Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility.
OBJECTIVE
To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting. OUTBREAK INVESTIGATION: A strain of vancomycin-resistant Enterococcus faecium not previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain of E faecium.


METHODS
Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.


RESULTS
Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day x 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).


CONCLUSIONS
VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.
Armstrong-Evans
M
M
Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Ontario, Canada.
Litt
M
M
McArthur
M A
MA
Willey
B
B
Cann
D
D
Liska
S
S
Nusinowitz
S
S
Gould
R
R
Blacklock
A
A
Low
D E
DE
McGeer
A
A
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D004197:Disease Reservoirs; D004352:Drug Resistance, Microbial; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006707:Homes for the Aged; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods; D008134:Long-Term Care / Q000379:methods; D008297:Male; D009735:Nursing Homes; D009864:Ontario / Q000453:epidemiology; D014640:Vancomycin / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D014640:Vancomycin