Infection Control Manual, Reservoirs, pg 1

VRE Infection Control Policy
	Introduction
	Epidemiology
	VRE Prevention & Control
	Reservoirs
	Inpatient Control Measures Identification Contact Precautions Patient Care Equipment Patient Transport Cleaning/Disinfection Antibiotic Usage
	Discharge/Transfer/Home Care
	Outpatient Control Measures
	Discontinuation of Isolation Precautions
	Surveillance/Outbreak Control
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Yale New Haven Hospital
QISS
GB 325
New Haven, CT
06504 USA

Dr. Jeff Topal
688-4634


Reservoirs, pg 1

Patients
Patients usually display asymptomatic colonization of the GI tract. Carriage is silent as GI colonization does not produce symptoms. It is estimated that for every VRE infection, there may be 10 colonized patients. Therefore, VRE may spread through a patient care unit or particular patient population long before any clinical infections become evident. Patients colonized or infected with VRE have an equal potential of transmitting the organism or contaminating their environment. Colonization is often prolonged lasting from weeks to years. The ability of the host to clear VRE from the GI tract is dependent on the host's underlying health status (improvement in the underlying illness or immune status) and/or removal of antibiotic selection pressure. Many patients with VRE colonization often will transiently clear VRE from the stool, only to become either easily re-colonized with their prior strain or a different strain. Attempts to eradicate VRE from the GI tract have been unsuccessful to date and may lead to the develop of VRE with increased antimicrobial resistance.

Environmental Sources
VRE has been recovered from many types of medical equipment and environmental surfaces. Such equipment has included, but is not limited to:

Bedside tables	ECG monitor/wires
Bedside rails	Computer keyboards/tables
Blood pressure cuffs	Automated medication dispensers (Pyxis)
Pulse oximeters	Scales
Stethoscopes	Cabinets
IV pumps	Patient gowns/bed linens
Call buttons	Doorknobs/handles

Additionally, VRE can persist on such devices and/or surfaces for days to weeks if not properly cleaned and disinfected. These devices and/or surfaces can serve as fomites from which healthcare workers' hands or gloves can become contaminated.

Last modified: December 20, 2000.