Skip to main content
Erschienen in: Infection 6/2011

01.12.2011 | Correspondence

Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates

verfasst von: M. R. E. Perugini, S. M. Nomi, G. K. Lopes, R. A. Belei, I. M. van der Heijden, A. K. Q. Mostachio, C. Grion, E. B. Couto Jr., S. F. Costa

Erschienen in: Infection | Ausgabe 6/2011

Einloggen, um Zugang zu erhalten

Abstract

More than 1,500 perirectal swab cultures and 552 environmental and equipment cultures were collected during the study period. Enterococcus faecium was the most frequent species isolated, being responsible for 71% of the positive cultures. Fifty infections were documented, with bloodstream infections (18, 36%) being the most frequent, followed by urinary tract infection (15, 30%). An educational intervention was given to 136 healthcare workers (HCWs), and a questionnaire regarding vancomycin-resistant enterococcus (VRE) transmission was also performed pre- and post-intervention. Overall, 858 opportunities of patient care were evaluated. The compliance with contact precautions did not improve; however, in general, the proportion of correct answers regarding VRE increased significantly when comparing pre- and post-intervention periods (p < 0.05). On the other hand, the proportion of environmental and equipment contaminated by VRE decreased significantly from pre- (23.2%) to post-intervention (8.2%) (p < 0.001) and was associated with a significant decrease in VRE infection from 7.7 to 1.9 when comparing the pre- and post-intervention periods. The use of vancomycin (defined daily dose [DDD]) did not change significantly over the study period (p = 0.970), and the use of teicoplanin increased (p < 0.001). Seventy-six percent of E. faecium belong to type and subtype A by pulsed-field gel electrophoresis (PFGE). This predominant type was found in the environment and caused colonization and infection. In conclusion, the present study showed that reduction of the proportion of environmental and equipment contamination was associated with a decrease of colonization and infection due to VRE, and that the strategy to control VRE dissemination should be based on local problems.
Literatur
1.
Zurück zum Zitat Yeh KM, Siu LK, Chang JC, Chang FY. Vancomycin-resistant enterococcus (VRE) carriage and infection in intensive care units. Microb Drug Resist. 2004;10:177–83.PubMedCrossRef Yeh KM, Siu LK, Chang JC, Chang FY. Vancomycin-resistant enterococcus (VRE) carriage and infection in intensive care units. Microb Drug Resist. 2004;10:177–83.PubMedCrossRef
2.
Zurück zum Zitat Lin MY, Hayden MK. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: recognition and prevention in intensive care units. Crit Care Med. 2010;38:S335–44.PubMedCrossRef Lin MY, Hayden MK. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: recognition and prevention in intensive care units. Crit Care Med. 2010;38:S335–44.PubMedCrossRef
3.
Zurück zum Zitat Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect. 2007;65:50–4.PubMedCrossRef Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect. 2007;65:50–4.PubMedCrossRef
4.
Zurück zum Zitat Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med. 2006;166:1945–51.PubMedCrossRef Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med. 2006;166:1945–51.PubMedCrossRef
5.
Zurück zum Zitat Drees M, Snydman DR, Schmid CH, Barefoot L, Hansjosten K, Vue PM, Cronin M, Nasraway SA, Golan Y. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008;46:678–85.PubMedCrossRef Drees M, Snydman DR, Schmid CH, Barefoot L, Hansjosten K, Vue PM, Cronin M, Nasraway SA, Golan Y. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008;46:678–85.PubMedCrossRef
6.
Zurück zum Zitat Grabsch EA, Burrell LJ, Padiglione A, O’Keeffe JM, Ballard S, Grayson ML. Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis. Infect Control Hosp Epidemiol. 2006;27:287–93.PubMedCrossRef Grabsch EA, Burrell LJ, Padiglione A, O’Keeffe JM, Ballard S, Grayson ML. Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis. Infect Control Hosp Epidemiol. 2006;27:287–93.PubMedCrossRef
7.
Zurück zum Zitat Duckro AN, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med. 2005;165:302–7.PubMedCrossRef Duckro AN, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med. 2005;165:302–7.PubMedCrossRef
8.
Zurück zum Zitat Lemmen SW, Häfner H, Zolldann D, Stanzel S, Lütticken R. Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment. J Hosp Infect. 2004;56:191–7.PubMedCrossRef Lemmen SW, Häfner H, Zolldann D, Stanzel S, Lütticken R. Distribution of multi-resistant Gram-negative versus Gram-positive bacteria in the hospital inanimate environment. J Hosp Infect. 2004;56:191–7.PubMedCrossRef
9.
Zurück zum Zitat Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol. 2005;26:650–3.PubMedCrossRef Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol. 2005;26:650–3.PubMedCrossRef
11.
Zurück zum Zitat Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 2003;52:1–42.PubMed Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 2003;52:1–42.PubMed
12.
Zurück zum Zitat Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40.PubMedCrossRef Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40.PubMedCrossRef
13.
Zurück zum Zitat Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis. 2007;44:664–70.PubMedCrossRef Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis. 2007;44:664–70.PubMedCrossRef
14.
Zurück zum Zitat van Belkum A, Tassios PT, Dijkshoorn L, Haeggman S, Cookson B, Fry NK, Fussing V, Green J, Feil E, Gerner-Smidt P, Brisse S, Struelens M; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Epidemiological Markers (ESGEM). Guidelines for the validation and application of typing methods for use in bacterial epidemiology. Clin Microbiol Infect. 2007;3:1–46.CrossRef van Belkum A, Tassios PT, Dijkshoorn L, Haeggman S, Cookson B, Fry NK, Fussing V, Green J, Feil E, Gerner-Smidt P, Brisse S, Struelens M; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Epidemiological Markers (ESGEM). Guidelines for the validation and application of typing methods for use in bacterial epidemiology. Clin Microbiol Infect. 2007;3:1–46.CrossRef
15.
Zurück zum Zitat Petrich AK, Luinstra KE, Groves D, Chernesky MA, Mahony JB. Direct detection of vanA and vanB genes in clinical specimens for rapid identification of vancomycin resistant enterococci (VRE) using multiplex PCR. Mol Cell Probes. 1999;13:275–81.PubMedCrossRef Petrich AK, Luinstra KE, Groves D, Chernesky MA, Mahony JB. Direct detection of vanA and vanB genes in clinical specimens for rapid identification of vancomycin resistant enterococci (VRE) using multiplex PCR. Mol Cell Probes. 1999;13:275–81.PubMedCrossRef
16.
Zurück zum Zitat Dalla Costa LM, Souza DC, Martins LT, Zanella RC, Brandilone MC, Bokermann S, Sader HS, Souza HA. Vancomycin-resistant Enterococcus faecium: first case in Brazil. Braz J Infect Dis. 1998;2:160–3.PubMed Dalla Costa LM, Souza DC, Martins LT, Zanella RC, Brandilone MC, Bokermann S, Sader HS, Souza HA. Vancomycin-resistant Enterococcus faecium: first case in Brazil. Braz J Infect Dis. 1998;2:160–3.PubMed
17.
Zurück zum Zitat Tresoldi AT, Cardoso LG, Castilho GV, Dantas SR, von Nowakonski A, Pereira RM, Trabasso P. Low prevalence of vancomycin resistant enterococci colonization in intensive care patients in a Brazilian teaching hospital. Braz J Infect Dis. 2006;10:239–41.PubMedCrossRef Tresoldi AT, Cardoso LG, Castilho GV, Dantas SR, von Nowakonski A, Pereira RM, Trabasso P. Low prevalence of vancomycin resistant enterococci colonization in intensive care patients in a Brazilian teaching hospital. Braz J Infect Dis. 2006;10:239–41.PubMedCrossRef
18.
Zurück zum Zitat Furtado GHC, Martins ST, Coutinho AP, Wey SB, Medeiros EA. Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil. Braz J Infect Dis. 2005;9:64–9.PubMedCrossRef Furtado GHC, Martins ST, Coutinho AP, Wey SB, Medeiros EA. Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil. Braz J Infect Dis. 2005;9:64–9.PubMedCrossRef
19.
Zurück zum Zitat Slaughter S, Hayden MK, Nathan C, Hu TC, Rice T, Van Voorhis J, Matushek M, Franklin C, Weinstein RA. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med. 1996;125:448–56.PubMed Slaughter S, Hayden MK, Nathan C, Hu TC, Rice T, Van Voorhis J, Matushek M, Franklin C, Weinstein RA. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med. 1996;125:448–56.PubMed
20.
Zurück zum Zitat Puzniak LA, Leet T, Mayfield J, Kollef M, Mundy LM. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2002;35:18–25.PubMedCrossRef Puzniak LA, Leet T, Mayfield J, Kollef M, Mundy LM. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2002;35:18–25.PubMedCrossRef
21.
Zurück zum Zitat Hayden MK, Blom DW, Lyle EA, Moore CG, Weinstein RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol. 2008;29:149–54.PubMedCrossRef Hayden MK, Blom DW, Lyle EA, Moore CG, Weinstein RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol. 2008;29:149–54.PubMedCrossRef
22.
Zurück zum Zitat Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 2000;160:1017–21.PubMedCrossRef Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 2000;160:1017–21.PubMedCrossRef
23.
Zurück zum Zitat Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol. 2005;26:650–3.PubMedCrossRef Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol. 2005;26:650–3.PubMedCrossRef
24.
Zurück zum Zitat Martínez JA, Ruthazer R, Hansjosten K, Barefoot L, Snydman DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med. 2003;163:1905–12.PubMedCrossRef Martínez JA, Ruthazer R, Hansjosten K, Barefoot L, Snydman DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med. 2003;163:1905–12.PubMedCrossRef
25.
Zurück zum Zitat Eckstein BC, Adams DA, Eckstein EC, Rao A, Sethi AK, Yadavalli GK, Donskey CJ. Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007;7:61.PubMedCrossRef Eckstein BC, Adams DA, Eckstein EC, Rao A, Sethi AK, Yadavalli GK, Donskey CJ. Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007;7:61.PubMedCrossRef
26.
Zurück zum Zitat Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis. 2006;42:1552–60.PubMedCrossRef Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis. 2006;42:1552–60.PubMedCrossRef
27.
Zurück zum Zitat Hota B, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product, or procedure? J Hosp Infect. 2009;71:123–31.PubMedCrossRef Hota B, Blom DW, Lyle EA, Weinstein RA, Hayden MK. Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product, or procedure? J Hosp Infect. 2009;71:123–31.PubMedCrossRef
28.
Zurück zum Zitat Kuriyama T, Williams DW, Patel M, Lewis MA, Jenkins LE, Hill DW, Hosein IK. Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from a teaching hospital in Wales. J Med Microbiol. 2003;52:821–7.PubMedCrossRef Kuriyama T, Williams DW, Patel M, Lewis MA, Jenkins LE, Hill DW, Hosein IK. Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from a teaching hospital in Wales. J Med Microbiol. 2003;52:821–7.PubMedCrossRef
29.
Zurück zum Zitat Barbosa D, Lima L, Silbert S, Sader H, Cendoroglo M, Draibe S, Camargo L, Vianna L, Belasco A, Sesso R. Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis. Am J Kidney Dis. 2004;44:337–43.PubMedCrossRef Barbosa D, Lima L, Silbert S, Sader H, Cendoroglo M, Draibe S, Camargo L, Vianna L, Belasco A, Sesso R. Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis. Am J Kidney Dis. 2004;44:337–43.PubMedCrossRef
30.
Zurück zum Zitat Falk PS, Winnike J, Woodmansee C, Desai M, Mayhall CG. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol. 2000;21:575–82.PubMedCrossRef Falk PS, Winnike J, Woodmansee C, Desai M, Mayhall CG. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol. 2000;21:575–82.PubMedCrossRef
Metadaten
Titel
Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates
verfasst von
M. R. E. Perugini
S. M. Nomi
G. K. Lopes
R. A. Belei
I. M. van der Heijden
A. K. Q. Mostachio
C. Grion
E. B. Couto Jr.
S. F. Costa
Publikationsdatum
01.12.2011
Verlag
Springer-Verlag
Erschienen in
Infection / Ausgabe 6/2011
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-011-0140-6

Weitere Artikel der Ausgabe 6/2011

Infection 6/2011 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.