. The combination of rapid PCR and WGS could rule in or out cases from the outbreak within less than a week. The new cleaning routine indicated that 3 approved quality-controlled discharge cleanings were required to reduce VRE acquisition. The fast lane to decision-making on control measures resulted in rapid introduction of the above routines.

With prompt infection control measures, the VRE outbreak was contained after 4 months. To prevent further outbreaks of VRE, active rapid screening, improved cleaning, and restriction of multiple-bed rooms are efficient measures to implement.