Montecalvo, M. A., Jarvis, W. R., Uman, J., Shay, D. K., Petrullo, C., Rodney, K., . . . Wormser, G. P. (1999). Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Annals of Internal Medicine, 131, 269–272.

To examine infection measures to reduce the transmission of vancomycin-resistant enterococci (VRE).

VRE cultures were obtained from all 259 patients (100%) in 404 admissions to the unit during the use of enhanced infection control strategies and 167 of 184 patients (91%) in 210 admissions to the unit during the use of standard infection control practices.

Enhanced Infection Control

1. Inpatient surveillance: perianal cultures on admission and weekly
2. Hand washing before and after patient contact
3. Contact isolation for VRE-colonized and VRE-infected patients
4. Gown and glove use on entry of rooms of VRE-colonized and ​VRE-infected patients
5. Consultation with infectious disease specialists when infection is first suspected
6. Systematic recommendation by infectious disease specialists to discontinue empirical vancomycin use after 72 hours
7. Systematic recommendation by infectious disease specialists to use oral metronidazole rather than oral vancomycin for Clostridium difficile colitis
8. Spatial separation of patients into three cohorts: VRE-positive, VRE-negative, and VRE-unknown patients
9. Surveillance of perianal cultures taken for inpatients with cancer housed off the oncology unit
10. Gown and glove use on entry of rooms of VRE-unknown patients
11. Assignment of staff cohorts; nurses and nursing assistants assigned to VRE-positive patients or VRE-negative and VRE-unknown patients
12. Patient orientation about VRE with an explanatory brochure
13. Monitoring compliance by observational studies
14. Environmental cultures taken in VRE-positive patient rooms before and after patient discharge and room disinfection

Patients were evaluated during the use of enhanced infection control strategies (n = 259) and standard infection control practices (n = 184).

Eleven-room, 22-bed adult oncology unit in a 650-bed tertiary care hospital

This was a prospective cohort study.

Standard infection control versus enhanced infection control:

• VRE infection rates
• Colonization
• Changes in antimicrobial use.

• VRE colonization was significantly reduced: 8.6 patients per 1,000 days versus 13.2 patients per 1,000 days
• Compliance with enhanced strategies: 91.7% of individuals who entered rooms wore gowns and gloves
• Enhanced infection control strategies: The incidence of VRE bloodstream infections decreased significantly (1.4 patients per 1,000 days versus 3.2 patients per 1,000 days for the standard group).

• No conceptual model was described.
• Single unit where patients were not transferred
• No randomization
• Fifteen infection control measures were implemented simultaneously; therefore, the influence of each intervention is unknown.