Last Reviewed: November 2011 Show
What is VRE?Enterococci are bacteria that are naturally present in the intestinal tract of all people. Vancomycin is an antibiotic to which some strains of enterococci have become resistant. These resistant strains are referred to as VRE. Are VRE infections serious?In general, enterococci are not very harmful or virulent. This applies to both antibiotic-resistant as well as nonresistant or sensitive strains. However, when VRE infects the urinary tract, surgical wounds or the bloodstream of hospitalized patients, it may be difficult to treat and, occasionally, may be life threatening. New antibiotics to treat VRE are under development. Who gets VRE?Serious VRE infections usually occur in hospitalized patients with serious underlying illnesses such as cancer, blood disorders, kidney disease or immune deficiencies. People in good health are not at risk of infection, but health care workers may play a role in transmitting the organism, if careful hand washing and other infection control precautions are not practiced. How is VRE spread?VRE is usually spread by direct contact with hands, environmental surfaces or medical equipment that has been contaminated by the feces of an infected person. What type of prevention is needed when caring for patients with VRE?When providing care in a private home, hospital or nursing home, health care workers should use disposable gloves and wash their hands with soap after caring for a person with VRE. A disposable gown should also be used if the type of care involves washing or turning the patient, or changing diapers. Routine cleaning of bed rails, toilets and commodes with a bleach solution or hospital-grade disinfectant is also important. In the hospital setting, equipment such as rectal thermometers and blood pressure cuffs should be assigned solely to the infected patient. Are special precautions needed for home care of patients with VRE?Standard precautions including hand washing and gloving should be followed. Otherwise, healthy household members are not at risk of VRE infection. Dishes and utensils can be washed in a dishwasher or with warm soapy water and rinsed. Bed linen and clothing can be washed in a washing machine using a standard detergent for clothing. Can nursing homes or hospitals refuse to accept patients with VRE?No. Such discrimination is unnecessary and may be illegal. Nursing homes and hospitals are expected to follow state and federal guidelines for VRE patients which include standard precautions and proper room assignment. Where can I get further information on VRE?For general information, contact the New York State Department of Health, Bureau of Communicable Disease Control, at (518) 473-4439. Patients in hospitals or nursing homes may contact the facility's infection control nurse. Series: Health Facilities Series: RHCF-7, D&TC-7, HMO-6, H-10, HHA-4 95-14 Purpose.These guidelines provide infection control information for hospitals, long term care facilities, and home care agencies on strategies to prevent transmission of vancomycin-resistant enterococci (VRE) from colonized or infected patients. These supplement recommendations published by the Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee (HICPAC)1, which have been endorsed by the Department of Health and its Infection Control Advisory Committee. Guidance for long-term care facilities and home health agencies, which was not covered by the HICPAC document, is included. This document solely addresses infection control. Recommendations for surveillance, antibiotic utilization, and other aspects of an institutional plan for VRE prevention and control are covered in the HICPAC guidelines referenced at the end of this communication. Background.Enterococci are part of the normal flora in the intestinal tract and are a common cause of nosocomial infections. In recent years, enterococci, like many other organisms, have developed resistance to certain antibiotics. Although VRE is not especially virulent, the lack of effective therapy for invasive infection and the potential for transfer of vancomycin resistance to other bacteria (i.e., Staphylococcus aureus) has made the control of VRE a public health concern. Also, VRE infections tend to occur in critically ill patients in whom the outcome is more frequently fatal. In the next few years, most health care facilities and agencies can expect to encounter VRE in their patient population. In New York State, VRE is endemic in many hospitals. All areas of the state are affected. Although a health care facility or agency may not have had a recognized case of VRE, this organism may be present in the patient population. Patients can be colonized with VRE and remain undetected. VRE does not pose an infection risk to health care workers. However, health care workers can transiently carry this organism and serve as vehicles for transmission to other patients. Admission and Transfer of Patients With VRE.The admission or transfer of patients should not be affected by VRE infection or colonization. All health care facilities and home care agencies must be prepared to implement the appropriate infection control measures for patients infected or colonized with VRE and other resistant organisms. It is inappropriate to refuse admission of a patient based solely on the fact that VRE is present. Such action negatively affects patients by limiting access to the desired level of care, including hospitalization, and unnecessarily extends hospital stay beyond the period of medical need. Today's health care environment must be viewed as a continuum where patients move back and forth across levels of care according to need. Open communication and sharing of information is therefore essential to the provision of quality care. The infection control office in a receiving facility should be notified when a patient with VRE is being considered for admission or transfer so that preparations can be made, including reinforcing staff education on control of VRE. Principles of Controlling VRE Transmission.Strategies for controlling VRE transmission are very basic: confine the organism and control the vehicles that can contribute to spread. Scrupulous handwashing, appropriate use of barrier precautions, and careful attention to environmental sanitation are the three most important elements of a control strategy. Health care workers should always treat stool and urine as if they contain potential pathogens. Beyond this, the nature of the control measures will be dictated by the type of facility in which care is provided and the vulnerability of its patient population. Patients vary in their susceptibility to becoming colonized with resistant organisms; exposure to antibiotics and invasive or indwelling devices are important risk factors. For these reasons, certain hospitalized patients appear to be at particular risk. Recommendations for control of VRE consider these variations in risk and consequently hospital guidelines are more restrictive than those for other health care settings. In addition, because VRE may be transmitted by contact with contaminated surfaces, greater attention is placed on recognizing where the patient or health-care worker may have contact which could result in transmission. Factors that should routinely be considered when making decisions about infection control measures and room assignments include:
The following recommendations are distinguished by the type of health care setting to which they apply. However, each facility or agency will need to adapt these guidelines on a case-by-case basis according to the situation and their previous experience with VRE. Hospital Guidelines.(These guidelines summarize the isolation precaution section of the HICPAC guidelines endorsed by the Department of Health and its Infection Control Advisory Committee.)
Long Term Care Guidelines.
Home Care Guidelines.Admission and transfer of patients with VRE to or from the home is not a concern, other than to alert the receiving facility or agency. In addition, there is no need to disrupt housing arrangements because a household member has VRE. Efforts to control VRE transmission in the home should focus on preventing cross-contamination via the nursing bag, clothing, and equipment which is carried to and from the home by the health care professional. Hands should be washed before leaving the home. Other persons in the home should be educated about VRE and instructed to clean and disinfect toilet facilities used by the patient and contain and dispose dressings and other disposable materials that may be contaminated. No special precautions for linen, dishes, or personal clothing is indicated. If persons in the home provide direct care, they too should be guided on the importance of handwashing, glove use, and other barriers as reasonable and appropriate to the situation. Reference: Dale Morse, M.D. Endorsement: Dennis Whalen Distribution: Which client should the nurse determine to be at the greatest risk for hospital acquired infection HAI )?All hospitalized patients are susceptible to contracting a nosocomial infection. Some patients are at greater risk than others-young children, the elderly, and persons with compromised immune systems are more likely to get an infection.
Which nursing action carries the greatest likelihood of contributing to the spread of vancomycinWhich nursing action carries the greatest likelihood of contributing to the spread of vancomycin-resistant enterococci (VRE)? -Emptying the Foley catheter bag of a client with VRE and then helping the client in the next bed transfer to a chair without washing hands between contact.
What is the most common client site for development of healthcare associated infections?The most common sites for HAIs are the urinary and respiratory systems, and central line-associated bloodstream infections. Consider practices that will reduce infections related to these systems.
Is vancomycinContact precautions are recommended in hospitals to prevent and control the transmission of vancomycin-resistant enterococci (VRE).
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