title: Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital.
abstract: BACKGROUND
  Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe the epidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control.
  
  
  METHODS
  We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures.
  
  
  RESULTS
  There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001).
  
  
  CONCLUSIONS
  Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.
authors.affiliation: Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP.
authors.forename: Flávia Alves Ferreira
authors.initials: FA
authors.lastname: Rossini
authors.forename: Renata
authors.initials: R
authors.lastname: Fagnani
authors.forename: Mirtes Loeschner
authors.initials: ML
authors.lastname: Leichsenring
authors.forename: Sônia Regina Perez Evangelista
authors.initials: SR
authors.lastname: Dantas
authors.forename: Luís Gustavo de Oliveira
authors.initials: LG
authors.lastname: Cardoso
authors.forename: Carlos Emílio
authors.initials: CE
authors.lastname: Levy
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Moretti
authors.forename: Plínio
authors.initials: P
authors.lastname: Trabasso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002648:Child; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D020713:Vancomycin Resistance; D055815:Young Adult