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To reduce rates of VRE colonization/disease, Investigators from Austin Health in Melbourne, Australia and the University of Melbourne introduced a multimodal hospital-wide bleach-based cleaning program (BBCP) that included a new product (sodium hypochlorite 1000ppm detergent), new standardized (routine and detailed) cleaning practices and modified glove/gown protocols to rely on alcohol-based handrub and sleeveless aprons. Rates of VRE pre- and post-BBCP were compared.
Grayson, et al. report that patients in four high-risk wards (liver transplant, renal, ICU, hem/oncology) were screened on admission and weekly for rectal VRE colonization, and rates were compared pre-BBCP (Period A [6 mo] Feb-July 2009) vs post-BBCP (Period B1 & B2 Feb-July and Aug-Jan 2010/11). Rates of VRE bacteremia (per 100 patients blood cultured [100PBC]) and of urinary tract infection [UTI] were compared - Period A vs B1 & B2.
A 37 percent reduction in newly recognized VRE colonizations was observed post-BBCP (208/1,948 patients screened [Period A] vs. 181/2,129 [Period B1] vs. 143/2,141 [Period B2], p<0.0001), despite an increase in screening compliance (68.1% vs 74.6% vs 71.9%, p=0.061) and a stable rate of on-admission VRE colonization (38/1.461 [2.6%] vs. 44/1795 [2.5%] vs. 38/1,840 [2.1%], p=0.34). VRE bacteremia declined from 0.48/100PBC (14/2935) pre-BBCP to 0.08/100PBC (5/6194) during the 12-month post- BBCP (p=0.0002), with a reduction in UTI cases (24 [A] vs 19 [B1] vs. 17 [B2]).
The researchers conclude that BBCP was associated with a significant reduction in rates of both new VRE colonizations (37 percent decrease) and VRE disease. This approach potentially represents a new paradigm in the management of VRE. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland, June 29 through July 2, 2011.
Reference: ML Grayson, AA Mahony, EA Grabsch, DR Cameron, RD Martin, M Heland, M Petty and S Xie. Marked reductions in rates of vancomycin-resistant enterococci (VRE) colonization & disease associated with introduction of a routine hospital-wide bleach cleaning program. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6).