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Infection-Control Measures Reduce Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

Marisa A. Montecalvo, MD; William R. Jarvis, MD; Jane Uman, MPH; David K. Shay, MD, MPH; Coleen Petrullo, RN; Karen Rodney, BS; Cheryl Gedris, MS; Harold W. Horowitz, MD; and Gary P. Wormser, MD
[+] Article, Author, and Disclosure Information

From New York Medical College and Westchester Medical Center, Valhalla, New York; and the Centers for Disease Control and Prevention, Atlanta, Georgia.

Presented in part at the 37th Interscience Conference in Antimicrobial Agents and Chemotherapy, Toronto, Ontario, Canada, 1997; Abstract no. J84.

Acknowledgments: The authors thank Robert C. Moellering Jr. for his review of this manuscript. They also thank Tauseef Ahmed, Eric Feldman, Karen Seiter, Carmello Puccio, Hoo Chun, Robert Nadelman, John Nowakowski, Margaret Carraher, Catharine Spratt, Connie Engleking, Matthew Arduino, Paul Visintainer, Carol Diventi, and the nursing staff of the oncology unit for their contributions to this study and Barbara Moreland for secretarial assistance.

Grant Support: Contract no. 200-94-0860 from the Centers for Disease Control and Prevention.

Requests for Reprints: Marisa A. Montecalvo, MD, Division of Infectious Diseases, New York Medical College, Macy Pavilion 209SE, Valhalla, NY 10595.

Current Author Addresses: Dr. Montecalvo, Ms. Petrullo, and Drs. Horowitz and Wormser: Division of Infectious Diseases, New York Medical College, Macy Pavilion 209SE, Valhalla, NY 10595.

Dr. Jarvis: Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-69, Atlanta, GA 30333.

Ms. Uman: 317 Broxton Road, Baltimore, MD 21212.

Dr. Shay: Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-34, Atlanta, GA 30333.

Ms. Rodney and Ms. Gedris: Department of Microbiology, Westchester Medical Center, Valhalla, NY 10595.

Ann Intern Med. 1999;131(4):269-272. doi:10.7326/0003-4819-131-4-199908170-00006
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Background: Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals.

Objective: To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting.

Design: Prospective cohort study.

Setting: Adult oncology inpatient unit.

Patients: 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices.

Interventions: Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed.

Measurements: VRE infection rates, VRE colonization rates, and changes in antimicrobial use.

Results: During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced.

Conclusion: Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.





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