Vancomycin-resistant Enterococcus (VRE) Reporting

The dedicated health professionals who work at Runnymede Healthcare Centre are committed to providing the best possible care for our patients and the community. Our hospital supports any initiative that will enhance patient safety, improve performance and strengthen the public’s confidence in Ontario’s hospitals.

Patients can be assured that Runnymede Healthcare Centre is a safe environment that delivers leading specialized complex continuing care.

VRE (Vancomycin-resistant Enterococcus) bacteraemia

Public reporting of Runnymede Healthcare Centre’s VRE rates will allow us to establish a baseline from which our hospital can track our rates over time. Should rates rise above our baseline we will internally review our processes, identifying areas for improvement, and implement strategies to reduce the incidence of VRE. Runnymede Healthcare Centre posts its infection rates online on a quarterly basis. On the Hospital’s website you can find information about VRE and other patient safety indicators.

What is Vancomycin-resistant Enterococcus (VRE)?

Enterococci are germs that live in the gastrointestinal tract (bowels) of most individuals and generally do not cause harm (this is termed “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.

What is bacteraemia?

Bacteraemia is the presence of bacteria in the bloodstream and is referred to as a bloodstream infection.

How is Vancomycin-resistant Enterococcus 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 an infected person or from touching articles soiled by feces. VRE can survive well on hands and can survive for weeks on inanimate objects such as toilet seats, taps, door handles, bedrails, furniture and bedpans. VRE is easy to kill with the proper use of disinfectants and good hand hygiene.

Risk factors for VRE

People at risk for colonization or infection with VRE are usually hospitalized and have an underlying medical condition which makes them susceptible to infection. These conditions include patients with:

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

What is a case of VRE bacteraemia?

A case is a patient identified with laboratory confirmed bloodstream infection with Vancomycin-resistant Enterococcus (VRE). A positive blood culture for VRE with the presence of one or more clinical symptoms of infection such as a temperature of 38C or greater, hypothermia (which is 34C or less), a drop in blood pressure of less than 30 mmHg, or worsening of mental and/or functional status.

What special precautions are required for VRE?

It is important that special precautions are taken to stop VRE from spreading to other patients at Runnymede Healthcare Centre. These precautions include:

• Once a case of VRE is identified the room and equipment used in the room will be thoroughly cleaned and disinfected for the germ
• Signage may be placed at room entrances to remind those that enter the room where VRE cases have been identified to take special precautions
• A long-sleeved gown and gloves must be worn by everyone who provides direct patient care
• Anyone who enters or leaves a room with a confirmed case of VRE must perform hand hygiene

What about family and other visitors?

Should the presence of the bacteria be discovered a patients family and visitors should not assist other patients with their personal care as this may cause the germ to spread. As with care-givers they may be required to wear a long-sleeved gown and gloves while visiting in the room. Before leaving the room with the confirmed case of VRE visitors must remove the gloves and gown and dispose of them in designated containers. They must thoroughly clean their hands.

Good hand hygiene practices

Beyond infections such as VRE good hand hygiene practices are supported by Runnymede Healthcare Centre and our dedicated team of healthcare professionals. People are strongly encouraged to clean their hands:

• After using the bathroom
• After blowing their nose
• Before eating and drinking
• Before and after any wound dressings are touched
• When hands are visibly dirty (soiled)
• While in hospital before and after leaving patient rooms

What will happen at home?

If a patient has VRE at the time they are discharged from Runnymede Healthcare Centre the change of spreading the germ to family members is small. That said, discharged patients, their caregivers and family members should practice the following:

• Everyone who might help with personal hygiene or with going to the toilet should practice good hand hygiene by washing their hands after contact
• Hands should be washed before any food is made and before people eat
• Everyone should wash their hands well after using the toilet
• Clothing may be laundered in the same manner as the rest of the household laundry
• No special cleaning of furniture or items (e.g. dishes) in the home is required
• Patients should always tell physicians, paramedics, nurses or other care providers that they have a confirmed case of MRSA. This helps to prevent the spread of the germ to other

What VRE rate information is being reported by Runnymede Healthcare Centre?

Runnymede Healthcare Centre will post quarterly rates and case counts of new VRE bacteraemia acquired in the hospital on our website. Further information on rates for all hospitals in the Province are available by contacting the Ministry of Health and Long-Term Care.

What determines the rate of VRE?

The total number of new cases of VRE bacteraemia acquired at Runnymede Healthcare Centre in a quarter is divided by the total number of patient days for that quarter. Patient days are the number of days spent in the hospital for all patients. The results are multiplied by 1000. This represents the rate of hospital acquired associated VRE bacteraemia at Runnymede Healthcare Centre per 1000 patient days for that quarter.

What is the healthcare system doing with the rate information?

Hospital acquired infection rates provide one measure of patient safety and quality of care. The rate of hospital acquired VRE bacteraemia can be used to analyze any trends of infection, sources of infection and general surveillance of VRE bacteraemia. It can also assist Runnymede Healthcare Centre in evaluating our infection prevention and control interventions and make further improvements based on this information.

Number of new hospital acquired cases of VRE/total number of patient days(for one Month) x 1000