title: Effectiveness of a multifaceted infection control policy in reducing vancomycin usage and vancomycin-resistant enterococci at a tertiary care cancer centre.
abstract: We undertook a prospective cohort study to evaluate the role of a multifaceted infection control policy including the use of a "vancomycin order form," in decreasing the transmission of vancomycin-resistant enterococci (VRE). In January 1997, a multifaceted infection-control policy was implemented amongst patients admitted to the M. D. Anderson Cancer Center in whom neutropenic fever developed or who were found to be colonized or infected with VRE. As part of this programme, we initiated the use of a vancomycin order form to reduce the use of empirical vancomycin. The total incidence of VRE infections declined from 0.437/1000 patient days in 1996-97 to 0.229/1000 patient days in 1998-99 (P=0.008). The VRE bloodstream infections declined from 0.338/1000 patient days in 1996-97 to 0.181/1000 patient days in 1998-99 (P=0.027). Empiric vancomycin use decreased from 416 g/1000 patient days in 1996-97 to 208 g/1000 patient days in 1998-99 (P<0.001), resulting in a decreased vancomycin cost from $2561 US dollars/1000 patient days in 1996-97 to $1195 US dollars/1000 patient days in 1997-98 (P<0.001). We conclude that a multifaceted infection control policy incorporating the use of a vancomycin order form can effectively decrease the use of empirical vancomycin and can play a role in limiting the spread of VRE in an endemic setting.
authors: Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors: Z H A
authors: ZH
authors: Shaikh
authors: C A
authors: CA
authors: Osting
authors: H A
authors: HA
authors: Hanna
authors: R B
authors: RB
authors: Arbuckle
authors: J J
authors: JJ
authors: Tarr
authors: I I
authors: II
authors: Raad
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002173:Cancer Care Facilities; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D017053:Infection Control; D011446:Prospective Studies; D013781:Texas / Q000453:epidemiology; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin