Vancomycin Resistant Enterococcus (VRE)
What is VRE?
Enterococcus is a bacteria normally present in the human intestinal tract and in the female genital tract, and is often found the environment, like in soil and water.
Enterococci continuously find new methods to avoid the effects of antibiotics. Vancomycin is an antibiotic used to treat certain infections, including those caused by Enterococcus strains. Antibiotic resistance occurs when organisms no longer respond to antibiotics designed to kill them. Enterococcus strains that develop resistance to vancomycin, an antibiotic used to treat some drug-resistant infections, they become vancomycin-resistant enterococci (VRE).
Who is at risk of getting VRE?
People with higher risk of getting infected with VRE include:
- People previously treated with antibiotics, including vancomycin, for long periods of time
- People who are hospitalized, have undergone surgical procedures, or have medical devices, such as catheters inserted into their bodies
- People with weakened immune systems, including patients in intensive care units, or in cancer or transplant wards.
Where can VRE be found?
VRE is most often found in the stool, but may also be present in the blood, urine, and wounds, or wherever it can be carried by blood. VRE may be found on the skin, especially in the warm and moist areas of the groin and under the arms
Colonization vs. infection
Colonization is the presence of microorganisms on or in a host, with growth and multiplication of the microorganism, but without interaction between the host and microorganism. Colonization does not require antibiotics.
Infection results from the body reacting to the microorganism. It may present without signs symptoms, or asymptomatically. On the other end of the spectrum, signs and symptoms may be found on assessment.
Principle sites for VRE colonization include the urinary tract, intestinal tract, respiratory tract, and the skin.
How can VRE be spread?
VRE is primarily spread via direct or indirect contact. In the health care setting, VRE can spread from one person to another through contact with contaminated surfaces or equipment or through person to person spread, often via contaminated hands. It is not transmitted by coughing or sneezing.
A patient with identified VRE infection or colonization may be placed in "CONTACT" precautions per LLUMC Policy M-50 Standard and Transmission-based Precautions. The primary reason to place a patient in contact precautions is for draining wounds that cannot be contained by a dressing. Contact precautions may be kept in place for patients whom providers prefer to keep a patient in isolation. Contact precautions for these patients include a private room, gown and gloves for ALL persons entering the room for any reason. Change gloves after contact with potentially infective material. After removing gloves, perform hand hygiene immediately. Patients in Contact precautions are not allowed to walk freely within the hospital. Patients in VRE isolation are allowed to visit outdoors if approved by Clinical Epidemiology and Infection Prevention (CEIP) and certain instructions are followed. Disposable food trays are not required.
If a patient needs to leave the nursing unit for a procedure within the hospital, the receiving department must be notified to prepare appropriate precautions before the patient’s arrival. The goal while transporting a patient with VRE is to avoid contamination of the transporting healthcare worker as well as contamination of the hospital environment. At a minimum, a pair of gloves should be brought along during transport in case direct contact with the patient is necessary. A gown should not be needed, unless major contact with the patient is anticipated. The environment should not be contaminated with dirty gloves. Doors and elevator buttons should be touched with clean, ungloved hands.
VRE is a very hardy organism. It can survive on hard surfaces for 7-10 days and on hands for hours. It is easy to kill with good handwashing and the proper use of disinfectants. It does not travel through the air, so face masks are not needed.
VRE infections are treated with antibiotics other than vancomycin. The best antibiotic for treatment is based on the results of a specimen culture and factors such as potential side effects and interactions with other drugs.
Preventing Antibiotic Resistance
Prevention is the best way to protect against antibiotic resistance. There are many ways individuals can take to protect themselves and others:
Frequent Hand Hygiene
The body is constantly exposed to millions of germs. Frequent hand hygiene with soap and water or an alcohol-based hand rub fights germs and prevents illness.
Know the Symptoms
Learn to recognize early signs of infection. If an infection is suspected or not improving, consult a healthcare professional.
Educate Patients on Proper Antibiotic Use
Not all infections need antibiotics. Discuss the right antibiotic, right dose, right length of treatment time, and side effects of antibiotics prescribed. Inform patients about antibiotic resistance and the dangers of misuse, including not completing an antibiotic regimen. Remind patients to call for guidance prior to stopping a prescribed antibiotic regimen.
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