R2826

Abstract (publication only)

Vancomycin-resistant enterococci (VRE) outbreak: lessons learned on the importance of near-patient
cleaning
M. Fraher*, M. Kelly, E. Cronin, B. O'Sullivan, C. Murphy, O. Murphy (Cork, IE)

Objectives: Outbreaks of vancomycin resistant enterococci (VRE) are not uncommon, especially in the
Intensive Care Unit (ICU) where patients have many risk factors for VRE. We report an outbreak of VRE in an
ICU where important lessons were learned on the role of environmental cleaning. Methods: Prior to the
outbreak, all patients admitted to the ICU had a weekly VRE screen (rectal swab). Over a one-week period,
there were 3 new cases of VRE colonisation. Prompt cleaning of the ICU ensued but 4 weeks later, there were 5
more cases of VRE colonisation. Outbreak control measures included hand hygiene educational sessions, deep
cleaning of the ICU, environmental screening and increased VRE screening. Results: These control measures
were successful and no further cases of VRE colonisation were identified. VRE was isolated from the
environment (cot sides of the bed, bed mattress and on a patient cupboard). All isolates were sent to a reference
laboratory for typing and confirmed that the environmental samples were the same strain as the 5 patients who
isolated VRE on the second occasion. Conclusion: Although VRE is known to persist in the environment, we
were concerned that VRE persisted despite cleaning of the ICU. Further investigation revealed that domestic
staff are responsible for cleaning the bottom half of the bed and that nursing staff are responsible for cleaning
the top half of the bed. But as the cot sides of a bed may be moved, it was unclear who’s role it was to clean the
cot sides. Although hospital staff are becoming increasingly aware of the importance of environmental cleaning
in the control of multi-drug resistant organisms, there remains a focus on cleaning floors and bathrooms.
Transmission to patients is however more likely to occur in "near-patient" areas such as the hospital bed and
patient equipment. While cleaning of toilets and floors is usually done by the domestic staff, who cleans these
"near-patient” areas is more grey and may be carried out by nursing staff, domestic staff or healthcare assistants;
depending on the nature of equipment to be cleaned. Clarification of “who cleans what” is vital to ensure that all
“near-patient” areas are cleaned at appropriate intervals and with the right method. The emphasis on
environmental cleaning should not just focus on cleaning floors and bathrooms but most importantly on “near-
patient” areas, which can be an important niche for transmission of multi-drug resistant organisms.