Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014–2017: successful control using a restrictive screening strategy

Table 1 Overview of dates, isolation and screening policies per phase and risk group during VREfm outbreak period

Risk group	Definition	Phase 1 Dec 14, 2015–Mar 20, 2016		Phase 2 Mar 21, 2016–Nov 13, 2016		Phase 3 Nov 14, 2016–Feb 5, 2017
Risk group	Definition	Identification strategy	Contact precautions	Identification strategy	Contact precautions	Identification strategy	Contactprecautions
VRE carrier	Patient infected or colonised with VREfm	N/A	Yes^a	N/A	Yes^a	N/A	Yes^a
VRE suspected	All patients with prior hospitalisation in the ADRZ hospital location Goes from September 1, 2014 until start of zero transmission period	Single rectal swab on admission	Yes, while awaiting result of single admission screening	Single rectal swab on admission	No	Single rectal swab on admission	No
	Patients transferred from nursing homes or rehabilitation centres	Single rectal swab on admission	Yes, while awaiting result of single admission screening	Single rectal swab on admission	No	No	No
	Roommate of unexpected VRE carrier	N/A	Yes^c	3 separate rectal cultures (collection at day 3, 5 and 7 after the last exposure)	Yes^a	3 separate rectal cultures (collection at day 3, 5 and 7 after the last exposure)	Yes^a
All patients (incl. low risk)	Hospital wide surveillance	Weekly screening of all patients hospitalised > 2 days^b	N/A	Weekly screening of all patients hospitalised > 2 days	N/A	Monthly screening of all patients hospitalised > 2 days	N/A

^aSingle room or cohorting with other VRE carriers if insufficient availability of single rooms
^bIn high risk departments (dialysis and ICU) all admitted patients are screened, regardless of the admission time
^cAfter cleaning of the ward was completed, patients were separated int two cohorts: clean (new admissions not fulfilling the criteria of ‘VRE suspected’), and VRE suspected, each with dedicated staff. Contact precaution (CP) policy: Single room or—if single room was not available—cohort CP of patients with same VRE status on multi occupancy room. Healthcare workers wear gown with long sleeves and gloves before each contact with the patient or the patient environment. Rooms were daily cleaned, medical devices were cleaning and disinfected (alcohol 70%) before leaving the room, and after patient discharge, the room is cleaned and disinfected (250 ppm chlorine)

ISSN: 2047-2994