Abstract
We experienced an outbreak of vancomycin-resistant enterococci (VRE) starting in April 2009. Our acute care hospital consists of 8 wards and 382 beds. We verified a total of 30 VRE carriers in 6 wards excluding the pediatric ward and the obstetrical and gynecological ward. The first carrier was a 66-year-old woman in the East 4 ward (neurosurgery). As we detected VRE from 4 patients in whom we suspected cross infection, we examined all the patients in the ward, and found 2 more carriers. Around the same time, 8 patients in either the West 4 or East 5 ward were found to be carriers, so we examined all patients in all wards. Subsequently, we found carriers in the West 5, East 6, and West 6 wards as well. We restricted new admittance to as well as discharge and transfer from those wards containing carriers until the infection statuses of all patients were confirmed. Once confirmed, we placed the carriers in cohort isolation, and performed active surveillance with culturing on admission as well as on a regular basis in non-carrier patients. We gave strict instructions to every ward as to disinfection of the environment and prevention of contagion. Still, a new carrier emerged, so we decided that it could no longer be left up to each ward to control the situation, and gathered all the carriers in the East 4 ward for intensive, isolated management. We also not only gave instructions to the medical staff, but made sure that the cleaning staff was adequately instructed as well. Consequently, the number of carriers rapidly decreased. It took us 14 months to extinguish the outbreak. The VRE isolated from the 30 carriers all possessed vanB, and pulsed-field gel electrophoresis suggested that all organisms potentially belonged to the same strain.
