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SNF Infection Control Guidelines for VRE Cheat Sheet (DRAFT) by [deleted]

Infection Control Guidelines for VRE

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Entero­ccocci bacteria are normally present in the human intestines and in the female genital tract and are often found in the enviro­nment. These bacteria can sometimes cause infect­ions. Vancomycin is an antibiotic that is used to treat some drug-r­esi­stant infections caused by entero­cocci. In some instances, entero­cocci have become resistant to this drug and thus are called vancom­yci­n-r­esi­stant entero­cocci (VRE). Most VRE infections occur in hospitals.

At least 25 percent of antibiotic prescr­iptions in nursing homes do not meet clinical guidelines for prescr­ibing. This use and overuse of antibi­otics results in side effects and drug-r­esi­stant bacteria. The Commun­ication and Decision making for Four Infections toolkit aims to reduce inappr­opriate prescr­ibing for the four infections for which antibi­otics are most frequently prescribed in nursing homes:
(1) Urinary tract infections (UTIs)
(2) Lower respir­atory tract infections
(3) Skin and soft tissue infections
(4) Gastro­int­estinal infections

When to Culture:

When entero­coccus is cultured, check sensit­ivities or ask lab if it is vancomycin resistant.

When to treat

Sympto­matic infection, not coloni­zation.

How to Isolate Cultur­e-p­ositive Residents

Do not use contact precau­tions in the absence of a draining wound, profuse respir­atory secret­ions, or evidence implic­ating the specific patient in ongoing transm­ission of the MDRO within the facility.
Use approp­riate hand hygiene before and after all resident contacts (soap and water, or waterless alcohol product).
Avoid placing resident in same room with person with indwelling medical device or open wound.
Use sterile bandages to contain secretions from VRE-in­fected wound.
Clean contam­inated surfaces with EPA-re­gis­tered hospital disinf­ectant.

When to Decolonize a Resident

Do not attempt; no proven successful regimen exists

VRE Infection Risk Factors

People at risk of getting VRE

The following persons are at increased risk becoming infected with VRE:
People who have been previously treated with the antibiotic vancomycin or other antibi­otics for long periods of time.
People who are hospit­alized, partic­ularly when they receive antibiotic treatment for long periods of time.
People with weakened immune systems such as patients in intensive care units, or in cancer or transplant wards.
People who have undergone surgical procedures such as abdominal or chest surgery.
People with medical devices that stay in for some time such as urinary catheters or central intrav­enous (IV) catheters.
People who are colonized with VRE

How VRE is spread

VRE is often passed from person to person by the contam­inated hands of caregi­vers. VRE can get onto a caregi­ver’s hands after they have contact with other people with VRE or after contact with contam­inated surfaces. VRE can also be spread directly to people after they touch surfaces that are contam­inated with VRE. VRE is not spread through the air by coughing or sneezing.