Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
Department of Infection Control, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA, Goes, The Netherlands.
Antimicrob Resist Infect Control. 2021 Feb 18;10(1):38. doi: 10.1186/s13756-021-00906-x.
The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014-February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as 'VRE suspected'. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak.
After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing 'VRE suspected' label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak.
Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected.
We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.
耐万古霉素肠球菌的出现给医疗保健环境带来了重大问题。在这里，我们描述了荷兰一家综合医院在 2014 年 12 月至 2017 年 2 月期间发生的万古霉素耐药粪肠球菌（VREfm）医院范围的暴发。由于暴发的发现较晚，约 25000 名（出院）患者被归类为“VRE 疑似”。因此，与国家指南相比，实施了缓和的筛选和隔离政策，以控制暴发。
暴发确定后，实施了筛选政策，包括对所有患者进行一次直肠拭子培养（含增菌肉汤），以停止隔离，并为重新入院的 VRE 疑似患者去除电子病历中的“VRE 疑似”标签。除了入院时的筛查外，还进行了定期的全院点患病率筛查，采取措施提高遵守标准感染控制预防措施的依从性，并加强环境清洁，以控制暴发。
2014 年 9 月至 2017 年 2 月期间，发现 140 名患者定植了 vanA 介导的万古霉素耐药粪肠球菌（VREfm）。其中 2 名患者发生菌血症。AFLP 分型表明暴发是由单一克隆引起的。在多个病房发现了广泛的环境污染。在暴发检测后九个月内，未发现新的 VRE 病例。
我们实施了基于靶向筛选和隔离的控制策略，同时实施了一般预防措施和环境清洁。该策略比荷兰国家 VRE 控制指南更为宽松。该策略成功地控制了暴发，同时减少了隔离天数和培养次数。
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