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An Australian healthcare facility that implemented aggressive environmental hygiene interventions such as institution-wide wash-downs with bleach, coupled with infection prevention and control practices, reports that it has eradicated bloodstream infections associated with vancomycin-resistant enterococci (VRE) in high-risk areas.
Andrew Mahony, MD, of Austin Health in Melbourne, Australia, reports that following the interventions, the rate of VRE bacteremia in the intensive care unit, transplant units, and other high-risk wards fell to zero, compared with 0.48 per 100 patients with blood cultures before the intervention. Mahony, presenting his findings at the 50th annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC)Â in Boston, adds that VRE colonization rates in new patients were also reduced significantly. In addition to the daily bleach cleaning, infection control protocol called for the wearing of sleeveless plastic aprons (instead of standard gowns) for healthcare workers providing direct patient care, as well as the wearing of gloves at all times.
Mahony reports that despite his facility following infection prevention and control guidelines issued by the Centers for Disease Control and Prevention (CDC), it was experiencing a significant increase in VRE colonization rates. In 1994, the hospital identified one patient with a positive rectal swab for VRE; in 2009, the number hadÂ increased to 597. Before introduction of the cleaning and infection control protocols, new VRE colonizations occurred at a rate of 10.0 per 100 patients screened; it decreased to 7.9 per 100 after the new procedures were implemented.
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