Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting

Background: Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U.S. hospitals. Objective: To determine whether enhanced infection-control strategies reduc e 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 s trategies and 184 patients evaluated during use of standard infection-contr ol practices. Interventions: Patient surveillance cultures were taken, patients were assi gned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control proce dures was monitored, patients were educated about VRE transmission, patient s taking antimicrobial agents were evaluated by an infectious disease speci alist, and environmental surveillance was performed. Measurements: VRE infection rates, VRE colonization rates, and changes in a ntimicrobial 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 rat e ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (1 0.3 patients per 1000 patient-days compared with 20.7 patients per 1000 pat ient-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.