Control of vancomycin-resistant enterococcus in health care facilities in a region.

Background: In late 1996, vancomycin-resistant enterococci were first detec ted in the Siouxland region of Iowa, Nebraska, and South Dakota. A task for ce was created, and in 1997 the assistance of the Centers for Disease Contr ol and Prevention was sought in assessing the prevalence of vancomycin-resi stant enterococci in the region's facilities and implementing recommendatio ns for screening, infection control, and education at all 32 health care fa cilities in the region. Methods: The infection-control intervention was evaluated in October 1998 a nd October 1999. We performed point-prevalence surveys, conducted a case-co ntrol study of gastrointestinal colonization with vancomycin-resistant ente rococci, and compared infection-control practices and screening policies fo r vancomycin-resistant enterococci at the acute care and long-term care fac ilities in the Siouxland region. Results: Perianal-swab samples were obtained from 1954 of 2196 eligible pat ients (89 percent) in 1998 and 1820 of 2049 eligible patients (89 percent) in 1999. The overall prevalence of vancomycin-resistant enterococci at 30 f acilities that participated in all three years of the study decreased from 2.2 percent in 1997 to 1.4 percent in 1998 and to 0.5 percent in 1999 (P<0. 001 by chi-square test for trend). The number of facilities that had had at least one patient with vancomycin-resistant enterococci declined from 15 i n 1997 to 10 in 1998 to 5 in 1999. At both acute care and long-term care fa cilities, the risk factors for colonization with vancomycin-resistant enter ococci were prior hospitalization and treatment with antimicrobial agents. Most of the long-term care facilities screened for vancomycin-resistant ent erococci (26 of 28 in 1998 [93 percent] and 23 of 25 in 1999 [92 percent]) and had infection-control policies to prevent the transmission of vancomyci n-resistant enterococci (22 of 25 [88 percent] in 1999). All four acute car e facilities had screening and infection-control policies for vancomycin-re sistant enterococci in 1998 and 1999. Conclusions: An active infection-control intervention, which includes the o btaining of surveillance cultures and the isolation of infected patients, c an reduce or eliminate the transmission of vancomycin-resistant enterococci in the health care facilities of a region. (N Engl J Med 2001;344:1427-33. ) Copyright (C) 2001 Massachusetts Medical Society.