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Canada Communicable Disease Report

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Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Preventing the Spread of Vancomycin-Resistant Enterococci (VRE) in Canada

Guidelines for Preventing the Spread of VRE (adapted from HICPAC) RECOMMENDATIONS

  1. The use of a single room with a private bathroom is essential for VRE positive patients with diarrhea, fecal incontinence, an ileostomy or colostomy, or open wounds, or in whom basic personal hygienic practices may be compromised by illness or age. Infants, toddlers, and cognitively or functionally impaired elderly patients are unaware of good hygienic practices. The large amount of hands-on care they require increases the likelihood of infection being transmitted or acquired. Therefore, education of parents and family members about the role of good hand washing and prompt disposal of diapers and soiled garments in the prevention of VRE transmission is of utmost importance(78). Patients without these symptoms or medical conditions and in whom basic hygienic practices are not compromised present less of a risk for transmission of VRE. There are no clear guidelines as to how such patients are best managed. Personal hygiene is a major factor that will guide decisions concerning isolation precautions. (Category B; Grade III - see Appendix)

  2. Health care personnel should wear gloves and gowns when entering the room of a patient who has been placed in isolation(43,79,80). It is important to change gloves between patient-care tasks. (Category B; Grade III)

  3. Gloves and gowns should be removed before leaving the patient's room and hands washed carefully with an antiseptic agent(79,81-84) or an antiseptic hand rinse if sinks are not readily available. After hand washing, the hands should not contact potentially contaminated environmental surfaces in the patient's room. (Category B; Grade III)

  4. For patients in isolation, equipment such as stethoscopes, blood pressure cuffs, scales, and all thermometers and thermometer components, including the electronic thermometer base, should remain in the room to be used with the patient colonized/infected with VRE(16). These items should be cleaned and appropriately disinfected before being used with other patients(79,85). Toys and infant weigh scales can serve as a reservoir of VRE in a nursery and/or pediatric unit. Only washable toys (no stuffed animals) should be available, and they should be disinfected before being put back into general circulation. A barrier (e.g., paper towel) should be placed between the infant and the weigh scale to ensure minimum contamination. Proper disinfection of the scale is essential after use. Any equipment used for multiple patients, such as portable radiographic machinery, electroencephalographic or pulse oximetry equipment, that comes in contact with the patient with VRE or potentially contaminated environmental surfaces should be cleaned with a low level disinfectant immediately after use(79). (Category B; Grade III)

  5. Screening surveys (perirectal swabs or stools, cultures of open wounds and drainages) should be conducted of roommates of patients newly found to be VRE positive. Additional screening of other ward patients, other potential contacts, staff and the environment may also be considered in outbreak situations, depending on the individual circumstances at the health care facility. (Category B; Grade III)

  6. There should be a policy for discontinuation of isolation. The optimal requirements are unknown, and individual discretion is required based on the setting, the patient population and other factors. A facility may choose to discontinue isolation precautions once the patient is reasonably well, continent of stool and capable of self-care with good hygiene. (Category C)

  7. A system should be established to permit identification of patients positive for multi-resistant organisms (e.g., MRSA, VRE) who are admitted, readmitted, or transferred to health care facilities. Consideration should be given to screening patients admitted from VRE endemic regions. Communication between infection control personnel upon transfer to other facilities (including long-term care, chronic care) is essential. (Category B; Grade III)

  8. Policies must be in place for the thorough cleaning and disinfection of environmental surfaces (bed rails, call bells, bedside tables, commodes, bathrooms) that may have been contaminated(16,43,63,68,86). Detergents or low level disinfectants are effective for cleaning when special attention is given to visibly soiled areas. Communication with housekeeping, nursing and administrative personnel is of particular importance in this setting(79). (Category B; Grade III)

  9. Transfers to other facilities such as long term care, rehabilitation, or other acute care facilities should not be delayed for patients who are colonized or infected with VRE. The facility receiving the patient should be notified that the patient has VRE. It should be able to provide appropriate isolation and care based on the assessment of the individual patient (as outlined in recommendations a to d) and the type of setting (acute care facility, rehabilitation centre, nursing home). Health care workers in long-term care, nursing homes, and rehabilitation facilities can refer to these guidelines or the long term care guidelines(87) for further assistance. (Category B; Grade III)

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