TY - JOUR
T1 - Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014-2017
T2 - successful control using a restrictive screening strategy
AU - Weterings, Veronica
AU - van Oosten, Anita
AU - Nieuwkoop, Ellen
AU - Nelson, Jolande
AU - Voss, Andreas
AU - Wintermans, Bas
AU - van Lieshout, Joris
AU - Kluytmans, Jan
AU - Veenemans, Jacobien
N1 - Funding Information:
We would like to acknowledge the healthcare workers, colleagues of the department of Infection control and Laboratory for Microbiology of the Admiraal De Ruyter Hospital?who contributed to the investigation and the control of this outbreak. Furthermore, the authors thank the department of Medical Microbiology and Infection Control of Amsterdam UMC for the AFLP analysis and dendrogram construction.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/2/18
Y1 - 2021/2/18
N2 - BACKGROUND: The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014-February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as 'VRE suspected'. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak.METHODS: After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing 'VRE suspected' label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak.RESULTS: Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected.CONCLUSION: We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.
AB - BACKGROUND: The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014-February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as 'VRE suspected'. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak.METHODS: After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing 'VRE suspected' label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak.RESULTS: Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected.CONCLUSION: We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.
KW - Isolation strategy
KW - Outbreak
KW - Resistance
KW - Screening strategy
KW - Vancomycin-resistant enterococci
KW - VRE
UR - http://www.scopus.com/inward/record.url?scp=85101212672&partnerID=8YFLogxK
U2 - 10.1186/s13756-021-00906-x
DO - 10.1186/s13756-021-00906-x
M3 - Article
C2 - 33602300
SN - 2047-2994
VL - 10
SP - 1
EP - 10
JO - Antimicrobial Resistance and Infection Control
JF - Antimicrobial Resistance and Infection Control
IS - 1
M1 - 38
ER -