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Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Keryn J. Christiansen
Affiliation:
Royal Perth Hospital, Perth, Western Australia Curtin University of Technology, Perth, Western Australia
Patricia A. Tibbett
Affiliation:
Royal Perth Hospital, Perth, Western Australia
William Beresford
Affiliation:
Women's & Children's Health Service, Perth, Western Australia
John W. Pearman
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Rosie C. Lee
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Geoffrey W. Coombs
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Ian D. Kay
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Frances G. O'Brien
Affiliation:
Curtin University of Technology, Perth, Western Australia
Silvano Palladino
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Charles R. Douglas
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Philip D. Montgomery
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Terri Orrell
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Allison M. Peterson
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Frank P. Kosaras
Affiliation:
Royal Perth Hospital, Perth, Western Australia
James P. Flexman
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Christopher H. Heath
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Cheryll A. McCullough
Affiliation:
Royal Perth Hospital, Perth, Western Australia

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 outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed 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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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