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Table 2 Overview of the implemented control measures during VREfm outbreak period

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

Overview of infection control measures during outbreak
2015 December (Phase I) Detection of the outbreak
Single hospital-wide screening limited to patients admitted for at least 48 h
2016 January Initiation of Outbreak Management Team (OMT)
Reporting outbreak to the national Early warning and response meeting of Hospital-acquired Infections and AntiMicrobial Resistance (SO-ZI/AMR)
Electronic labelling of VRE-positive patients (confirmed label) and patients with prior hospitalisation in het ADRZ hospital in from September 1, 2014, or prior hospitalisation in a nursing home or rehabilitation centre (‘VRE suspected’ label)
Informing local hospital personnel and patients, and surrounding hospitals and nursing homes
Introducing screening for VRE carriage on admission for all patients with electronic ‘VRE suspected’ label and patients from nursing homes or rehabilitation centres
Weekly hospital-wide VRE rectal screening limited to patients admitted for at least 48 h. In high risk departments (dialysis and ICU) all admitted patients are screened, regardless of the admission time
Start of cleaning and disinfection (250 ppm chlorine) of the entire hospital: wards are cleaned one by one, whereby patients are temporarily transferred to other (not yet cleaned) parts of the same or other wards
Introduction of disinfectant wipes for contact surfaces in patient rooms and general areas
Start of mandatory plenary training sessions for all healthcare workers on general precautions and cleaning issues
Clear division of cleaning tasks for healthcare workers and cleaning personnel
February After cleaning of the ward: release rooms previously occupied by VRE positive patients after cleaning and disinfection based on environmental cultures
March (Phase II) Audits of adherence to infection control and cleaning protocols by infection control department
Implementing screening and isolation protocol for ‘high risk’ patients (direct contacts of VRE carriers, mostly roommates)
Reintroducing of cleaning and disinfection (250 ppm chlorine) of the entire hospital: departments are cleaned one by one, whereby patients are temporarily transferred to other (not yet cleaned) departments
Intensifying communication to healthcare workers and managers
November (Phase III) Screening for VRE carriage upon admission limited to only patients with prior hospitalisation in het ADRZ hospital in period December 1, 2015–November 14, 2016
Monthly hospital-wide VRE rectal screening limited to patients admitted for at least 48 h. In high risk departments (dialysis and ICU) all admitted patients are screened, regardless of the admission time
2017 February (End of the outbreak) Removing all outbreak related ‘VRE suspected’ labels in the electronic patient system
Start hospital-wide VRE rectal screening limited to patients admitted for at least 7 days
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