Journal article
Eradication of a large outbreak of a single strain of vanB vancomycin‐resistant Enterococcus faecium at a major Australian teaching hospital
Infection Control and Hospital Epidemiology, Vol.25(5), pp.384-390
2004
Abstract
OBJECTIVE: To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital. INTERVENTIONS: Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin). RESULTS: A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the out-break under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregated patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars). CONCLUSION: Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.
Details
- Title
- Eradication of a large outbreak of a single strain of vanB vancomycin‐resistant Enterococcus faecium at a major Australian teaching hospital
- Authors/Creators
- K.J. Christiansen (Author/Creator)Pa.A. Tibbett (Author/Creator)W. Beresford (Author/Creator)J.W. Pearman (Author/Creator)R.C. Lee (Author/Creator)G.W. Coombs (Author/Creator)I.D. Kay (Author/Creator)F.G. O’Brien (Author/Creator)S. Palladino (Author/Creator)C.R. Douglas (Author/Creator)P.D. Montgomery (Author/Creator)T. Orrell (Author/Creator)A.M. Peterson (Author/Creator)F.P. Kosaras (Author/Creator)J.P. Flexman (Author/Creator)C.H. Heath (Author/Creator)C.A. McCullough (Author/Creator)
- Publication Details
- Infection Control and Hospital Epidemiology, Vol.25(5), pp.384-390
- Publisher
- University of Chicago Press
- Identifiers
- 991005544939507891
- Murdoch Affiliation
- Murdoch University
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.23 Antibiotics & Antimicrobials
- 1.23.173 MRSA and VRE
- Web Of Science research areas
- Infectious Diseases
- Public, Environmental & Occupational Health
- ESI research areas
- Social Sciences, general