To screen or not to screen, that is the VRE question

Helen Cadwallader 1, David Speers 1,2, Michelle Harvey 1

Sir Charles Gairdner Hospital, Nedlands, WA, Australia

PathWest Laboratory Medicine WA, Nedlands, WA, Australia


VRE screening and isolation for higher risk patients has been performed by WA hospitals for many years. Despite this, the number of VRE detections in WA has been increasing since 2001. A two year alternative horizontal strategy for VRE management is being undertaken at SCGH, an adult tertiary hospital offering transplantation, haematology and intensive care services.

The expected benefits include improved patient flow, reduced transmission of all multi-resistant organisms on the higher risk wards, and reduced personal protective equipment (PPE) and pathology costs.
The cessation of screening and isolation of higher risk patients has been replaced with universal measures to minimise the transmission of VRE on the higher risk wards. This approach includes:
• hand hygiene compliance to the state benchmark and compliance with the dress code policy
• compliance with correct use of PPE and aseptic technique
• enhanced environmental cleaning services
• dedicated equipment policy with limited shared equipment and between-patient cleaning and/or disinfection of shared equipment
• chlorhexidine patient bathing
• antimicrobial stewardship program.

The rate of VRE infections is reviewed by the Infection Prevention and Control Unit and reported to the Healthcare Associated Infection Unit of WA Health.
Quarterly reporting of staff compliance with the new approach to the hospital executive occurs with an action plan to address suboptimal performance.

The alternative approach is in the early stages. Over the two year trial the number of VRE infections at SCGH will be compared to several peer group hospitals in WA.

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