Control of Vancomycin-Resistant Enterococci at a Community Hospital: Efficacy of Patient and Staff Cohorting

OBJECTIVE: To evaluate the efficacy of patient and staff cohorting to control vancomycin-resistant enterococci (VRE) at an Indianapolis community hospital. DESIGN: To interrupt transmission of VRE, a VRE pointprevalence survey of hospital inpatients was conducted, and VREinfected or -colonized patients were cohorted on a single ward with dedicated nursing staff and patient-care equipment. To assess the impact of the intervention, staff compliance with contact isolation procedures was observed, and the VRE point-prevalence survey was repeated 2 months after the cohort ward was established. RESULTS: Following the establishment of the cohort ward, VRE prevalence among all hospitalized inpatients decreased from 8.1% to 4.7% (25 positive cultures among 310 patients compared to 13 positive cultures among 276 patients, P=.14); VRE prevalence among patients whose VRE status was unknown before cultures were obtained decreased from 5.9% to 0.8% (18 positive cultures among 303 patients compared to 2 positive cultures among 262 patients, P=.002); and observed staff-patient interactions compliant with published isolation recommendations increased (5 [22%] of 23 interactions compared to 36 [88%] of 41 interactions, P<.0001). CONCLUSIONS: Our data suggest that, in hospitals with endemic VRE or continued VRE transmission despite implementation of contact isolation measures, establishing a VRE cohort ward may be a practical and effective method to improve compliance with infection control measures and thereby to control epidemic or endemic VRE transmission (Infect Control Hosp Epidemiol 1999;20:106-109). Vancomycin-resistant enterococci (VRE) have emerged as a major cause of hospital-acquired infections. Between 1989 and 1996, the percentage of nosocomial enterococcal infections caused by strains resistant to vancomycin reported to the National Nosocomial Infections Surveillance System increased from 0.3% to 15% (unpublished data, Centers for Disease Control and Prevention [CDC], 1997). 1 Over the past several years, there have been numerous reports of VRE outbreaks in acute-care facilities. 2-6 At the same time, data from state health departments have shown that the prevalence of VRE is increasing rapidly in hospitals. 7 This increase poses important problems because of the lack of available effective antimicrobial therapy for these infections and the possibility of transfer of vancomycin-resistance genes to other gram-positive microorganisms, such as Staphylococcus aureus. 8