title: Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting.
abstract: BACKGROUND
  Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals.
  
  
  OBJECTIVE
  To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Adult oncology inpatient unit.
  
  
  METHODS
  259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices.
  
  
  METHODS
  Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed.
  
  
  METHODS
  VRE infection rates, VRE colonization rates, and changes in antimicrobial use.
  
  
  RESULTS
  During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced.
  
  
  CONCLUSIONS
  Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.
authors.affiliation: Division of Infectious Diseases, New York Medical College and Westchester Medical Center, Valhalla 10595, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Montecalvo
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: J
authors.initials: J
authors.lastname: Uman
authors.forename: D K
authors.initials: DK
authors.lastname: Shay
authors.forename: C
authors.initials: C
authors.lastname: Petrullo
authors.forename: K
authors.initials: K
authors.lastname: Rodney
authors.forename: C
authors.initials: C
authors.lastname: Gedris
authors.forename: H W
authors.initials: HW
authors.lastname: Horowitz
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003428:Cross Infection / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control; D016522:Oncology Service, Hospital; D011446:Prospective Studies; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin