Costs and Savings Associated With Infection Control Measures That Reduced Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

AbstractObjective:To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting.Design:Evaluation of costs and savings, using historical control data.Setting:Adult oncology unit of a 650-bed hospital.Participants:Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients.Methods:Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model.Results:The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings.Conclusion:The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least see to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.

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Infection-Control Measures Reduce Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

Annals of Internal Medicine ◽

10.7326/0003-4819-131-4-199908170-00006 ◽

1999 ◽

Vol 131 (4) ◽

pp. 269 ◽

Cited By ~ 136

Author(s):

Marisa A. Montecalvo ◽

William R. Jarvis ◽

Jane Uman ◽

David K. Shay ◽

Coleen Petrullo ◽

...

Keyword(s):

Infection Control ◽

Control Measures ◽

Endemic Setting ◽

Infection Control Measures ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

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Success of an Infection Control Program to Reduce the Spread of Carbapenem-Resistant Klebsiella pneumoniae

Infection Control and Hospital Epidemiology ◽

10.1086/596734 ◽

2009 ◽

Vol 30 (5) ◽

pp. 447-452 ◽

Cited By ~ 136

Author(s):

Sandeep Kochar ◽

Timothy Sheard ◽

Roopali Sharma ◽

Alan Hui ◽

Elaine Tolentino ◽

...

Keyword(s):

Intensive Care Unit ◽

Infection Control ◽

Control Program ◽

Control Measures ◽

Infection Control Program ◽

Infection Control Measures ◽

Carbapenem Resistant ◽

Number Of Patients ◽

The Mean ◽

Vancomycin Resistant

Objective.To assess the effect of enhanced infection control measures with screening for gastrointestinal colonization on limiting the spread of carbapenem-resistant Klebsiella pneumoniae in a New York City hospital endemic for this pathogen.Design.Retrospective observational study with pre- and postinterventional phases.Methods.Beginning in 2006, a comprehensive infection control program was instituted in a 10-bed medical and surgical intensive care unit at a university-based medical center. In addition to being placed in contact isolation, all patients colonized or infected with carbapenem-resistant gram-negative bacilli, vancomycin-resistant Enterococcus, or methicillin-resistant Staphylococcus aureus were cohorted to one end of the unit. Improved decontamination of hands and environmental surfaces was encouraged. In addition, routine rectal surveillance cultures were screened for the presence of carbapenem-resistant pathogens. The number of patients per quarter with clinical cultures positive for carbapenem-resistant K. pneumoniae was compared during the approximately 2-year periods before and after the intervention.Results.The mean number ( ± SD) of new patients per 1,000 patient-days per quarter with cultures yielding carbapenem-resistant K. pneumoniae decreased from 9.7 ± 2.2 before the intervention to 3.7 ± 1.6 after the intervention (P< .001 ). There was no change in the mean number of patient-days or the mean number of patients per quarter with cultures yielding methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, or carbapenem-resistant Acinetobacter baumannii or Pseudomonas aeruginosa after the intervention. There was no association between antibiotic usage patterns and carbapenem-resistant K. pneumoniae.Conclusions.The comprehensive intervention that combined intensified infection control measures with routine rectal surveillance cultures was helpful in reducing the incidence of carbapenem-resistant K. pneumoniae in an intensive care unit where strains producing the carbapenemase KPC were endemic.

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Vancomycin-Resistant Enterococci: The Value of Infection Control and Antibiotic Control Policy

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2006/974748 ◽

2006 ◽

Vol 17 (suppl b) ◽

pp. 9B-12B ◽

Cited By ~ 1

Author(s):

Karl Weiss

Keyword(s):

Health Care ◽

Infection Control ◽

Health Care System ◽

Control Measures ◽

Canadian Health Care System ◽

Infection Control Measures ◽

Vancomycin Resistant Enterococci ◽

Canadian Health ◽

Canadian Health Care ◽

Vancomycin Resistant

Vancomycin-resistant enterococci (VRE) represent a major challenge for the Canadian health care system. The clinical significance of VRE in the Canadian health care system has increased over the past two decades, with outbreaks reported in Ontario and Quebec, although most provinces have been affected. This organism has been a substantial human and financial burden for Canadian institutions. VRE have been shown to be associated with an increased mortality, a longer hospital stay and a much higher overall cost compared with vancomycinsusceptible strains. Enterococci are now the third most important nosocomial pathogen in American intensive care units. The two most common species,Enterococcus faecalisandEnterococcus faecium, have shown remarkable adaptability in responding to antibiotics. The arrival of VRE in Canada has forced hospitals to implement stringent and costly infection control measures. A multifaceted approach, including antibiotic restriction and stringent infection control measures, is important in managing VRE prevalence in Canadian institutions.

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First Report of Nosocomial Outbreak of Vancomycin-Resistant Enterococcus Faecium Infection Among COVID-19 Patients Hospitalized in a Non-Intensive Care Unit Ward in Central Europe

10.21203/rs.3.rs-955202/v1 ◽

2021 ◽

Author(s):

Yashar Jalali ◽

Igor Šturdík ◽

Monika Jalali ◽

Ján Kyselovič ◽

Adriána Liptáková ◽

...

Keyword(s):

Infection Control ◽

Central Europe ◽

Control Strategies ◽

Health Care Systems ◽

Blood Stream ◽

Control Measures ◽

Outbreak Investigation ◽

Strain Identification ◽

Strict Adherence ◽

Vancomycin Resistant

Abstract Background: The COVID-19 pandemic in 2020 exerted immense pressure on health care systems worldwide, causing substantial resources to be diverted to respond to the pandemic. These changes raise the concern about the potential for reduction in adherence to long-established measures in the prevention of healthcare-associated infections (HAI). Enterococcus species account for most of human enterococcal HAI and multidrug-resistant infections and have become a major threat to modern public health. We examine the rise in the number of vancomycin resistant E. faecium blood stream and urinary tract infections in a COVID-19 department during an epidemiologic outbreak investigation to detect and eliminate nosocomial clusters of the bacteria. Methods: Strain identification was performed by classical isolation and biochemical and cultivation methods. Antibiotic testing results were interpreted according to European committee on antimicrobial susceptibility testing (EUCAST) guidelines. Six isolated samples underwent whole genome sequencing (WGS) during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing.Results: WGS revealed two genotypically distinct VRE clusters, one of which had genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control strategies.Conclusions: This study provides the first description of an outbreak caused by vanA-ST17 E. faecium strains among COVID-19 patients in central Europe, and the first description of an outbreak caused by vanB-ST117 and vanA-ST17 E. faecium strains in Slovakia. This study can help raise awareness about the need for strict adherence to infection control measures and the implementation of rational antimicrobial stewardship as a routine part of COVID-19 management.

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Risk Factors for Long-Term Vancomycin-Resistant Enterococci Persistence—A Prospective Longitudinal Study

Microorganisms ◽

10.3390/microorganisms7100400 ◽

2019 ◽

Vol 7 (10) ◽

pp. 400 ◽

Cited By ~ 2

Author(s):

Correa-Martinez ◽

Stollenwerk ◽

Kossow ◽

Schaumburg ◽

Mellmann ◽

...

Keyword(s):

Risk Factors ◽

Infection Control ◽

Control Measures ◽

Factors Associated ◽

Infection Control Measures ◽

Vancomycin Resistant Enterococci ◽

History Of ◽

Vancomycin Resistant ◽

Prospective Longitudinal

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that require effective infection control measures, representing a challenge for healthcare systems. This study aimed at identifying risk factors associated with prolonged VRE carriage and determining the rate of clearance that allows the discontinuation of contact precautions. During a 2-year study, screening was performed in patients with a history of VRE or at risk of becoming colonized. After bacterial identification and antibiotic susceptibility testing, glycopeptide resistance was confirmed by PCR. Isolates were compared via whole genome sequence-based typing. Risk factors were recorded, and follow-up screening was performed upon readmission, defining patients as long-term carriers if still colonized ≥10 weeks after first detection. Of 1059 patients positive for VRE, carriage status was assessed upon readmission in 463 patients. VRE was cleared in 56.4% of the cases. Risk factors associated with long-term persistence were hospital stays (frequency, length), hemato-oncological disease, systemic treatment with steroids, and use of antibiotics. No specific genotypic clustering was observed in patients with VRE clearance or persistence. VRE clearance is possibly underestimated. The identification of risk factors favoring long-term carriage may contribute to a targeted implementation of infection control measures upon readmission of patients with history of VRE.

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Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/502595 ◽

2005 ◽

Vol 26 (7) ◽

pp. 646-649 ◽

Cited By ~ 44

Author(s):

Nalini Singh ◽

Marie-Michèle Léger ◽

Joyce Campbell ◽

Billie Short ◽

Joseph M. Campos

Keyword(s):

High Risk ◽

Infection Control ◽

Dna Fingerprinting ◽

Active Surveillance ◽

Genetic Relatedness ◽

Control Measures ◽

Infection Control Measures ◽

Vancomycin Resistant Enterococci ◽

Surveillance Cultures ◽

Vancomycin Resistant

AbstractBackground and Objective:Multidrug-resistant organisms (MDROs), such as vancomycin-resistant enterococci (VRE), cause serious infections, especially among high-risk patients in NICUs. When VRE was introduced and transmitted in our NICU despite recommended infection control practices, we instituted active surveillance cultures to determine their efficacy in detecting and controlling spread of VRE among high-risk infants.Methods:Active surveillance cultures, other infection control measures, and a mandatory in-service education module on preventing MDRO transmission were implemented. Cultures were performed on NICU admission and then weekly during their stay. Molecular DNA fingerprinting of VRE isolates facilitated targeting efforts to eliminate clonal spread of VRE. Repetitive sequence PCR (rep-PCR)-based DNA fingerprinting was used to compare isolates recovered from patients with VRE infection or colonization. Environmental VRE cultures were performed around VRE-colonized or -infected patients. DNA fingerprints were prepared from the products of rep-PCR amplification and analyzed using software to determine strain genetic relatedness.Results:Active surveillance cultures identified 65 patients with VRE colonization or infection among 1,820 admitted to the NICU. Rep-PCR performed on 60 VRE isolates identified 3 clusters. Cluster 1 included isolates from 21 patients and 4 isolates from the environment of the index patient. Clusters 2 and 3 included isolates from 23 and 3 patients, respectively. Similarity coefficients among the members of each cluster were 95% or greater.Conclusions:Control of transmission of multi-clonal VRE strains was achieved. Active surveillance cultures, together with implementation of other infection control measures, combined with rep-PCR DNA fingerprinting were instrumental in controlling VRE transmission in our NICU. (Infect Control Hosp Epidemiol 2005;26:646-649)

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Lack of Transmission of Vancomycin-Resistant Enterococci in Three Long-Term–Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/501628 ◽

1999 ◽

Vol 20 (05) ◽

pp. 341-343 ◽

Cited By ~ 15

Author(s):

Christina A. Greenaway ◽

Mark A. Miller

Keyword(s):

Infection Control ◽

Long Term Care ◽

Point Prevalence ◽

Control Measures ◽

Term Care ◽

Infection Control Measures ◽

Vancomycin Resistant Enterococci ◽

Care Facilities ◽

Vancomycin Resistant

Abstract Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.

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