title: A hospital-wide screening programme to control an outbreak of vancomycin-resistant enterococci in a large tertiary hospital in Hong Kong.
abstract: BACKGROUND
  Apart from individual small-scale outbreaks, infections with vancomycin-resistant enterococci are uncommon in Hong Kong. A major outbreak of vancomycin-resistant enterococci, however, occurred at a large tertiary hospital in 2013. We describe the successful control of this outbreak and share the lessons learned.
  
  
  METHODS
  In 2013, there was an abnormal increase in the incidence of vancomycin-resistant enterococci carriage compared with baseline in multiple clinical departments at Queen Elizabeth Hospital. A multipronged approach was adopted that included a 10-week hospital-wide active screening programme, which aimed to identify and isolate hidden vancomycin-resistant enterococci carriers among all in-patients. The identified carriers were completely segregated in designated wards where applicable. Other critical infection control measures included directly observed hand hygiene and environmental hygiene. A transparent and open disclosure approach was adopted throughout the outbreak.
  
  
  RESULTS
  The infection control measures were successfully implemented. The active screening of vancomycin-resistant enterococci was conducted between 30 September and 10 November 2013. A total of 7053 rectal swabs were collected from patients in 46 hospital wards from 11 departments. The overall carriage rate of vancomycin-resistant enterococci was 2.8% (201/7053). Pulsed-field gel electrophoresis showed a predominant outbreak clone. We curbed the outbreak and kept the colonisation of vancomycin-resistant enterococci among patients at a pre-upsurge low level.
  
  
  CONCLUSIONS
  We report the largest cohesive effort to control spread of vancomycin-resistant enterococci in Hong Kong. Coupled with other infection control measures, we successfully controlled vancomycin-resistant enterococci to the pre-outbreak level. We have demonstrated that the monumental tasks can be achieved with meticulous planning, and thorough communication and understanding between all stakeholders.
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Hong Kong.|Infection Control Team, Queen Elizabeth Hospital, Hong Kong.
authors.forename: C Kc
authors.initials: CK
authors.lastname: Lai
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Hong Kong.|Infection Control Team, Queen Elizabeth Hospital, Hong Kong.
authors.forename: S Yn
authors.initials: SY
authors.lastname: Wong
authors.affiliation: Infection Control Team, Queen Elizabeth Hospital, Hong Kong.
authors.forename: S Sy
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Chief Infection Control Officer's Office, Hospital Authority, Hong Kong.
authors.forename: H K
authors.initials: HK
authors.lastname: Siu
authors.affiliation: Department of Microbiology, The Chinese University of Hong Kong, Hong Kong.
authors.forename: C Y
authors.initials: CY
authors.lastname: Chiu
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Hong Kong.|Infection Control Team, Queen Elizabeth Hospital, Hong Kong.|Chief Infection Control Officer's Office, Hospital Authority, Hong Kong.
authors.forename: D Nc
authors.initials: DN
authors.lastname: Tsang
authors.affiliation: Department of Microbiology, The Chinese University of Hong Kong, Hong Kong.
authors.forename: M Py
authors.initials: MP
authors.lastname: Ip
authors.affiliation: Queen Elizabeth Hospital, Hong Kong.
authors.forename: C T
authors.initials: CT
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D006235:Hand Disinfection; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D062606:Tertiary Care Centers; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Enterococcus; Hong Kong; Mass screening; Vancomycin