Vancomycin Resistant Enterococcus (VRE)

Enterococcus is a type of bacteria that is normally found in people’s bowels. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. When this bacteria becomes resistant to certain antibiotics it is called VRE. These bacteria can sometimes cause infection. People with VRE can spread it to others when they forget to wash their hands after using the washroom. It can also be spread by the unwashed hands or on gloves of personnel after direct contact with patients or the contaminated environment. VRE can live in the environment for a long time if not cleaned properly. VRE is not spread through the air by coughing or sneezing.

The risk of VRE infection is more common in people with a weakened immune system, those that are critically ill, if already have serious medical conditions as well as those who have received many antibiotics.

Using an alcohol-based hand rub or hand washing before and after contact with any patient is the best way you can help prevent the spread of VRE.

These patients will be placed under isolation precautions. It is important for all who enter the patient’s room, to follow all of the directions on the precaution sign posted outside the room.

STEGH currently has an active VRE surveillance program. One component (VRE bacteraemia infections) of this surveillance program will be released December 30, 2008.

VRE bacteraemia – is the presence of VRE bacteria in the bloodstream.

Rates of VRE Acquired Infections at STEGH

STEGH	Target	Jan – Mar 09	Apr – Jun 09	July – Sept 09	Oct - Dec 2009	Jan-March 2010	Apr-Jun 2010
Case	N/A	0	0	0	0	0	0
Rate	N/A	0	0	0	0	0	0

Cases

The number of new hospital acquired VRE bacteraemia infections will be posted on a quarterly basis. (Note: 0 cases = 0, 1 – 4 cases = < 5, 5 and more cases will be indicated by the whole number)

Infection Rate per 1,000 Patient Days

The VRE bacteraemia infection rate is calculated as a rate per 1,000 patient days. The total patient days represents the sum of the number of days during which services were provided to all inpatients during the given time frame.

Rates in Small Facilities

The smaller the facility, the greater the rates will vary – this is because of a change in even one case in a small facility will cause the rate to go up or down considerably.

Target Rate

The target rate is not currently available but it is anticipated that this will be established by the MOHTLC for hospitals of comparable size in the near future.

What does hospital-acquired mean?
Sometimes when patients are admitted to the hospital, they get infections while they are in the hospital. This is a hospital-acquired infection or a nosocomial infection. Usually it is MRSA, VRE or C. difficile.

VRE Rate

The method of calculation of the VRE bacteraemia infection rate for the reporting period (on a quarterly basis) is:

Number of nosocomial patients with laboratory identification of VRE bacteraemia   x 1000
Total number of patient days

Where the numerator is the total number of newly identified cases for VRE bacteraemia associated with the reporting facility, for the reporting period. The denominator is the total number of in-patient days for the reporting period. There are no exclusion criteria.

STEGH - Working hard to manage the spread of VRE

St. Thomas Elgin General Hospital takes the care and safety of our patients very seriously, and we are committed to transparency, and continuous improvement. 

Unfortunately, like many hospitals in Ontario our size, on any given day, in all likelihood, STEGH has patients in isolation with infectious diseases such as VRE. Our focus on patient and staff safety includes a concerted effort in preventing and managing VRE in this facility.

The STEGH Infection Control Committee has supported and recommended a number of strategies to minimize risk as outlined in our policies and procedures.

STEGH uses multiple controls to prevent the spread of VRE, which includes but is not limited to:

• Hand hygiene facilitation: Alcohol based hand rub (ABHR) has been strategically placed at Point of Care within the patient’s environment so that all care providers can easily access it. STEGH participated in the MOHLTC Just Clean Your Hands pilot and continues to emphasize hand hygiene practice as one of the key components to prevent spread.

• Education: STEGH staff has been educated on the procedure for managing VRE which is based on the Provincial Infectious Disease Advisory Committee’s (PIDAC) ARO Best Practice Guidelines. Infection Control practices are audited on a regular basis.

• Use of Personal Protective Equipment (PPE): The use of PPE (gown, and gloves) is required by all who enter the patient environment.

• Isolation requirements: Our control measures include appropriate patient placement. Patients with VRE will have a ‘Contact’ isolation sign posted outside their room that reviews all necessary instructions that must be followed by all as they enter and exit the patient room. The isolation signage provides a visible communication tool that prompts enhanced environmental cleaning.

• Tracking VRE: STEGH screens all patients known to have a history of VRE, have risk factors for VRE on admission to our hospital.

• Environmental cleaning is ongoing using recommended germicides.

  • STEGH conducts daily room cleaning using a special disinfectant.

  • Our cleaning staff is well trained and is dedicated to keeping our hospital clean and safe for our patients.

Visit the Ministry of Health Care and Long-Term Care website to view other hospital's rates

If you have any questions about this information or about our hospital’s infection prevention and control program, please contact us.

Learn More About VRE

Infection Prevention and Control at STEGH