A Multidisciplinary Approach to Vancomyocin-resistant Enterococcus Outbreak Management

        Natalie Joy Goertz, Registered Nurse, Infection Control; Janice Qubty, BScN, Manager of Medicine, Victoria Campus; Elaine Mayo, Registered Practical Nurse, P.S.A. T.S.A. Infrastructure Admin; Marg Kooy, BScN, Coordinator of Medicine and Respirology; Barbara Watson, BScN, MScN, Educator; Tara Vyn, BScN, MScN, Infection Control, London Health Sciences Centre, London, ON, Canada
        Issue: Vancomyocin resistant Enterococcus (VRE) outbreaks can be difficult to control. January 2009 to June 2009 London Health Sciences Centre experienced a VRE outbreak involving 4 medical units. Previous outbreak management was confusing due to inconsistent communication and fragmented implementations.
        Project: A multidisciplinary team was created to provide clear communication and implementation to staff on a weekly basis. Four major areas of focus were; infection control, education, cleaning and physician initiatives. Infection control implementations were prevalence screening, chlorhexidine bathing, creation of outbreak binders and additional protocols for patient transfer/placement. Educational methods were role playing/case reviews, observational/environmental audits and “ask the experts” bulletin boards. Cleaning initiatives involved checklists and spot checks. Physicians incorporated infection control content into orientation sessions and a “physician pause” to determine appropriate measures required for entering a room.
        Results: The multidisciplinary team provided comprehensive outbreak initiatives and improved communication which contributed increased compliance to outbreak implementations. The outbreak binders and cleaning checklists gave staff a guide to consult for appropriate outbreak measures. The role playing and case reviews helped staff understand the impact of VRE to patient morbidity/mortality. In addition, the audits, cleaning spot checks and “ask the expert” bulletin boards provided staff with feedback and a forum to have questions answered. Many of these initiatives, including the physician initiatives, was continued after outbreak resolution and is believed to contribute to sustained resolution.
        Lessons Learned: Involvement of multiple services created a united front and proved to be effective outbreak management. Relationships were strengthened between infection control, the leadership team and front line staff.