Fact Sheet for Health Care Professionals

What is VRE?

Enterococci are bacteria that live in the gastrointestinal tract of most individuals and generally do not cause harm ("colonization"). Vancomycin-resistant enterococci (VRE) are strains of enterococci that are resistant to the antibiotic vancomycin. If a person has an infection caused by VRE, such as a urinary tract infection or blood infection, it may be more difficult to treat.

How is VRE spread?

VRE is spread from one person to another by contact, usually on the hands of caregivers. VRE can be present on the caregiver's hands either from touching contaminated material excreted by the infected person or from touching articles soiled by faeces. VRE can survive well on hands and can survive for weeks on inanimate objects such as toilet seats, door handles, bedrails, furniture, stethoscopes, rectal thermometers and bedpans.

Risk factors for VRE

• Recent hospitalization in health care facilities outside Canada
• Critical illness(es) in intensive care units
• Severe underlying disease or weakened immune systems
• Urinary catheters
• Exposure to (or contact with) a client/patient/resident with VRE
• Antibiotic use, particularly vancomycin

Remind all staff and visitors to practice good hand hygiene before and after client/patient/resident contact/care. Health care staff should review the correct method of hand hygiene, as well as demonstrate the proper donning/removal of personal protective equipment (PPE) to clients/patients/residents, families and visitors.

Good hand hygiene practices refer to the use of waterless alcohol hand rub or soap and running water for at least 15 seconds.

• Before and after each client/patient/resident contact
• Before performing invasive procedures
• Before preparing, handling, serving or eating food
• After care involving the body fluids of a client/patient/resident and before moving to another activity
• Before putting on and after taking off gloves and PPE
• After personal body functions (e.g. blowing one's nose)
• Whenever there is doubt about the necessity for doing so
• When hands accidentally come into contact with secretions, excretions, blood and body fluids
• After contact with items in the client/patient/resident's environment

1. Admission screening for VRE must be completed:



• Check for previous history of VRE or high risk for VRE using the admission screening tool.
• If the client/patient/resident has been a contact of a VRE case in the past, screening specimens must be obtained.
• If the client/patient/resident is considered to be at risk for VRE based on the results of the screening tool, screening specimens must be obtained.


2. If the client/patient/resident is known to have had VRE in the past, Additional Precautions must be initiated:



• Hand hygiene as described in Routine Practices
• Appropriate client/patient/resident placement
• Gloves for entering the patient's room or bed space in acute care, or for direct care of residents in long term care
• Long-sleeved gown for entering the patient's room or bed space in acute care, or for direct care of residents in long term care
• Dedicated equipment or adequate cleaning and disinfecting of shared equipment, including transport equipment
• Daily cleaning and disinfection of all touched surfaces in the room
• Special discharge cleaning protocol is vital for VRE


3. Notify the Infection Prevention and Control Professional or delegate to discuss the infection control management of client/patient/resident activities.
4. Precautions are not to be discontinued until reviewed by Infection Prevention and Control.
5. Additional surveillance specimens for colonization or client/patient/resident
   contact(s) may be required, as directed by Infection Prevention and Control.

1. All families/visitors must practice good hand hygiene before and after leaving the client/patient/resident's room.
2. Families/visitors who provide direct care are to wear the same PPE as staff. "Direct care" is defined as providing hands-on care, such as bathing, washing, turning the client/patient/resident, changing clothes/diapers, dressing changes, care of open wounds/lesions, toileting. Feeding and pushing a wheelchair are not classified as direct care.
3. Provide written information for clients/patients/residents that explains the precautions required.

For more information on good hand hygiene practices, visit Ontario's website www.justcleanyourhands.ca.