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Reducing the incidence of vancomycin-resistant Enterococci (VRE): A 12-month outcome on an adult inpatient oncology unit

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      ISSUE: Oncology patients are at increased risk for acquiring resistant bacteria due to multiple antibiotic therapies, frequent and prolonged hospitalizations, and immunosuppression secondary to disease and treatment. Over the summer of 2003, an increased incidence of VRE and corresponding utilization of infection control precautions was noted on the adult oncology unit.
      PROJECT: A multidisciplinary team met to identify and outline interventions to reduce factors contributing to horizontal transmission of antibiotic resistant pathogens in this patient population. The team's purpose was to provide a safer environment through the promotion of basic infection control practices, including standard precautions; promote early identification and isolation of patients with drug-resistant organisms; and educate staff, patients, and families regarding the importance of basic infection control practices and active surveillance screening cultures for drug-resistant organisms.
      Education and observational studies were done by the department of epidemiology to increase staff knowledge and awareness of current infection control practices. Routine cleaning needs were identified, cleaning responsibilities clarified, and storage of shared patient equipment was improved.
      Scripts were developed to assist staff in discussing the importance of screening with patients and families. Patient letters were developed to outline the unit's plan and the importance of hand hygiene for patients and visitors. All oncology patients were screened for VRE on admission and weekly thereafter. Patients identified as VRE positive were placed on drug-resistant organism (DRO) precautions, an enhanced contact precaution that required gowns and gloves for entry into the patient room. Precautions days were tracked monthly. Bimonthly team meetings were held to discuss and address issues and provide real time data for review and analysis.
      RESULTS: Through a multidisciplinary collaborative effort, we were able to initiate and sustain a greater than 50% reduction in the number of new cases of VRE. Fewer patients on infection control precautions impacted nursing care time, increasing both patient and staff satisfaction.
      LESSONS LEARNED: Active surveillance screening cultures and prompt isolation, in conjunction with basic infection control measures, can promote a safer patient environment and reduce the risk of horizontal transmission in a high-risk patient population.
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