Vancomycin-resistant Enterococci (VRE)

What is Vancomycin-resistant Enterococci (VRE)?

Enterococci are bacteria that 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 often used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE).

What is Methicillin-resistant Staphylococcus aureus (MRSA)?

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain or all types of the beta-lactam classes of antibiotics such as penicillins, penicillinase-resistant penicillins (e.g. cloxacillin) and cephalosporins.

Risk factors for MRSA and VRE

Risk factors for MRSA acquisition include invasive procedures, prior treatment with antibiotics, prolonged hospital stay, stay in an intensive care or burn unit, surgical wound infection and being a close contact of a colonized person. MRSA can also be transmitted from mother to child through breast milk.

Risk factors for VRE include severity of underlying illness, presence of invasive devices, prior colonization with VRE, antibiotic use, close contact with a colonized person and length of hospital stay.

How are MRSA and VRE transmitted?

The single most important mode of transmission of both MRSA and VRE in a health care setting is via the hands of health care workers who acquire it from contact with colonized or infected patients, or after handling contaminated material or equipment. The unrecognized colonized patient presents a particular risk for transmission to other patients.

How are MRSA and VRE diagnosed?

All patients admitted to TBRHSC are screened for any risk factors of an antibiotic resistant organism. Risk factors include but are not limited to:

  1. those previously in a health care facility (for greater than 12 hours) within the past 12 months
  2. those living in a communal type setting (correctional facility, homeless shelter, etc.)
  3. those having home health care or on dialysis
  4. those with any history of injection drug use

Those patients indicating “yes” to risk factors for MRSA or VRE are screened with both nasal and rectal swabs.

How are MRSA and VRE treated?

Treatment depends on how sick patients are with the disease and whether they have an infection or are colonized with the organism.

What precautions are used to prevent the spread of both MRSA and VRE in the hospital?

All patients with MRSA or VRE are “flagged” on the electronic medical record for future visits. This way staff can take precautions upon their arrival. These extra steps will include placing the patient in a private room with additional precautions that will include gowning, gloving for any patient or patient environment contact as well as hand hygiene before and after all contact with patient. At TBRHSC, all visitors entering the room of a patient with additional precautions in place (on “isolation”) will be required to wear a gown and gloves.

MRSA and VRE Public Reporting

Thunder Bay Regional Health Sciences Centre reports on a quarterly basis hospital acquired Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) bacteraemia infection rates.

What will be publicly reported?

TBRHSC will post its quarterly rate and case count of new MRSA and VRE bacteraemia acquired in their facility on their website. At the end of each quarter, the Ministry will report the previous quarter’s data on its website.

What does hospital-acquired mean?

Sometimes when patients are admitted to the hospital they get infections. This is a hospital-acquired infection. In the case of either MRSA or VRE, this may mean that symptoms began 72 hours after admission to the hospital; or that the infection was present at the time of admission but was related to a previous admission to the hospital within the last four weeks.

What determines the rate?

The total number of new cases of MRSA and VRE bacteraemia acquired in the hospital in a quarter is divided by the total number of patient days for that quarter. Patient days are the number of days spent in a hospital for all patients. The results are multiplied by 1000. This represents the rate of hospital acquired associated MRSA and VRE bacteraemia associated with the reporting facility per 1000 patient days for that quarter. The rates of infection will be calculated by quarter.

What will the health care system do with the rate information?

Hospital acquired infection rates provide one measure of patient safety and quality of care. The rate of hospital acquired MRSA bacteraemia and VRE bacteraemia will be used to analyze any trends province wide of infection, sources of infection and general surveillance of MRSA and VRE bacteraemia. It can also assist hospitals to evaluate the effectiveness of infection prevention and control interventions and make further improvements based on this information.