Abstract
BACKGROUND
Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals.
OBJECTIVE
To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting.
DESIGN
Prospective cohort study.
SETTING
Adult oncology inpatient unit.
PATIENTS
259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices.
INTERVENTIONS
Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed.
MEASUREMENTS
VRE infection rates, VRE colonization rates, and changes in antimicrobial use.
RESULTS
During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced.
CONCLUSION
Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.
Collapse