Skip to main content Accessibility help

Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the Treatment of Hematologic Malignancies and Hematopoietic Stem-Cell Transplantation

  • Clyde D. Ford (a1), Michaela A. Gazdik Stofer (a2) (a3), Jana Coombs (a2), Bert K. Lopansri (a2) (a4), Brandon J. Webb (a2) (a4), Gabriela Motyckova (a1) and Finn Bo Petersen (a1)...



While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence.


Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures.


A regional referral center for acute leukemia and hematopoietic stem-cell transplantation.


Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed.


During 2009–2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation.


We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18–0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation.


Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE.

Infect Control Hosp Epidemiol 2017;38:1055–1061


Corresponding author

Address correspondence to Clyde D. Ford, MD, Intermountain Blood and Marrow Transplant Program, Latter Day Saints Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84143 (


Hide All
1. Kanamori, H, Rutala, WA, Sickbert-Bennett, EE, Weber, DJ. Review of fungal outbreaks and infection prevention in healthcare settings during construction and renovation. Clin Infect Dis 2015;61:433444.
2. Boix-Palop, L, Nicholas, C, Xercavins, M, et al. Bacillus species pseudo-outbreak: construction works and collateral damage. J Hosp Infect 2017;56:160165.
3. Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678685.
4. Martinez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterocci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:19051912.
5. Homan, WL, Tribe, D, Poznanski, S, et al. Multilocus sequence typing scheme for Enterococcus faecium. J Clin Microbiol 2002;40:19631971.
6. Benjamini, Y, Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc 1995;Series B 57:289300.
7. Ford, CD, Lopansri, BK, Haydoura, S, et al. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol 2015;36:4753.
8. Ford, CD, Lopansri, BK, Gazdik, MA, et al. Are the hospital environment and unit colonization pressure risk factors for vancomycin-resistant Enterococcus colonization on contemporary units dedicated to the treatment of hematologic malignancies and hematopoietic stem cell transplantation? Am J Infect Control 2016;44:11101115.
9. Ford, CD, Gazdik, MA, Lopansri, BK, et al. Vancomycin-resistant Enterococcus colonization and bacteremia and hematopoietic stem-cell transplantation outcomes. Biol Blood Marrow Transplant 2017;23:340346.
10. Teltsch, DY, Hanley, J, Loo, V, Goldberg, P, Gursahaney, A, Buckeridge, DL. Infection acquisition following intensive care unit room privatization. Arch Intern Med 2011;171:3238.
11. Boswell, TC. Reduction in MRSA environmental contamination with a portable HEPA-filtration unit. J Hosp Infect 2006;63:4754.
12. Muzslay, M, Moore, G, Turton, JF, Wilson, AP. Dissemination of antibiotic-resistant enterococci within the ward environment: the role of airborne bacteria and the risk posed by unrecognized carriers. Am J Infect Control 2013;41:5760.
13. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:15521560.
14. Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.
15. McManus, AT, McManus, WF, Mason, AD, Aitcheson, AR, Pruitt, BA. Microbial colonization in a new intensive care burn unit. Arch Surg 1985;120:217223.
16. Michael, KE, No, D, Roberts, MC. VanA-positive multi-drug-resistant Enterococcus spp. isolated from surfaces of a US hospital laundry facility. J Hosp Infect 2017;95:218223.
17. Bonten, MJ, Slaughter, S, Ambergen, A, et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci. Arch Intern Med 1998;158:11271132.
18. Harris, AD, Pineles, L, Belton, G, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:15711580.
19. Slaughter, S, Hayden, MK, Nathan, C, et al. A comparison of the effect of universal use of gloves and gowns with that of glove use only on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448456.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed