Preventing the spread of vancomycin-resistant enterococci in a long-term care facility.
OBJECTIVE
To test the hypothesis that infection control practices can prevent the spread of vancomycin-resistant enterococci (VRE) to residents of a long-term care facility (LCF) from an affiliated acute care facility with a high endemic rate of colonization.


METHODS
Point prevalence study of the rate of rectal colonization.


METHODS
A state-supported veterans nursing home and an acute care veterans hospital.


METHODS
Residents in a state veterans home.


METHODS
Identification of patients with rectal colonization by VRE before transfer to the state veterans home, contact isolation for colonized veterans, use of oral bacitracin to eliminate colonization.


METHODS
Rectal swab and culture for VRE, review of clinical records and recording of presumptive risk factors for VRE colonization. The risk factors were age, gender, length of stay at nursing home, treatment with vancomycin or oral antibiotics, prior hospitalization at the acute care facility during the prior year, use of indwelling urethral catheters, presence of diarrhea, and fecal or urinary incontinence.


RESULTS
Sixty-nine of 200 residents were cultured in the first study (1996) and 130 of 230 residents were cultured in the second study (1998). Residents who consented to culture differed from those who did not only with regards to gender (2 vs 7, P = .012). In neither study were any residents found to be colonized with VRE who had not already been identified as positive on admission.


CONCLUSIONS
Adherence to infection control practices by the patient care staff of the LTCF was associated with the absence of transmission of VRE colonization among its residents. The presence of rectal colonization with VRE in an acute care patient should not be a barrier to acceptance in a nursing home.
Silverblatt
F J
FJ
Department of Veterans Affairs Medical Center, Providence, Rhode Island 02908, USA.
Tibert
C
C
Mikolich
D
D
Blazek-D'Arezzo
J
J
Alves
J
J
Tack
M
M
Agatiello
P
P
D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001414:Bacitracin / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D016022:Case-Control Studies; D019353:Endemic Diseases / Q000517:prevention & control* / Q000706:statistics & numerical data; D016983:Enterococcus; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D006787:Hospitals, Veterans; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D010360:Patient Transfer; D015995:Prevalence; D012007:Rectum / Q000382:microbiology*; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D014481:United States; D014493:United States Department of Veterans Affairs; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D001414:Bacitracin