Is my family at risk if I have become colonized with VRE?

• VREisnomoredangerousthanothernormalbacteriathatpeoplecarryontheirskinandareexposedtoeveryday

• Youcancarryonwithyourusualactivitiesandremindeveryonetowashtheirhandsoften.Youshouldwashyourhandsafteryougotothebathroomortouchanywoundsasamatterofroutine,notjustforVRE

Ifafamilymemberassistsinpatientcare,nursingstaffwillinformthepersonsinvolvedofanyextraprecautionsnecessary

Personsvisitingshouldbeawareoftheirownhealthstatussoastoavoideitherputtingthepatientatincreasedriskorthemselvesatrisk

Itisnotrecommendedtovisitanypatientifyouarefeelingunwell,forexample,ifyouhavevomiting/Diarrhoeaorflulikesymptoms

Can a patient go home with VRE?

HavingVREisnotareasonforremaininginhospital,onceapatientisotherwisefitfordischarge.AnynecessaryfollowupwillbearrangedwiththepatientsGPorpublichealthnurse

What will happen in the future if the patient needs to go to hospital?

IfapatientattendsanyhospitalinthefuturetheyshouldinformmedicalandnursingstafftherethattheyhavehadVRE.Swabsandotherspecimenswillbetakenforlaboratoryanalysis.

ForfurtherinformationpleasecontacttheinfectioncontrolteaminBlackrockClinic.

Compiled by Joanne Flanagan, Clinical Nurse Specialist, Infection Prevention and Control

Authorised by Dr Anne Gilleece, Consultant MicrobiologistPublished date August 2009 Last reviewed August 2009

Blackrock Clinic Rock Road, Blackrock, Co. Dublin Tel: 01 2832222 Fax: 01 2064314

www.blackrock-clinic.com

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AccreditedbyJointCommissionInternational

Information and Advice for Patients and Visitors

Vancomycin resistant enterococcus (VRE)

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What are enterococci?

•Enterococciaremostcommonlyfoundinthebowelsofmostanimals,includinghumans,wheretheymakeuppartofthenormalbacterialflora.Theycanalsobefoundinthehumangenitaltract

• Theyarehardymicroorganismsthatcansurvivetheharshestenvironmentsandcanbefoundinsoil,waterandonvegetation

• Mostpeoplewhocarryenterococcidon’tsufferanyilleffects.Carryingenterococciharmlesslylikethisiscalled“colonisation”

• Sometimesenterococcicauseinfectionsiftheyenterthebody.Thisismorelikelytohappentopeoplewhoarealreadyunwell,particularlythosewhoareinhospitalwithaseriousillness

• Therearemanydifferentspeciesofenterococci,butonlyafewhavethepotentialtocauseinfectionsinhumans.Morethan95%ofinfectionsduetoenterococciarecausedbyjusttwospecies,EnterococcusfaeciumandEnterococcusfaecalis

What type of infections do enterococci cause?

• Mostpeoplewhocarryenterococcidon’tsufferanyilleffects

• Enterococcicancausearangeofdifferentinfectionsincluding:

oWoundinfections

oUrinarytractinfections

oInfectionsoftheabdomenandpelvis

oInfectionsinthebileduct(cholangitis)

oHeartvalveinfection(endocarditis)

oBacteraemia(infectionoftheblood)

What are vancomycin-resistant enterococci (VRE)?

Vancomycin-ResistantEnterococci(VRE)areenterococcithathavebecomeresistanttovancomycin.

Are some people more at risk than others?

• MostpeoplewhocarryVREdon’tsufferanyilleffects

• VREcolonisationandinfectionsmainlyoccurinhospitalpatients

• CertainpeopleareatincreasedriskofVREcolonisation.Theseincludepatients:

Thatarecurrentlyonorhaverecentlytakenvancomycinorotherantibiotics(includingcephalosporins,ciprofloxacin,aminoglycosides,clindamycinandmetronidazole)foranextendedperiod

Withconditionsthatcompromisetheimmunesystem(e.g.cancerchemotherapy)

Whohavespentalongtimeinhospitalorotherhealthcaresetting

Whohaveundergonesurgicalprocedures,especiallyabdominalorchestsurgery

Whohavealong-termindwellingcatheter(e.g.intravenousorurinarycatheters)

Inspecialistunitssuchasintensivecareorrenalunits

• However,VREaresometimesfoundinthefaecesofpeoplewhohaveneverbeeninhospitalorhavenotrecentlybeengivenantibiotics

How is VRE spread?

• VREismostcommonlyspreadbydirectHANDcontactwithapersoncolonisedorinfectedwithVREorindirectlyviathehandsofhealthcareworkers

• VREisalsospreadbytouchingcontaminatedsurfaces(e.g.railings,doorhandles)thathavebeencontaminatedbysomeonewhohasnotwashedtheirhands

• SomeinfectionsoriginatefromVREthatmaybepatient’sownnormalbacterialflora

VRE is NOT passed through the air or by coughing

Hand washing is critical to prevent the spread of VRE

Is VRE treatable?

HealthypeoplewhocarryVREintheirbodies(colonization)donotneedtreatment.

Patientswithindwellingcatheterswhohavedevelopedinfectionsduetoenterococci/VREmayneedtohavethecatheterremoved.Antibiotictherapymaybeneededforseriousinfections.

ThosewithVREinfections(e.g.bacteraemia)willbetreatedwithotherantibiotics

How can VRE spread be controlled?

• VREismostcommonlyspreadviahands,equipment,andsometimestheenvironment

• Goodhygienemeasures(frequenthand-washingandcleaningoftheenvironment)shouldbepracticedatalltimestopreventthespreadofVRE(andothermicroorganisms)frompersontoperson.GlovesandgownsshouldbewornifsomeoneisincontactwithbodyfluidsthatmaycontainVRE(e.g.faeces)

• HandwashingisthebestwaytopreventthespreadofVRE

• ApatientfoundtobecolonisedwithVREwillbeisolatedandcaredforusingbarrierprecautions,suchasapronsandgloves

The most important ways to prevent and control VRE are:

1. Handwashing

Itisimportantthathealthcareworkersandvisitorswashtheirhandsbeforeandaftervisitingapatient.Providedhandsarenotsoiled(whentheyshouldbewashedwithsoapandwater),alcoholgelscanbeused

2. Sensible antibiotic prescribing

Onlyprescribecertainantibioticsincludingvancomycin,tothosepatientswhoreallyneedthem

3. Good environmental cleaning and decontamination practices

4. Staff education on how to recognise and control VRE

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