Isolation for VRE

Here's a link to the CDC that might help: http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/m0039349/m0039349.asp

and an excerpt:

"Notify appropriate hospital staff promptly when VRE are detected (see When VRE Are Isolated From a Clinical Specimen).

Inform clinical staff of the hospital's policies regarding VRE-infected or colonized patients. Because the slightest delay can lead to further spread of VRE and complicate control efforts, implement the required procedures as soon as VRE are detected. Clinical staff are essential to limiting the spread of VRE in patient-care areas; thus, continuing education regarding the appropriate response to the detection of VRE is critical (see Education Programs).

Establish system(s) for monitoring appropriate process and outcome measures (e.g., cumulative incidence or incidence density of VRE colonization, rate of compliance with VRE isolation precautions and handwashing, interval between VRE identification in the laboratory and implementation of isolation precautions on the wards, and the percentage of previously colonized patients admitted to the ward who are identified promptly and placed on isolation precautions). Relay these data to the clinical, administrative, laboratory, and support staff to reinforce ongoing education and control efforts (67).

Initiate the following isolation precautions to prevent patient-to-patient transmission of VRE:

Place VRE-infected or colonized patients in private rooms or in the same room as other patients who have VRE (8).

Wear gloves (clean, nonsterile gloves are adequate) when entering the room of a VRE-infected or colonized patient because VRE can extensively contaminate such an environment (3,8,16,17). When caring for a patient, a change of gloves might be necessary after contact with material that could contain high concentrations of VRE (e.g., stool).

Wear a gown (a clean, nonsterile gown is adequate) when entering the room of a VRE-infected or colonized patient a) if substantial contact with the patient or with environmental surfaces in the patient's room is anticipated, b) if the patient is incontinent, or c) if the patient has had an ileostomy or colostomy, has diarrhea, or has a wound drainage not contained by a dressing (8).

Remove gloves and gown before leaving the patient's room and immediately wash hands with an antiseptic soap or a waterless antiseptic agent (68-71). Hands can be contaminated via glove leaks (72-76) or during glove removal, and bland soap does not always completely remove VRE from the hands (77).

Ensure that after glove and gown removal and handwashing, clothing and hands do not contact environmental surfaces in the patient's room that are potentially contaminated with VRE (e.g., a door knob or curtain) (3,8).

Dedicate the use of noncritical items (e.g., a stethoscope, sphygmomanometer, or rectal thermometer) to a single patient or cohort of patients infected or colonized with VRE (17). If such devices are to be used on other patients, adequately clean and disinfect these devices first (78).

Obtain a stool culture or rectal swab from roommates of patients newly found to be infected or colonized with VRE to determine their colonization status, and apply isolation precautions as necessary. Perform additional screening of patients on the ward at the discretion of the infection-control staff.

Adopt a policy for deciding when patients infected or colonized with VRE can be removed from isolation precautions. The optimal requirements remain unknown; however, because VRE colonization can persist indefinitely (4), stringent criteria might be appropriate, such as VRE-negative results on at least three consecutive occasions (greater than or equal to 1 week apart) for all cultures from multiple body sites (including stool or rectal swab, perineal area, axilla or umbilicus, and wound, Foley catheter, and/or colostomy sites, if present).

Because patients with VRE can remain colonized for long periods after discharge from the hospital, establish a system for highlighting the records of infected or colonized patients so they can be promptly identified and placed on isolation precautions upon readmission to the hospital. This information should be computerized so that placement of colonized patients on isolation precautions will not be delayed because the patients' medical records are unavailable.

Local and state health departments should be consulted when developing a plan regarding the discharge of VRE-infected or colonized patients to nursing homes, other hospitals, or home-health care. This plan should be part of a larger strategy for handling patients who have resolving infections and patients colonized with antimicrobial-resistant microorganisms."

THanks for the info! What I hate about what the hospitals I have come in contact with are doing.....These are long term pts, They get a + VRE culture and then isolate them, then get 3 negatives and take them off of isolation, then reculture them a week or 2 later and we find out that they are again + for VRE!! Meanwhile, we have been taking care of the pts and they haven't been on iso and they have been transported out of their rooms, all over the hospital for tests, etc..... Just frustrating.

A few things to keep in mind about VRE -

1) most research indicates that once you have it, it is yours for life. We've all played the reculture game but it is just a game with VRE.

2) Many dialysis patients are found to be positive probably due to infusion of vancomycin with dialysate when treating infection. Rarely are post-treatment cultures done in the acute care setting.

3) The recommendations from the CDC/HICPAC are specified for the acute hospital setting and may need/be amenabe to modification in other settings. My own research indicates that in the non-acute setting the biggest risk factor for care related transmission is fecal incontinence.

I do distinguish between transmission and acquisition - the biggest risk for acquisition is of course treatment with vancomycin.

We regard VRE extremely serious at my facility. This includes the long term care units and the acute units.

We practice Contact Isolation with VRE. If you follow Standard Precautions you will be fine. I would agree with everything except the head covers and shoe covers.

Because of your task I am curious - do you set up your machine in the patients room and do you clean it afterwards and what is your protocol for cleaning the machine after dialysis and what is your protocol for cleaning the machine after an isolation patient's treatment?

Cali

On our med-surg floors, and maybe throughout the hospital, they have stopped isolating VRE.

all the hospitals in oahuhawaii are using vanco. 1 mg. iv infuse to most patients. they are not telling them, what is up in oahu? they are using vanco for (in patient and out patient surgery.)

i am new, is this normal for infection control.

kandycane

Hi I am a dialysis nurse and had a pt the other week that is in the

ICU and had VRE previously and now is again VRE +. They cultured her urine somehow, she voids about 10 cc/day!! The infection control dept says that to enter the pts room, you must gown, glove, wear shoe covers, mask and cap for your hair. Is this standard iso for VRE?????????? I am not accustomed to the iso procedures for VRE.

Shoe covers, mask and a cap???????? I have never heard of these used for VRE...

THanks for the info! What I hate about what the hospitals I have come in contact with are doing.....These are long term pts, They get a + VRE culture and then isolate them, then get 3 negatives and take them off of isolation, then reculture them a week or 2 later and we find out that they are again + for VRE!! Meanwhile, we have been taking care of the pts and they haven't been on iso and they have been transported out of their rooms, all over the hospital for tests, etc..... Just frustrating.

It happens all the times...Sometimes a pt would come in and he/she is not on isolation a few days later they put the pt. on isolation and all you can think of is "oh boy" I mean everybody was in there without gloves and touching everything...