Discontinuation of Systematic Surveillance and Contact Precautions for Vancomycin-ResistantEnterococcus(VRE) and Its Impact on the Incidence of VREfaeciumBacteremia in Patients with Hematologic Malignancies

Abstract

OBJECTIVE To study the effect of discontinuation of systematic surveillance for vancomycin-resistant Enterococcus (VRE) and contact isolation of colonized patients on the incidence of VRE bacteremia SETTING A hematology-oncology unit with high prevalence of VRE colonization characterized by predominantly sporadic molecular epidemiology PARTICIPANTS Inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation METHODS The incidence of VRE bacteremia was measured prospectively during 2 different 3-year time periods; the first during active VRE surveillance and contact precautions and the second after discontinuation of these policies. We assessed the collateral impact of this policy change on the incidence of bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection even though we maintained contact precautions for these organisms. Incidence of infectious events was measured as number of events per 1,000 patients days per month. Time series analysis was used to evaluate trends. RESULTS The incidence of VRE bacteremia remained stable after discontinuation of VRE surveillance and contact precautions. The incidence of MRSA bacteremia and Clostridium difficile infection for which we continued contact precautions also remained stable. Aggregated antibiotic utilization and nursing hours per patient days were similar between the 2 study periods. CONCLUSION Active surveillance and contact precautions for VRE colonization did not appear to prevent VRE bacteremia in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation with high prevalence of VRE characterized by predominantly sporadic molecular epidemiology.

Rates of blood cultures positive for vancomycin-resistant Enterococcus in Ontario: a quasi-experimental study

“…24,26,35 In contrast, our results are not consistent with 2 recent studies. 27,31 However, one study 27 was conducted in an immunocompromised patient population at a single centre where all patients were admitted to single-bed rooms with private bathroom. Thus, the results may not be generalizable to less specialized hospital settings where patients are admitted to multipatient rooms and share bathrooms.…”

“…21 However, the efficacy of contact precautions to prevent the spread of antimicrobial-resistant organisms including VRE has been questioned in 2 randomized controlled trials, 22,23 and studies investigating the impact of discontinuation of VRE screening and isolation practices have given conflicting results. [24][25][26][27] Infection control practices for VRE in Canadian institutions are increasingly heterogeneous, and there is no clear consensus on the best approach. [28][29][30] In Ontario, before June 2012, all inpatient hospitals maintained active VRE screening and isolation programs; 14 in June 2012, some hospitals discontinued this practice, citing concern over the effectiveness of the programs and potential adverse effects of isolating patients.…”

Global variances in infection control practices for vancomycin resistant Enterococcus – results of an electronic survey

“…A study of discontinuation of contact precautions of haematology patient’s admitted to single rooms in a unit in a before/after study showed no significant difference in VRE blood stream infection (BSI) between time periods [9]. Another Canadian study comparing rates of VRE BSI between hospitals that employ screening and isolation and those that abandoned screening, found a rise in VRE BSI in all hospitals, but the rate of increase was highest in non-screening hospitals – this study is not yet complete however [10].…”

BMT Settings, Infection and Infection Control

“…However, Almyroudis et al (2016) reported on the discontinuation of systemic surveillance and contact precautions for VRE and its impact on the incidence of VRE faecium bacteraemia in patients with haematological malignancies. In this study, the incidence of VRE bacteraemia remained stable after discontinuation of surveillance and contact precautions.…”

“…In this study, the incidence of VRE bacteraemia remained stable after discontinuation of surveillance and contact precautions. Furthermore, contact isolation can be associated with medication errors, reduced visits of physicians and nurses, safety concerns such as increased falls and bedsores, anxiety and depression among patients and a significant increase in the cost of care (Almyroudis et al 2016 (Dykewicz and Kaplan 2000).…”