Greater surveillance, infection control measures decreased vancomycin-resistant enterococci

ATLANTA — Levels of vancomycin-resistant enterococci in a neonatal intensive care unit declined after the implementation of strengthened surveillance and infection control policies, data presented here at the 59th Annual Epidemic Intelligence Service Conference indicated.

Results from passive surveillance conducted from Jan. 28 to Feb. 24, 2009 prompted a hospital to notify the Indiana State Department of Health (ISDH) that three patients with vancomycin-resistant enterococci infection had been identified in the hospital’s neonatal ICU, according to researchers from the CDC and the IDSH.

Matthew D. Ritchey, DPT, MPH, of the CDC and IDSH, and colleagues defined cases as culture-confirmed vancomycin-resistant enterococci colonization or infection involving a pulsed-field gel electrophoresis pattern indistinguishable from the initial isolates’ pattern in infants seen in the hospital’s neonatal ICU from Feb. 25 to June 9, 2009.

The researchers also reviewed records and the current infection control measures before comparing the performance of active surveillance cultures and incidence of colonization between two intervention periods.

Period A, which took place from Feb. 25 to March 18, 2009, included weekly active surveillance cultures, improved cleaning procedures and contact precautions for patients.

Period B, however, which took place from March 19 to June 9, 2009, included twice-weekly active surveillance cultures; more rigorous diaper-handling and isolation practices; and cohorting of the staff, according to the researchers.

Thirty-five of 93 infants were colonized with vancomycin-resistant enterococci, the researchers noted, with newly identified cases peaking at the beginning of each period as surveillance efforts changed. Active surveillance cultures increased from 22.1 per 100 days during Period A to 27.2 during Period B.

Incidence of vancomycin-resistant enterococci colonization, however, decreased from 5.0 to 1.7 cases per 100 patient-days, and no positive cultures were found after May 15. No colonized infants developed clinical infection during the investigation.

Active surveillance identified high levels of vancomycin-resistant enterococci colonization, and increased surveillance and improved infection control may have led to a decrease in this number, the researchers concluded. – by Melissa Foster

For more information:

Ritchey MD. Session O. Presented at: 59th Annual Epidemic Intelligence Service Conference; April 19-23, 2010; Atlanta.

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