Infection control and VRE

[Wishart, Michael]

[Cross posted from ASID OzBug list with permission – I will share replies with David Gordon- Moderator]

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This may be a heretical question but I would be interested in views on the value of screening and control programs for VRE.
Currently we have, along I presume with many hospitals, moderate endemic levels of VRE (560 cases last year versus none in 2007). There has been a lot of attempts initially at control including screening and contact tracing, as well as hand hygiene and cleaning issue (only partly successful). Screening has reduced somewhat (only immediate bay contacts if patient still in) and some entry/exit screening in ICU and monthly surveillance in high risk areas like renal and gastro.
It is likely that what we detect is only a (unknown) proportion of the pool of VRE in the hospital. Patients transferred from Flinders to Repat Hospital for various reasons are screened and around 15% are positive, suggesting quite a pool of unknown VRE carriers, although the transferred patients might be higher risk than the general patient population.
Detection of VRE causes many logistical problems and costs including further screening, huge bed pressures and blocks, problems for theatres/ radiology etc. Cost is hard to quantitate but would be huge.

When VRE first appeared we sought but failed to get support for intensive control when it might have been possible.
Now it is endemic, there is a likely considerable pool of “unknowns”, patients are coming with it from other hospitals and perhaps even the community, current control efforts are not too successful (maybe partly a reflection on overall infection control practices and cleaning/antibiotics),huge bed pressure and other problems managing colonised patients and in the context that only a very small number of colonised patients have infection, is it time to abandon these efforts of screening and isolation and accept that widespread transmission occurs. The money save might be better spent enhancing cleaning/general hand hygiene or employing another ID consultant!
Thanks for any comments,
Regards
David

Prof David Gordon
Head of Micro and Infectious Diseases
Flinders Medical Centre, SA Pathology

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