Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region
Belinda E. Ostrowsky, M.D., M.P.H., William E. Trick, M.D., Annette H. Sohn, M.D., Stephen B. Quirk, M.P.P., Stacey Holt, M.M.Sc., Loretta A. Carson, M.S., Bertha C. Hill, B.S., Matthew J. Arduino, Ph.D., Matthew J. Kuehnert, M.D., and William R. Jarvis, M.D.
Background In late 1996, vancomycin-resistant enterococci werefirst detected in the Siouxland region of Iowa, Nebraska, andSouth Dakota. A task force was created, and in 1997 the assistanceof the Centers for Disease Control and Prevention was soughtin assessing the prevalence of vancomycin-resistant enterococciin the region's facilities and implementing recommendationsfor screening, infection control, and education at all 32 healthcare facilities in the region.
Methods The infection-control intervention was evaluated inOctober 1998 and October 1999. We performed point-prevalencesurveys, conducted a case–control study of gastrointestinalcolonization with vancomycin-resistant enterococci, and comparedinfection-control practices and screening policies for vancomycin-resistantenterococci at the acute care and long-term care facilitiesin the Siouxland region.
Results Perianal-swab samples were obtained from 1954 of 2196eligible patients (89 percent) in 1998 and 1820 of 2049 eligiblepatients (89 percent) in 1999. The overall prevalence of vancomycin-resistantenterococci at 30 facilities that participated in all threeyears of the study decreased from 2.2 percent in 1997 to 1.4percent in 1998 and to 0.5 percent in 1999 (P<0.001 by chi-squaretest for trend). The number of facilities that had had at leastone patient with vancomycin-resistant enterococci declined from15 in 1997 to 10 in 1998 to 5 in 1999. At both acute care andlong-term care facilities, the risk factors for colonizationwith vancomycin-resistant enterococci were prior hospitalizationand treatment with antimicrobial agents. Most of the long-termcare facilities screened for vancomycin-resistant enterococci(26 of 28 in 1998 [93 percent] and 23 of 25 in 1999 [92 percent])and had infection-control policies to prevent the transmissionof vancomycin-resistant enterococci (22 of 25 [88 percent] in1999). All four acute care facilities had screening and infection-controlpolicies for vancomycin-resistant enterococci in 1998 and 1999.
Conclusions An active infection-control intervention, whichincludes the obtaining of surveillance cultures and the isolationof infected patients, can reduce or eliminate the transmissionof vancomycin-resistant enterococci in the health care facilitiesof a region.
Source Information
From the Hospital Infections Program, National Center for Infectious Diseases (B.E.O., W.E.T., A.H.S., S.H., L.A.C., B.C.H., M.J.A., M.J.K., W.R.J.), and the Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office (B.E.O., W.E.T., A.H.S., M.J.K.), Centers for Disease Control and Prevention, Atlanta; and the Siouxland District Health Department, Sioux City, Iowa (S.B.Q.).
Address reprint requests to Dr. Ostrowsky at the Medical College of Virginia Campus of Virginia Commonwealth University, Epidemiology and Infection Control Unit, 1200 E. Broad St., West Hospital, East Wing Rm. 202B, P.O. Box 980019, Richmond, VA 23298, or at bostrow{at}hsc.vcu.edu.
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