title: Horizontal infection prevention measures and a risk-managed approach to vancomycin-resistant enterococci: An evaluation.
abstract: BACKGROUND
  The use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed.
  
  
  METHODS
  Routine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions. Cost avoidance and value-added benefits were monitored by the hospital finance department. VRE monitoring on these high-risk units and facility-wide comprehensive bacteremia surveillance continued as per established protocols. Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI) remained unchanged.
  
  
  RESULTS
  VRE bacteremia rates did not increase with the change to the VRE risk-managed approach. The number of patients requiring VRE isolation in all areas of the hospital decreased from an average of 32 to 6 beds per day. Statistically significant reductions in CDI and MRSA rates were observed possibly related to the aggressive decluttering, equipment cleaning, and AMS program elements.
  
  
  CONCLUSIONS
  A risk-managed approach to VRE can be implemented without adverse consequences and potentially with significant benefits to a facility.
authors.affiliation: Infection Prevention and Control, Vancouver Coastal Health, Vancouver, BC, Canada. Electronic address: elizabeth.bryce@vch.ca.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bryce
authors.affiliation: Infection Prevention and Control, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Grant
authors.affiliation: Infection Prevention and Control, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Sydney
authors.initials: S
authors.lastname: Scharf
authors.affiliation: Patient Safety and Quality, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Dempster
authors.affiliation: Pharmaceutical Sciences, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Tim T Y
authors.initials: TT
authors.lastname: Lau
authors.affiliation: Patient Safety and Quality, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Felicia
authors.initials: F
authors.lastname: Laing
authors.affiliation: Patient Safety and Quality, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Salomeh
authors.initials: S
authors.lastname: Shajari
authors.affiliation: Patient Safety and Quality, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Forrester
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004363:Drug Utilization / Q000592:standards; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods*; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Risk management; Vancomycin-resistant enterococci