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VANCOMYCIN-RESISTANT ENTEROCOCCUS (VRE) – Changes to our Screening Practice

June 25, 2012 The Ottawa Hospital (TOH) is very proud of the advances we have made in Infection Prevention and Control.  A dedicated team of health professionals and support staff all work hard to ensure that our hands, the healthcare environment and all medical equipment is clean. At over 90%, our hand hygiene rates are now among the highest in the province, resulting in safer care for our patients.

Quality and safety are priorities at TOH and our entire team works hard to deliver the safest care possible. A key Infection Prevention and Control practice is the monitoring of a number of infections that may have an impact on patient outcomes. Since 1998, TOH has been actively testing patients to see if they carry vancomycin-resistant enterococcus or VRE, an antibiotic-resistant bacterium or germ that lives in the lower intestine.  Most people are unaware that they carry VRE, as they have no symptoms. If testing identified VRE in a patient, special precautions were used including isolation and protective equipment for the health care worker (gowns and gloves).

When we implemented the practice, we were concerned that there would be transfer of this resistance to another, stronger organism. However, this (gene) transfer has not happened.  Over the past decade, we have learned that VRE rarely causes serious infections and most people who carry VRE do not suffer any ill effects at all from this bacterium.  In fact, many experts no longer consider VRE to be a ‘superbug’.  As a result TOH, along with a number of other hospitals, has recently changed its practice and will no longer test patients for VRE. Patients previously identified as carriers of VRE will be treated in the same manner as other patients. They will not be placed in isolation rooms and staff caring for them will not require a gown and gloves (unless there are other reasons for these measures).

This change will help us to strengthen our efforts to reduce the risk of all healthcare acquired infections among all our patients. It will allow us to reinvest and redirect resources to strengthen the work already being done in the existing pillars of infection prevention. These include including waste management, environmental auditing, reducing patient transfers, continuing to improve our hand hygiene rates and decluttering.

If you have concerns or questions, please contact

VRE, screening and you: Answers to questions you may have

What is VRE?
All people are carriers of many different types of bacteria. Normally bacteria living on our bodies keep us healthy, but on occasion we can be carriers of harmful bacteria.  VRE is a germ (bacterium) that lives in the gut of a small number of people, and it can be harmful if it causes an infection. Although the risk of infection with VRE is low and VRE is quite resistant to antibiotics, there are now antibiotics available to treat a VRE infection.

How has TOH cared for patients with VRE previously?
Until recently TOH had been testing select patients when admitted to the hospital to check if they have VRE in their gut.  If a patient was identified as a carrier of the VRE germ, they (he/she was) were placed in a private room and the health care provider always wore gloves and sometimes a yellow gown when providing care for the patient.

Why is TOH changing how they care for patients with VRE?
TOH has been actively controlling VRE since 1998 and we have not seen any worrisome trends or increases in serious infections caused by this germ.  VRE causes very few infections in patients, mostly because VRE is not very good at causing infections compared with other germs.

When VRE was first identified, there was a fear that it might pass on its antibiotic resistance abilities to other more aggressive bacteria; fortunately, we know now that this almost never happens.

Therefore, along with many other hospitals nationally and provincially, we will no longer consider VRE to be a “superbug”.

Are we putting patients at risk by stopping VRE surveillance and isolation?
The risk of us stopping VRE control is very small.  The benefit to stopping is much greater.  We will reinvest into enhancing excellent infection control standards in the hospital for all patients, which will help prevent infections from occurring.

What if we see an increase in VRE in the hospital?  How will we know if we are harming people?
We will continue to track VRE infections and treat them appropriately.  If we see a concerning trend of increased infections, we will take swift and appropriate action to prevent further infections.