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.