M. Armstrong-evans et al., Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility, INFECT CONT, 20(5), 1999, pp. 312-317
OBJECTIVES: To describe the investigation and control of transmission of va
ncomycin-resistant enterococci (VRE) in a residential long-term-care (LTC)
setting.
OUTBREAK INVESTIGATION: A strain of vancomycin-resistant Enterococcus faeci
um not previously isolated in Ontario colonized five residents of a 254-bed
LTC facility in Toronto. The index case was identified when VRE was isolat
ed from a urine culture taken after admission to a local hospital. Screenin
g of rectal swabs from all 235 residents identified four others who were co
lonized with the same strain of E faecium.
CONTROL MEASURES: Colonized residents were cohorted. VRE precautions were e
stablished as follows: gown and gloves for resident contact, restriction of
contact between colonized and noncolonized residents, no sharing of person
al equipment and daily double-cleaning of residents' rooms and wheelchairs.
OUTCOME: Two colonized residents died of causes unrelated to VRE. Although
bacitracin therapy (75,000 units four times a day x 14 days) failed to erad
icate carriage in two of three surviving residents, both cleared their carr
iage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months
after isolation precautions were discontinued and from 125 residents (51%)
9 months later identified no new cases. Total cost of investigation and con
trol was $12,061 (Canadian).
CONCLUSION: VRE may be transmitted in LTC facilities, and colonized LTC res
idents could become important VRE reservoirs. Control of VRE transmission i
n LTC facilities can be achieved even with limited resources.