Control of vancomycin-resistant enterococci at a community hospital: Efficacy of patient and staff cohorting

OBJECTIVE: To evaluate the efficacy of patient and staff cohorting to contr ol vancomycin-resistant enterococci (VRE) at an Indianapolis community hosp ital. DESIGN: To interrupt transmission of VRE, a VRE point-prevalence survey of hospital inpatients was conducted, and VRE-infected or colonized patients w ere cohorted on a single ward with dedicated nursing staff and patient-care equipment. To assess the impact of the intervention, staff compliance with contact isolation procedures was observed, and the VRE point-prevalence su rvey was repeated 2 months after the cohort ward was established. RESULTS: Following the establishment of the cohort ward, VRE prevalence amo ng all hospitalized inpatients decreased from 8.1% to 4.7% (25 positive cul tures among 310 patients compared to 13 positive cultures among 276 patient s, P=.14); VRE prevalence among patients whose VRE status was unknown befor e cultures were obtained decreased from 5.9% to 0.8% (18 positive cultures among 303 patients compared to 2 positive cultures among 262 patients, P=.0 02); and observed staff-patient interactions compliant with published isola tion recommendations increased (5 [22%] of 23 interactions compared to 36 [ 88%] of 41 interactions, P<.0001). CONCLUSIONS: Our data suggest that, in hospitals with endemic VRE or contin ued VRE transmission despite implementation of contact isolation measures, establishing a VRE cohort ward may be a practical and effective method to i mprove compliance with infection control measures and thereby to control ep idemic or endemic VRE transmission (Infect Control Hosp Epidemiol 1999;20:1 06-109).