COLONIZATION WITH VANCOMYCIN-RESISTANT ENTEROCOCCUS-FAECIUM - COMPARISON OF A LONG-TERM-CARE UNIT WITH AN ACUTE-CARE HOSPITAL

OBJECTIVE: To compare the epidemiology of vancomycin-resistant Enteroc occus faecium (VRE) in a longterm-care unit and an acute-care hospital . DESIGN: Point-prevalence surveys for VRE rectal colonization of pati ents were carried out over a 21-month period in patients in a long-ter m-care unit and an acute-care hospital (medical ward and intensive-car e units). The environment and hands of healthcare workers also were sa mpled for VRE. Contour-clamped homogeneous electric field (CHEF) elect rophoresis was used to evaluate possible transmission among roommates and the relatedness of patient strains to those in the environment and on the hands of healthcare workers. SETTING: A 200-bed Veterans Affai rs Medical Center with an attached 90-bed long-term-care unit. RESULTS : From December 1994 to January 1996, rectal VRE colonization of patie nts in the long-term-care unit increased significantly from 9% to 22%. In contrast, patients on the medical ward rarely were colonized after the first survey in December 1994, and only two intensive-care-unit p atients were found to be colonized during the four surveys. The enviro nment was contaminated persistently in the long-term-care unit. In the four surveys, carriage of VRE on hands of healthcare workers varied f rom 13% to 41%; 65% of healthcare workers with VRE found on their hand s worked in the long-term-care unit. Seven different strains were iden tified by CHEF typing. Although the initial survey found only vanA str ains, subsequent surveys showed vanB strains also were present. CONCLU SIONS: Residents of a long-term-care unit frequently were colonized wi th VRE, but infections were uncommon in this population. The environme nt of the long-term-care unit was contaminated with VRE, and VRE was f ound frequently on the hands of healthcare workers in this unit. Both vanA and vanB genotypes were found in this setting.