Montecalvo, M. A., Jarvis, W. R., Uman, J., Shay, D. K., Petrullo, C., Rodney, K., . . . Wormser, G. P. (1999). Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Annals of Internal Medicine, 131, 269–272.
DOI Link
Study Purpose
To examine infection measures to reduce the transmission of vancomycin-resistant enterococci (VRE).
Intervention Characteristics/Basic Study Process
VRE cultures were obtained from all 259 patients (100%) in 404 admissions to the unit during the use of enhanced infection control strategies and 167 of 184 patients (91%) in 210 admissions to the unit during the use of standard infection control practices.
Enhanced Infection Control
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Inpatient surveillance: perianal cultures on admission and weekly
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Hand washing before and after patient contact
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Contact isolation for VRE-colonized and VRE-infected patients
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Gown and glove use on entry of rooms of VRE-colonized and VRE-infected patients
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Consultation with infectious disease specialists when infection is first suspected
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Systematic recommendation by infectious disease specialists to discontinue empirical vancomycin use after 72 hours
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Systematic recommendation by infectious disease specialists to use oral metronidazole rather than oral vancomycin for Clostridium difficile colitis
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Spatial separation of patients into three cohorts: VRE-positive, VRE-negative, and VRE-unknown patients
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Surveillance of perianal cultures taken for inpatients with cancer housed off the oncology unit
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Gown and glove use on entry of rooms of VRE-unknown patients
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Assignment of staff cohorts; nurses and nursing assistants assigned to VRE-positive patients or VRE-negative and VRE-unknown patients
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Patient orientation about VRE with an explanatory brochure
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Monitoring compliance by observational studies
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Environmental cultures taken in VRE-positive patient rooms before and after patient discharge and room disinfection
Sample Characteristics
Patients were evaluated during the use of enhanced infection control strategies (n = 259) and standard infection control practices (n = 184).
Setting
Eleven-room, 22-bed adult oncology unit in a 650-bed tertiary care hospital
Study Design
This was a prospective cohort study.
Measurement Instruments/Methods
Standard infection control versus enhanced infection control:
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VRE infection rates
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Colonization
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Changes in antimicrobial use.
Results
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VRE colonization was significantly reduced: 8.6 patients per 1,000 days versus 13.2 patients per 1,000 days
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Compliance with enhanced strategies: 91.7% of individuals who entered rooms wore gowns and gloves
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Enhanced infection control strategies: The incidence of VRE bloodstream infections decreased significantly (1.4 patients per 1,000 days versus 3.2 patients per 1,000 days for the standard group).
Limitations
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No conceptual model was described.
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Single unit where patients were not transferred
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No randomization
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Fifteen infection control measures were implemented simultaneously; therefore, the influence of each intervention is unknown.