VRE (Vancomycin-resistant Enterococci)
Every hospital in Ontario reports the quarterly rate and case count of VRE bacteraemia acquired in their facility. QHC rates are listed along with all Ontario hospitals on the Health Quality Ontario website: http://www.hqontario.ca/System-Performance/Hospital-Care-Sector-Performance
To ensure patient confidentiality in smaller cities, the Ministry of Health and Long-Term Care has advised hospitals that have between one and four cases in a month to report the number of cases as "less than 5".
Cases of VRE are defined as a patient identified with a laboratory confirmed bloodstream infection.
Questions and Answers about VRE
What is VRE?
Enterococci are germs that live in the gastrointestinal tract (bowels) of most individuals and generally do not cause harm (this is termed "colonization"). Vancomycin-resistant enterococci (VRE) are strains of enterococci that are resistant to the antibiotic vancomycin. If a person has an infection caused by VRE, such as a urinary tract infection or blood infection, it may be more difficult to treat.
How is VRE spread?
VRE is spread from one person to another by contact, usually on the hands of caregivers. VRE can be present on the caregiver's hands either from touching contaminated material excreted by an infected person or from touching articles soiled by faeces. VRE can survive well on hands and can survive for weeks on inanimate objects such as toilet seats, taps, door handles, bedrails, furniture and bedpans. VRE is easy to kill with the proper use of disinfectants and good hand hygiene.
What special precautions are required for VRE?
It is important that special precautions are taken to stop VRE from spreading to other patients in the hospital. These precautions include:
- Single room accommodation (the door can remain open)
- A long-sleeved gown and gloves must be worn by everyone who cares for you
- A sign may be placed on your door to remind others who enter your room about the special precautions
- The room and the equipment used in the room will be cleaned and disinfected regularly
- Everyone who leaves your room must clean their hands well
- You must wash your hands before you leave your room
What about family / visitors?
Your family and visitors should not assist other patients with their personal care as this may cause the germ to spread. They may be required to wear a long-sleeved gown and gloves while in your room. Before leaving your room, visitors must remove the gloves and gown and dispose of them in the garbage container and the linen hamper located in your room. Then they must clean their hands.
Good hand hygiene practices
Remind all staff and visitors to practice good hand hygiene before and after they touch you. Ask your nurse or doctor to demonstrate proper hand hygiene techniques (15 seconds of soap and running water OR waterless alcohol hand rub until hands are dry).
You need to clean your hands:
- After using the bathroom
- After blowing your nose
- Before eating and drinking
- Before and after you touch your dressing or wounds
- When your hands are visibly dirty (soiled)
- Before you leave your room
What will happen at home?
If you have VRE at the time of discharge from hospital, the chance of spreading the germ to your family is small. But, we do recommend you practice the following:
- Everyone who might help you with your personal hygiene or with going to the toilet should wash their hands after contact with you.
- Wash your hands before you make any food and before you eat. This practice should be followed by everyone in the household.
- Wash your hands well after using the toilet. Make sure others that use the bathroom wash their hands well afterwards.
- Clothing may be laundered in the same manner as the rest of the household laundry.
- No special cleaning of furniture or items (e.g. dishes) in the home is required.
- If you share a bathroom at home, clean the toilet and sink at least weekly with a germicidal cleanser.
- Always tell your physician, paramedics, nurses or other care providers that you have VRE. This helps prevent spread to others.
Questions and Answers about Public Reporting of Infectious Diseases
What does "nosocomial" or "hospital acquired" mean?
"Nosocomial" is a latin word that means the disease or infection happened while you were under treatment in a hospital or other health care facility.
How do you know if your hospital's rate is too high?
Quinte Health Care Infection Control Practitioners continually track the rates of numerous infectious diseases to determine if the number of cases is rising above the normal baseline. If we feel our rates have risen above our baseline, we look internally at our hospital's processes, identify areas for improvement, and implement strategies to reduce the incidences of these infections in our organization while also working closely with our Public Health Unit and Regional Infection Control Network.
If we identify a high rate of MRSA or VRE, we review our infection prevention and control practices to ensure that they align with the Provincial Infectious Diseases Advisory Committee (PIDAC) best practices documents, as well as the "Just Clean Your Hands" program. In addition, we also review our environmental cleaning practices to ensure that we are following the PIDAC best practices documents. We also consult with our local public health unit to identify any further action that is required.
What conclusions should patients draw from a high number of cases of either MRSA or VRE in your hospital?
Patients should know that this hospital is safe, that the care you receive here is top-notch, and that every effort - on behalf of every one of us - is to ensure you receive the highest quality of care possible.
Public reporting of MRSA and VRE rates are additional examples of helpful measures used to ensure the care provided to you is even safer, and improves over time. It provides a snapshot of what has happened with respect to one infection - either MRSA or VRE - in a hospital over a certain period of time.
A high number of either MRSA or VRE cases in a quarterly period does not necessarily mean that a hospital is "unsafe"; a lower number of cases in a quarter does not necessarily mean that a hospital is "safe." Rates can vary from hospital to hospital, quarter to quarter. Some hospitals may experience higher rates of MRSA and/or VREdue to their type (i.e. acute care) and patient population (i.e. elderly). That is why it is vital that MRSA and VRE rates be viewed in the context of other performance indicators.
That said, the analysis of our MRSA and VRE rates over time will certainly provide us with helpful information that we can use to make quality improvements in our organization. We look forward to working with our health professionals to make those improvements in the time ahead.
Why do the rates fluctuate?
Rates will vary from quarter to quarter. The smaller a facility, the greater the chance the rates will vary. This is because a change in even one case in a small facility will cause the rate to go up or down considerably.
Can the MRSA or VRE rates be used as a guide to choosing hospitals?
No. MRSA or VRE rates should not be used as a guide to choosing which hospital to seek care at. These rates are indicators and represent only a snapshot of an isolated area of a hospital's performance. Like other indicators, it is important to look at MRSA or VRE rates in a broader context.
Hospital care is complicated and depends on many factors. That is why many indicators must be examined in order to get a sense of how hospitals are performing - where they excel and where improvements could be made. It is important to look at all of these indicators in combination. To judge performance on only one indicator would be misleading.