Room contamination, patient colonization pressure, and the risk of vancomycin-resistant Enterococcus colonization on a unit dedicated to the treatment of hematologic malignancies and hematopoietic stem cell transplantation.
Contaminated surfaces and colonization pressure are risk factors for vancomycin-resistant Enterococcus (VRE) colonization in intensive care units (ICUs). Whether these apply to modern units dedicated to the care of hematologic malignancies and hematopoietic stem cell transplant (HSCT) procedures is unknown.



We reviewed the records of 780 consecutive admissions for acute leukemia, autologous HSCT, or allogeneic HSCT in which the patient was at risk for hospital-acquired VRE and underwent weekly surveillance. We also obtained staff and room cultures, observed staff behavior, and performed VRE molecular strain typing on selected isolates.



The overall rate of VRE colonization was 11.4 cases/1,000 patient days. Cultures of room surfaces revealed VRE isolates in 10% of terminally cleaned rooms. A prior VRE-colonized room occupant did not increase risk, and paired isolates from 20 patients and prior occupants were indistinguishable on molecular typing in only 1 pair. VRE colonization pressure was significantly associated with acquisition. Cultures of unit personnel and shared equipment were negative except for weighing scales. Observation of unit clinical personnel showed high compliance for hand sanitation and but less so for gowns. Conversely, ancillary staff showed poor compliance.



Transmission of VRE from room surfaces seems to be an infrequent event. Encouraging adherence to surveillance, disinfection, and contact isolation protocols may decrease VRE colonization rates.
Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, UT; Division of Infectious Diseases, LDS Hospital, Salt Lake City, UT. Electronic address: clyde.ford@imail.org.
Clyde D
CD
Ford
Division of Infectious Diseases, LDS Hospital, Salt Lake City, UT; Division of Infectious Diseases, University of Utah, Salt Lake City, UT.
Bert K
BK
Lopansri
Division of Infectious Diseases, LDS Hospital, Salt Lake City, UT.
Michaela A
MA
Gazdik
Division of Infectious Diseases, LDS Hospital, Salt Lake City, UT; Division of Infectious Diseases, University of Utah, Salt Lake City, UT.
Brandon
B
Webb
Statistical Data Center, LDS Hospital, Salt Lake City, UT.
Gregory L
GL
Snow
Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, UT.
Daanish
D
Hoda
Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, UT.
Barbara
B
Adams
Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, UT.
Finn Bo
FB
Petersen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection; D016983:Enterococcus / Q000302:isolation & purification*; D004783:Environmental Microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000635:transmission; D019337:Hematologic Neoplasms; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance; D055815:Young Adult
D000900:Anti-Bacterial Agents; D014640:Vancomycin
Acute leukemia; Environmental contamination; Healthcare worker compliance