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Hello,
My managers have asked me to review our current practices of isolating
VRE positive patients. This is mainly due to the limited number of
single rooms within our facility. I am interested to know how you
manage patients who have a positive VRE screen, whether you isolate or
not, what risk assessments you undertake to determine as to whether to
isolate or not and whether you have introduced a yoghurt regime for
these patients and how you then manage these patients.Thanking you in advance,
Barbara
Barbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677
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Dear Barbara,
We isolate our VRE patients mandatorily and manage them with Contact Precautions 2. If there is no single room available (and we are a 250 bed hospital with only 6 single rooms), we put them in a two bed bay and close a bed regardless of bed status for that day in the hospital. We cohort VRE patients whenever possible. There are some hospitals in our AHS who also isolate the contacts of VRE patients (besides isolating the patient themselves). These contacts are cleared after they have had a negative rectal swab for VRE.
Kind regards,
RitaCNC Infection Control | Hornsby & Ku-ring-gai Health Service
Palmerston Road,
Tel 02 9477 9232 | Pager 52533|
rroy@nsccahs.health.nsw.gov.au
http://www.health.nsw.gov.au>>> “May, Barbara” 27/02/2013 8:35 am >>>
Hello,My managers have asked me to review our current practices of isolating
VRE positive patients. This is mainly due to the limited number of
single rooms within our facility. I am interested to know how you
manage patients who have a positive VRE screen, whether you isolate or
not, what risk assessments you undertake to determine as to whether to
isolate or not and whether you have introduced a yoghurt regime for
these patients and how you then manage these patients.Thanking you in advance,
Barbara
Barbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677
This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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Hi Barbara
As you know out here in the west we have a very stringent program.
Despite the limited number of single rooms in my facility we still
continue to isolate patients or cohort under contact precautions. These
patients are never cleared as there is no evidence that clearance can be
achieved. When these patients are placed on antibiotics, they often
revert back to VRE being detected despite many negative screens. One of
the highest risk factor for an outbreak and spread is diarrhoea so if
you are pressed for rooms and a decision, I would insist on someone with
diarrhoea being isolated.Regards
Rosie
Rosie Lee
RN. BSc. CICPCoordinator – Infection Prevention & Management
SMH Service – Royal Perth HospitalPh + 61 8 9224 2805 Fax + 61 8 9224 1989
IMPORTANT NOTICE: The contents of this email (including any attachments)
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telephone________________________________
Behalf Of May, Barbara
Hello,
My managers have asked me to review our current practices of isolating
VRE positive patients. This is mainly due to the limited number of
single rooms within our facility. I am interested to know how you
manage patients who have a positive VRE screen, whether you isolate or
not, what risk assessments you undertake to determine as to whether to
isolate or not and whether you have introduced a yoghurt regime for
these patients and how you then manage these patients.Thanking you in advance,
Barbara
Barbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677
This message is intended for the addressee(s) named and may contain
confidential information. If you are not the intended recipient, please
delete the message and any attachments and notify the sender. Views
expressed in this message are those of the individual sender, and are
not necessarily the views of NSW Health or any of its entities.Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives
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Hi Barbara, we isolate all provisional and confirmed cases of VRE in Single rooms under CONTACT PRECATUIONS – we are lucky as the majority of our beds are in private rooms. Cheers Katie
Katie Dwan| Infection Prevention & Control Co-ordinator
St Vincent’s Hospital Toowoomba | 22-36 Scott Street TOOWOOMBA 4350
T 07 4690 4042| F 07 4690 4400 E katie.dwan@stvincents.org.au | W http://www.stvincents.org.auHello,
My managers have asked me to review our current practices of isolating VRE positive patients. This is mainly due to the limited number of single rooms within our facility. I am interested to know how you manage patients who have a positive VRE screen, whether you isolate or not, what risk assessments you undertake to determine as to whether to isolate or not and whether you have introduced a yoghurt regime for these patients and how you then manage these patients.Thanking you in advance,
BarbaraBarbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Hi Barbara,
We isolate all VRE positive patients in a single room and use contact precautions.
In our dialysis unit we do our best to provide a single room but at times also have to cohort two VRE patients together.Kind regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076Hello,
My managers have asked me to review our current practices of isolating VRE positive patients. This is mainly due to the limited number of single rooms within our facility. I am interested to know how you manage patients who have a positive VRE screen, whether you isolate or not, what risk assessments you undertake to determine as to whether to isolate or not and whether you have introduced a yoghurt regime for these patients and how you then manage these patients.Thanking you in advance,
BarbaraBarbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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Hi Barbara
In my lovely hospital here we have 80+% single rooms (including 2 in our 15 bed ICU), so isolation of inpatients with VRE is not a problem, and we isolate all patients with a history of VRE. We do have a ‘clearance’ regime that involves 3 negative rectal swabs (plus any other infected / colonised sites) at least 3 months after last positive, on no antibiotic therapy for at least 2 weeks, and the clearance swabs must be at least a week apart.
Having said all that, in hospitals with limited single rooms I have seen all sorts of algorithms for isolation of VRE. Some of the thoughts in these include risk of transmission (high risk patients: those with diarrhoea or symptomatic infection; high risk areas like dialysis / transplant / oncology / ICU) and time since last positive.
There was actually a discussion a while ago (?Ozbug, ?HICSIG) about the whole value of VRE precaution, since the actual morbidity with VRE infection is low (even though colonisation rates may be increasing), so there are varied opinions on this.
Cheers
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailHello,
My managers have asked me to review our current practices of isolating VRE positive patients. This is mainly due to the limited number of single rooms within our facility. I am interested to know how you manage patients who have a positive VRE screen, whether you isolate or not, what risk assessments you undertake to determine as to whether to isolate or not and whether you have introduced a yoghurt regime for these patients and how you then manage these patients.Thanking you in advance,
BarbaraBarbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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Hi Michael,
I’m interested to know how you manage the clearance regime to get the weekly
rectal swabs over a three week period for all your VRE positive patients
over time.Do you have a computer tracking and readmission and flagging system or is
this tracking done manually?What if the VRE patient goes home before the 3 weeks is up? I’m guessing
that with the exception of your dialysis patients the average length of stay
of most inpatients is probably only 4-5 days so do you follow up pts after
discharge to complete the clearance regime?Would be interested to hear from other infection control teams with similar
clearance regimes and those who also have a large accumulated numbers of
VRE positive patients as to how tracking and readmission
flagging/identification occurs.Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Michael Wishart
Hi Barbara
In my lovely hospital here we have 80+% single rooms (including 2 in our 15
bed ICU), so isolation of inpatients with VRE is not a problem, and we
isolate all patients with a history of VRE. We do have a ‘clearance’ regime
that involves 3 negative rectal swabs (plus any other infected / colonised
sites) at least 3 months after last positive, on no antibiotic therapy for
at least 2 weeks, and the clearance swabs must be at least a week apart.Having said all that, in hospitals with limited single rooms I have seen all
sorts of algorithms for isolation of VRE. Some of the thoughts in these
include risk of transmission (high risk patients: those with diarrhoea or
symptomatic infection; high risk areas like dialysis / transplant / oncology
/ ICU) and time since last positive.There was actually a discussion a while ago (?Ozbug, ?HICSIG) about the
whole value of VRE precaution, since the actual morbidity with VRE infection
is low (even though colonisation rates may be increasing), so there are
varied opinions on this.Cheers
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
w:
http://www.holyspiritnorthside.org.auPlease consider the environment before printing this email
Of May, Barbara
Hello,
My managers have asked me to review our current practices of isolating VRE
positive patients. This is mainly due to the limited number of single rooms
within our facility. I am interested to know how you manage patients who
have a positive VRE screen, whether you isolate or not, what risk
assessments you undertake to determine as to whether to isolate or not and
whether you have introduced a yoghurt regime for these patients and how you
then manage these patients.Thanking you in advance,
Barbara
Barbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677
This message is intended for the addressee(s) named and may contain
confidential information. If you are not the intended recipient, please
delete the message and any attachments and notify the sender. Views
expressed in this message are those of the individual sender, and are not
necessarily the views of NSW Health or any of its entities.Messages posted to this list are solely the opinion of the authors, and do
not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives –
registration and login required.Replies to this message will be directed back to the list. To create a new
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express consent of the sender. The Communication may contain copyright
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entities or of third parties. If you are not the intended recipient of the
Communication, please notify the sender immediately by return e-mail, delete
the Communication, and do not read, copy, print, retransmit, store or act in
reliance on the Communication. Any views expressed in the Communication are
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SVHAC. SVHAC does not guarantee the integrity of the Communication, or that
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Hi,
Based on currently available evidence, VRE in Hong Kong manifests as small/ medium sized clusters occurring in a few hospitals. And our strategy is promptly strict isolation once VRE case is found, for details, please visit CHP website http://www.chp.gov.hk/files/pdf/cdw_v8_25.pdf
Furthermore, to minimize infection risk, we will input relevant information for VRE positive in patient’s e-record. If patient with VRE is readmitted or transferred to other hospitals, alert message would be prop-up for reminding staff that this particular case would require strict isolation.
Our wards are very busy, always crowded with patient. However, we insist to implement the strict isolation strategy for VRE case. For implementation, we explain to our staff, if VRE case is not properly isolated, risk of VRE outbreak may be happened in their workplaces. Our staff are well informed that some of our local hospitals with VRE outbreak, the enhanced control measures would be last for months. Hence, staff know, they will have a lot of hard work, if they have VRE outbreak, for details, please refer to our VRE outbreak news http://icidportal.ha.org.hk/sites/en/Lists/Training%20Calendar/Attachments/90/VRE%20%20overview%20NOV2012.pdf
Regards,
Sony SO
Nursing Officer, Infection Control Team
Kwong Wah Hospital
Hong Kong SAR, CHINA
Tel:+ 852 3517-2409 Fax: +852 2332-3348 email:sony@ha.org.hk
http://www3.ha.org.hk/kwh/main/tc/index.asp
http://www.tungwah.org.hk/?content317
Please consider the environment before printing this e-mailHi Barbara
As you know out here in the west we have a very stringent program. Despite the limited number of single rooms in my facility we still continue to isolate patients or cohort under contact precautions. These patients are never cleared as there is no evidence that clearance can be achieved. When these patients are placed on antibiotics, they often revert back to VRE being detected despite many negative screens. One of the highest risk factor for an outbreak and spread is diarrhoea so if you are pressed for rooms and a decision, I would insist on someone with diarrhoea being isolated.
Regards
Rosie
Rosie Lee
RN. BSc. CICP
Coordinator – Infection Prevention & Management
SMH Service – Royal Perth HospitalPh + 61 8 9224 2805 Fax + 61 8 9224 1989
IMPORTANT NOTICE: The contents of this email (including any attachments) may be privileged and confidential. Any unauthorised use of its contents is expressly prohibited.
If you received this email in error, please advise me by reply email or telephone
________________________________Hello,
My managers have asked me to review our current practices of isolating VRE positive patients. This is mainly due to the limited number of single rooms within our facility. I am interested to know how you manage patients who have a positive VRE screen, whether you isolate or not, what risk assessments you undertake to determine as to whether to isolate or not and whether you have introduced a yoghurt regime for these patients and how you then manage these patients.Thanking you in advance,
BarbaraBarbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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Hi Barbara
We are currently taking a risk assessment approach in the prioritisation for single room accommodation for contact precautions. We have both VRE faecium van B and VRE faecium van A (resistant to Teicoplanin), as in other facilities we believe that VRE van B is now endemic within our facilities, where as VRE van A is not endemic and therefore we prioritise single room accommodation for this type. As when VRE van B was the “new-kid-on-the-block” and strict contact precautions and “isolation” was implemented in an effort to prevent transmission and endemicity, we are now taking this approach with van A.
We would also prioritise MRSA over VRE van B as it is associated with higher morbidity and mortality rates.
As previous mentioned in previous responses we would certainly prefer patients colonised with VRE van B with diarrhoea to be accommodated in a single room.
We do have an evidence-based VRE clearance protocol which we have been offering to patients for a number of years with varying degrees of success. For the most part patients a very appreciative of the opportunity to try and have the stigma of a resistant organism alert connected forever to their name.
In our facility we are working with all HCWs to understand that, for the most part, it is our actions or omissions that result in the transmission of multi-resistant organisms. Missing hand hygiene moments, not cleaning equipment between patients, not providing hand hygiene opportunities for our patients, not maintaining a clean environment. When these simple activities are not adhered to in general (often before we are aware of an MRO result), placing a brick wall between the HCW and the patient doesn’t necessarily increase compliance.
In short, single room accommodation for VRE van B is not a priority in our facility.
Beth
Beth BintInfection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________Hello,
My managers have asked me to review our current practices of isolating VRE positive patients. This is mainly due to the limited number of single rooms within our facility. I am interested to know how you manage patients who have a positive VRE screen, whether you isolate or not, what risk assessments you undertake to determine as to whether to isolate or not and whether you have introduced a yoghurt regime for these patients and how you then manage these patients.Thanking you in advance,
BarbaraBarbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities. Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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