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Risk of Environmental and Healthcare Worker Contamination With Vancomycin-Resistant Enterococci During Outpatient Procedures and Hemodialysis

Published online by Cambridge University Press:  21 June 2016

Elizabeth A. Grabsch ,
Laurelle J. Burrell ,
Alexander Padiglione ,
Jason M. O'Keeffe ,
Susan Ballard  and
M. Lindsay Grayson
Elizabeth A. Grabsch
Affiliation:
Microbiology Department, Victoria, Australia
Laurelle J. Burrell
Affiliation:
Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
Alexander Padiglione
Affiliation:
Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
Jason M. O'Keeffe
Affiliation:
Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
Susan Ballard
Affiliation:
Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
M. Lindsay Grayson*
Affiliation:
Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
*
Infectious Diseases Department, Austin Health, Studley Road, Heidelberg, VIC, Australia3084 ([email protected])
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Abstract

Objective.

To assess the risk of environmental and healthcare worker (HCW) contamination with vancomycin-resistant enterococci (VRE) during outpatient procedures performed on fecally continent patients currently colonized with VRE (cVRE) or previously colonized with VRE (pVRE).

Design.

Observational study.

Setting.

Outpatient consultation and radiology rooms and the hemodialysis unit in a university teaching hospital.

Patients.

Fecally continent cVRE and pVRE patients.

Interventions.

Both cVRE and pVRE patients attended standardized mock outpatient consultations and routine hemodialysis sessions in an area that had been thoroughly cleaned and microbiologically confirmed to be free of VRE contamination. After each session, the patient, environment, and participating HCW were tested for VRE contamination.

Results.

Fourteen cVRE patients participated in 49 mock outpatient consultation sessions and radiology sessions or 26 actual hemodialysis sessions, and 7 pVRE patients participated in 28 outpatient consultation sessions. Sessions with cVRE patients had higher rates of contamination of the environment (chair cultures were positive for VRE in 36% of outpatient consultation sessions, 58% of hemodialysis sessions; couch cultures were positive in 48% of outpatient consultation sessions, 42% of radiology sessions, and 45% of hemodialysis sessions), contamination of HCW gowns (gown cultures were positive in 20% of outpatient consultation sessions, 4% of radiology sessions, and 30% of hemodialysis sessions), and contamination of patients' own hands (hand cultures were positive in 36% of outpatient consultation sessions, 25% of radiology sessions, and 54% of hemodialysis sessions). Overall, contamination rates associated with pVRE patients attendance at outpatient consultations were 12% of those noted for cVRE patients (odds ratio, 0.10; 95% confidence interval, 0.03-0.42; P = .001).

Conclusions.

Given the nature of the contamination risk posed by fecally continent cVRE patients undergoing outpatient procedures, infection control measures should focus on effective HCW and patient hand hygiene and chair and couch cleaning, to minimize transmission of VRE.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 3 , March 2006 , pp. 287 - 293
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Padiglione, A, Wolfe, R, Grabsch, EA, et al. Risk factors for the new detection of vancomycin-resistant enterococci (VRE) in acute-care hospitals that employ strict infection control procedures. Antimicrob Agents Chemother 2003; 47:2492–2498.CrossRefGoogle ScholarPubMed
2.Grayson, ML, Grabsch, EA, Johnson, PD, et al. Outcome of a screening program for vancomycin-resistant enterococci in a hospital in Victoria. Med J Aust 1999; 171:133–136.CrossRefGoogle Scholar
3.Centers for Disease Control and Prevention. Guidelines for isolation precautions in hospitals. Am J Infect Control 1996; 24:24–52.CrossRefGoogle Scholar
4.Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR Morb Mortal Wkly Rep 1993; 42:597–599.Google Scholar
5.Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995; 16:105–113.Google Scholar
6.Standing Committee on Infection Control. Guidelines for the Management of Patients With Vancomycin-Resistant Enterococci (VRE) Colonisation/Infection. Melbourne, Australia: Department of Human Services; 1999.Google Scholar
7.Smith, TL, Iwen, PC, Olson, SB, Rupp, ME. Environmental contamination with vancomycin-resistant enterococci in an outpatient setting. Infect Control Hosp Epidemiol 1998; 19:515–518.Google Scholar
8.Hacek, DM, Trick, WE, Collins, SM, Noskin, GA, Peterson, LR. Comparison of the Rodac imprint method to selective enrichment broth for recovery of vancomycin-resistant enterococci and drug-resistant Enterobacteriaceae from environmental surfaces. J Clin Microbiol 2000; 38:4646–4648.CrossRefGoogle ScholarPubMed
9.Donskey, CJ, Chowdhry, TK, Hecker, MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000; 343:1925–1932.Google Scholar
10.ASTM. El 115-86, standard test method for evaluation of surgical hand scrub formulation. In: Annual Book of ASTM Standards. Easton, PA: ASTM; 1988:644–645.Google Scholar
11.Teixeira, LM, Facklam, RR, Enterococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, Jorgensen, JH, Yolken, RH, eds. Manual of Clinical Microbiology 8th ed. Washington, DC: American Society for Microbiology; 2003:422–433.Google Scholar
12.Bell, J, Paton, J, Turnidge, J. Emergence of vancomycin-resistant enterococci in Australia: phenotypic and genotypic characteristics of isolates. J Clin Microbiol 1998; 36:2187–2190.Google Scholar
13.Dutka-Malen, A, Evers, S, Courvalin, P. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR. J Clin Microbiol 1995; 33:24–27.CrossRefGoogle Scholar
14.D'Agata, EM, Gautam, S, Green, WK, Tang, YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002; 34:167–172.Google Scholar
15.Padiglione, A, Grabsch, EA, Olden, D, et al. Fecal colonization with vancomycin-resistant enterococci in Australia. Emerg Infect Dis 2000; 6:534–536.Google Scholar
16.Mayer, RA, Geha, RC, Helfand, MS, Hoyen, CK, Salata, RA, Donskey, CJ. Role of fecal incontinence in contamination of the environment with vancomycin-resistant enterococci. Am J Infect Control 2003; 31:221–225.Google Scholar
17.Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994; 32:1148–1153.Google Scholar
18.Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Morb Mortal Wkly Rep 2002; 51(RR-16):1–45.Google ScholarPubMed
19.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000; 356:1307–1312.CrossRefGoogle ScholarPubMed