Utility of environmental sampling for the prevention of transmission of vancomycin resistant enterococci (VRE) in hospitals.
BACKGROUND
Although vancomycin resistant enterococci (VRE) have been shown to contaminate environmental surfaces in the room of a patient infected or colonized with VRE there is limited evidence that links environmental contamination with acquisition.


OBJECTIVE
To determine whether a policy of environmental sampling and room closure is more effective than cleaning and visual inspection of the room without culturing, in preventing the transmission of VRE to the next admitted patient.


METHODS
The rooms of consecutive patients with VRE were alternatively managed according to either Protocol I (terminal cleaning, inspection and admission of new patient(s)) or Protocol II (terminal cleaning, environmental cultures and closing of the room pending negative results). The next admitted patient to all rooms had rectal swabs obtained for VRE within 24 hours of admission, three to five days after admission and upon discharge from the room and/or the facility. The proportion of patients who acquired the same strain of VRE after being admitted to rooms handled according to either Protocol I or Protocol II was compared.


RESULTS
The risk of acquisition of VRE by patients admitted to a room managed according to Protocol I (1/19) was not significantly different than for patients admitted to a room managed according to Protocol II (0/12) (p=0.99). At least one positive environmental culture was obtained in 8/14 (57.1%) rooms managed according to Protocol II.


CONCLUSIONS
Although VRE may be detected in the hospital environment there is insufficient evidence to conclude that routinely obtaining negative environmental cultures from the room of a patient infected or colonized with the organism is more effective in preventing VRE transmission to subsequent patients, provided the room is adequately cleaned and disinfected.
Williams
Victoria R
VR
Infection Prevention and Control, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Office B112, Toronto, ON M4N 3M5. Victoria.Williams@sunnybrook.ca
Callery
Sandra
S
Vearncombe
Mary
M
Simor
Andrew E
AE
D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D052918:Environmental Restoration and Remediation; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods*; D010362:Patients' Rooms; D014640:Vancomycin / Q000494:pharmacology; D020713:Vancomycin Resistance
D014640:Vancomycin