title: Screening and electronic labelling of ward contacts of vancomycin-resistant Enterococcus faecium vanB carriers during a single-strain hospital outbreak and after discharge from hospital.
abstract: A large single-strain outbreak of vancomycin-resistant Enterococcus faecium (VREF) vanB occurred in Royal Perth Hospital from July to December 2001. When a VREF-carrying patient was discovered on a ward, all patients on the ward were screened with rectal swabs. A total of 172 patients were colonised, four with infections, but no deaths were attributable to VREF. The number of rectal swabs required to detect each carrier was recorded. On average four rectal swabs, each collected on separate days, were needed to detect more than 90 per cent of the 172 VREF carriers who were epidemiologically linked to the Royal Perth Hospital outbreak. An electronic alert system (Micro-Alert) was used to identify ward contacts of VREF carriers and enabled those who had not been screened before discharge to be followed-up and screened. Ninety-six contacts were actively followed-up in October 2001 and 32 (33.3%) were found to be VREF carriers. From 28 September 2001 to 30 April 2002, a total of 1,977 ward contacts were screened after discharge from hospital and 54 (2.73%) were found to be carrying VREF. We conclude that during single-strain outbreaks of vancomycin-resistant enterococci in hospitals, patient contacts need to be screened on more than three occasions in order to detect most of the carriers and control the outbreak. Secondly, electronic labelling and active follow-up of ward contacts of VREF carriers resulted in a significant number of carriers being detected who otherwise posed a risk of initiating further outbreaks in hospitals if they were readmitted.
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia. john.pearman@health.wa.gov.au
authors.forename: John W
authors.initials: JW
authors.lastname: Pearman
authors.forename: Peta L
authors.initials: PL
authors.lastname: Perry
authors.forename: Frank P
authors.initials: FP
authors.lastname: Kosaras
authors.forename: Charles R
authors.initials: CR
authors.lastname: Douglas
authors.forename: Rosie C
authors.initials: RC
authors.lastname: Lee
authors.forename: Allison M
authors.initials: AM
authors.lastname: Peterson
authors.forename: C Terri
authors.initials: CT
authors.lastname: Orrell
authors.forename: Claire H
authors.initials: CH
authors.lastname: Khinsoe
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
authors.forename: Keryn J
authors.initials: KJ
authors.lastname: Christiansen
mesh_terms: D002353:Carrier State / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D016358:Contact Tracing / Q000379:methods*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D008403:Mass Screening; D010351:Patient Discharge; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D014640:Vancomycin