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