PMID- 29475013
OWN - NLM
STAT- MEDLINE
DCOM- 20190114
LR  - 20190114
IS  - 1532-2939 (Electronic)
IS  - 0195-6701 (Linking)
VI  - 100
IP  - 4
DP  - 2018 Dec
TI  - Recommendations for the successful control of a large outbreak of 
      vancomycin-resistant Enterococcus faecium in a non-endemic hospital setting.
PG  - e216-e225
LID - S0195-6701(18)30109-9 [pii]
LID - 10.1016/j.jhin.2018.02.016 [doi]
AB  - BACKGROUND: A large outbreak of three epidemic vancomycin-resistant Enterococcus 
      faecium (VRE) clones affected the study hospital for almost two years. AIM: To 
      describe the strategy to successfully control this outbreak and eradicate VRE 
      from the study hospital. METHODS: Infection control interventions started after 
      detection of VRE in three patients. Hospital-wide surveillance was started after 
      ongoing transmission despite isolation precautions, cleaning and contact tracing. 
      Hygiene education and discipline were enhanced. Despite these interventions, 
      additional measures were required to control the outbreak, such as ward 
      disinfection with hydrogen peroxide vapour and the introduction of a VRE 
      quarantine ward. Ultimately, ciprofloxacin prophylaxis for haematological 
      patients on chemotherapy was abandoned. FINDINGS: Over a 22-month period, 242 VRE 
      carriers were identified. Of these, 128 (53%) patients were detected by 
      hospital-wide surveillance alone. Three epidemic clones were detected: ST494-vanA 
      (N = 160), ST78-vanA (N = 23) and ST117-vanB (N = 32). In total, 5614 possible 
      contacts were identified. VRE transmission occurred on 13 out of 23 wards. VRE 
      was cultured from clinical specimens in 22 patients (seven with bacteraemia). 
      Since January 2014, no further transmission of these VRE clones has been 
      observed. CONCLUSION: Infection control measures according to international 
      guidelines were insufficient to expose the outbreak to its full extent and 
      control it. Its full extent only became apparent after sustained hospital-wide 
      screening. Successful control of this hospital-wide VRE outbreak was feasible, 
      but required great effort. Final containment and eradication of the epidemic 
      clones was achieved by environmental decontamination with hydrogen peroxide 
      vapour, strict isolation precautions, a VRE quarantine ward and antimicrobial 
      stewardship.
CI  - Copyright (c) 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
FAU - Frakking, F N J
AU  - Frakking FNJ
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands; Department of Medical Microbiology, 
      University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: 
      F.N.J.Frakking@umcutrecht.nl.
FAU - Bril, W S
AU  - Bril WS
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands.
FAU - Sinnige, J C
AU  - Sinnige JC
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands; Department of Medical Microbiology, 
      University Medical Centre Utrecht, Utrecht, The Netherlands.
FAU - Klooster, J E Van't
AU  - Klooster JEV
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands.
FAU - de Jong, B A W
AU  - de Jong BAW
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands.
FAU - van Hannen, E J
AU  - van Hannen EJ
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands.
FAU - Tersmette, M
AU  - Tersmette M
AD  - Department of Medical Microbiology and Immunology, St Antonius Hospital, 
      Nieuwegein and Utrecht, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20180221
PL  - England
TA  - J Hosp Infect
JT  - The Journal of hospital infection
JID - 8007166
SB  - IM
MH  - Cross Infection/*epidemiology/microbiology/prevention & control
MH  - *Disease Outbreaks
MH  - Disease Transmission, Infectious/*prevention & control
MH  - Enterococcus faecium/drug effects/*isolation & purification
MH  - Gram-Positive Bacterial Infections/*epidemiology/microbiology/prevention & 
      control
MH  - Hospitals
MH  - Humans
MH  - Infection Control/*methods
MH  - Vancomycin-Resistant Enterococci/*isolation & purification
OTO - NOTNLM
OT  - ARE
OT  - Infection prevention
OT  - Outbreak
OT  - VRE
EDAT- 2018/02/24 06:00
MHDA- 2019/01/15 06:00
CRDT- 2018/02/24 06:00
PHST- 2017/11/23 00:00 [received]
PHST- 2018/02/14 00:00 [accepted]
PHST- 2018/02/24 06:00 [pubmed]
PHST- 2019/01/15 06:00 [medline]
PHST- 2018/02/24 06:00 [entrez]
AID - S0195-6701(18)30109-9 [pii]
AID - 10.1016/j.jhin.2018.02.016 [doi]
PST - ppublish
SO  - J Hosp Infect. 2018 Dec;100(4):e216-e225. doi: 10.1016/j.jhin.2018.02.016. Epub 
      2018 Feb 21.