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Vancomycin-Resistant Enterococci (VRE) in The Intensive Care Unit in a Nonoutbreak Setting: Identification of Potential Reservoirs and Epidemiological Associations Between Patient and Environmental VRE

Published online by Cambridge University Press:  14 December 2017

Hélène McDermott ,
Mairead Skally ,
James O’Rourke ,
Hilary Humphreys  and
Deirdre Fitzgerald-Hughes
Hélène McDermott
Affiliation:
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Center, Beaumont Hospital, Dublin. Ireland
Mairead Skally
Affiliation:
Department of Microbiology, Beaumont Hospital, Dublin, Ireland
James O’Rourke
Affiliation:
Department of Anesthesia, Beaumont Hospital, Dublin, Ireland
Hilary Humphreys
Affiliation:
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Center, Beaumont Hospital, Dublin. Ireland Department of Microbiology, Beaumont Hospital, Dublin, Ireland
Deirdre Fitzgerald-Hughes*
Affiliation:
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Center, Beaumont Hospital, Dublin. Ireland
*
Address correspondence to Dr Deirdre Fitzgerald Hughes, Department of Clinical Microbiology, RCSI Education and Research Center, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland (dfitzgeraldhughes@rcsi.ie)
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Abstract

OBJECTIVE

Among nosocomial bloodstream infections caused by enterococcal species, Ireland has the highest proportion caused by vancomycin-resistant enterococci (VRE) in Europe at 45.8%. The contribution of the near-patient environment to VRE transmission outside of outbreaks was investigated.

DESIGN

A prospective observational study was conducted during 7 sampling periods.

METHODS

Recovery of VRE isolates by swabbing the near-patient environment and patients in the intensive care unit (ICU) was conducted to identify reservoirs, clinical and molecular epidemiological associations, and the success of active surveillance cultures (ASCs).

RESULTS

Of 289 sampling occasions involving 157 patients and their bed spaces, VRE isolates were recovered from patient bed spaces, clinical samples, or both on 114 of 289 sampling occasions (39.4%). The patient and their bed space were positive for VRE on 34 of 114 VRE-associated sampling occasions (29.8%). Of 1,647 environment samples, 107 sites (6.5%) were VRE positive, with significantly greater VRE recovery from isolation rooms than from the open-plan area (9.1% vs 4.1%; P < .0001). The most frequently VRE-contaminated sites were the drip stand, bed control panel, and chart holders, which together accounted for 61% of contaminated sites. The use of ASCs resulted in a 172% increase in identification of VRE-colonized patients. Molecular typing revealed 2 environmental clusters, 1 cluster involving 3 patients and generally greater heterogeneity of patient isolates compared to environmental isolates.

CONCLUSION

Even outside of outbreaks, near-patient ICU environmental contamination with VRE is common. Better infection control policies that limit environmental transmission of VRE in the ICU and that are supported by molecular epidemiological studies, in real time, are needed.

Infect Control Hosp Epidemiol 2018;39:40–45

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 40 - 45
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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