What are the CDC recommendations for prevention of person-to-person transmission of VRE?

Updated: Jun 10, 2021
  • Author: Susan L Fraser, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Isolation measures to prevent person-to-person transmission include the following (also see the CDC’s Guideline for Isolation Precautions): [61]

  • Hand washing with antimicrobial soaps and hand rubs with alcohol-based solutions is critical to prevent spread of organisms.

  • Place patients with VRE infections in private rooms or in rooms with other infected patients.

  • Wear gloves when entering a VRE-colonized or VRE-infected room, and wear a gown if substantial contact with patients or their environment is anticipated.

  • Remove gloves and gown before leaving the room, and wash with antiseptic soap or with alcohol-based gel if the gloves are not visibly soiled.

  • Dedicate the use of items such as stethoscopes, blood pressure cuffs, and thermometers to a single patient (or group of patients) colonized or infected with VRE. In addition, all room surfaces should be disinfected on a regular schedule.

The above isolation measures, in combination with surveillance cultures, have been effective in eliminating small VRE outbreaks caused by dissemination of single strains of VRE. These measures may not be as effective in the setting of large polyclonal VRE outbreaks. In a study from an ICU of a hospital experiencing a large polyclonal outbreak, the use of gloves and gowns was not more effective than the use of gloves alone in preventing rectal VRE colonization. In a neonatal ICU, however, control of transmission of multiclonal VRE strains was achieved through a multifaceted approach that included active surveillance cultures of all neonates, DNA fingerprinting of all isolates, contact isolation, staff education, use of waterless hand antiseptics, and removal of electrical thermometers. [62]

One large, cluster-randomized ICU study failed to demonstrate the effectiveness of enhanced infection control precautions to prevent transmitting VRE to other patients, possibly because adherence to barrier precautions was not 100%. [63] The authors advocate that good adherence to isolation precautions is important to reduce transmission of VRE in healthcare facilities, and that reducing body site density of organisms and environmental contamination may also be helpful.

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