The Society for Healthcare Epidemiology of America (SHEA) Committee on Long-Term Care decided in 1996 that there was need to develop a position document about vancomycin-resistant enterococci (VRE) in long-term—care facilities (LTCFs). This document is intended to complement the two previous position statements from our committee that discuss antibiotic use and antibiotic resistance in LTCFs. It is designed to supplement Hospital Infection Control Practice Advisory Committee (HICPAC) recommendations and to provide realistic guidelines for the LTCF.

The elimination of chlorofluorocarbons by the Clean Air Act has led to the development of alternative technologies for low-temperature sterilization in the healthcare setting, including 100% ethylene oxide, ethylene oxide with other stabilizing gases, immersion in peracetic acid, and gas plasmas. The ideal sterilant does not exist, and infection control professionals should understand the advantages and disadvantages of these processes. However, when combined with adherence to standard cleaning protocols, the available data suggest that the currently available Food and Drug Administration-cleared low-temperature sterilization technologies can inactivate a clinically relevant inoculum of highly resistant organisms

Hospitals in the process of building or renovating intensive-care units (ICUs) often establish multidisciplinary design teams. However, these teams rarely include infection control professionals. Because nosocomial infection is common in the ICU, design features can affect the risk of infection transmission, and outbreaks can occur during construction, this exclusion seems shortsighted. Infection control professionals are familiar with the relevant research, as well as the regulations and guidelines related to ICU design and infection control practices. Not only is their input essential to the design and construction of safe and effective units but their presence on the design team can allow the prospective collection of comparative data to turn the building project into a research project.