Practice forumHorizontal infection prevention measures and a risk-managed approach to vancomycin-resistant enterococci: An evaluation

•A risk-managed approach to vancomycin-resistant enterococci management was implemented only after introduction of 2 horizontal infection prevention measures, namely a comprehensive environmental cleaning program and an antimicrobial stewardship program.•As part of the risk-managed approach, clinical units deemed at higher risk of vancomycin-resistant enterococci (VRE) infection (bone marrow and solid organ transplant units, burns-trauma unit, intensive care unit) continued to perform admission and weekly point prevalence screening for VRE, whereas all other areas discontinued admission screening for VRE and VRE isolation precautions.•Surveillance for methicillin-resistant Staphylococcus aureus and Clostridium difficile remained unchanged for all clinical units, including the higher-risk units.•Almost 2 years after the vancomycin-resistant enterococci (VRE) risk management approach was introduced, VRE bacteremias remain unchanged throughout the facility; the number of patients requiring VRE isolation in all areas of the hospital decreased from 32 (new and readmitted patients) to 6 beds per day.•The aggressive equipment and surface cleaning program and antimicrobial stewardship efforts have resulted in statistically significant decreases in rates of Clostridium difficile and methicillin-resistant Staphylococcus aureus.

BackgroundThe use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed.MethodsRoutine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions. Cost avoidance and value-added benefits were monitored by the hospital finance department. VRE monitoring on these high-risk units and facility-wide comprehensive bacteremia surveillance continued as per established protocols. Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI) remained unchanged.ResultsVRE bacteremia rates did not increase with the change to the VRE risk-managed approach. The number of patients requiring VRE isolation in all areas of the hospital decreased from an average of 32 to 6 beds per day. Statistically significant reductions in CDI and MRSA rates were observed possibly related to the aggressive decluttering, equipment cleaning, and AMS program elements.ConclusionA risk-managed approach to VRE can be implemented without adverse consequences and potentially with significant benefits to a facility.