Marked reductions in rates of vancomycin-resistant enterococci (VRE) colonization & disease associated with introduction of a routine hospital-wide bleach cleaning program
© Grayson et al; licensee BioMed Central Ltd. 2011
Published: 29 June 2011
Introduction / objectives
To reduce rates of VRE colonization/disease, we introduced a multimodal hospital-wide bleach-based cleaning program (BBCP) that included a new product (sodium hypochlorite 1000ppm + detergent), new standardised (routine and detailed) cleaning practices & modified glove/gown protocols to rely on alcohol-based handrub & sleeveless aprons. Rates of VRE pre- & post-BBCP were compared.
Patients in 4 high-risk wards (liver transplant, renal, ICU, hem/oncology) were screened on admission & weekly for rectal VRE colonization, & rates were compared pre-BBCP (Period A [6 mo] – Feb-July 2009) vs post-BBCP (Period B1 & B2 – Feb-July & Aug-Jan 2010/11). Rates of VRE bacteremia (per 100 patients blood cultured [100PBC]) & of urinary tract infection [UTI] were compared - Period A vs B1 & B2.
A 37% reduction in newly recognised VRE colonizations was observed post-BBCP (208/1948 patients screened [Period A] vs 181/2129 [Period B1] vs 143/2141 [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 (38/1461 [2.6%] vs 44/1795 [2.5%] vs 38/1840 [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 mo post-BBCP (p=0.0002), with a reduction in UTI cases (24 [A] vs 19 [B1] vs 17 [B2]).
The BBCP was associated with a significant reduction in rates of both new VRE colonizations (37% decrease) & VRE disease. This approach potentially represents a new paradigm in the management of VRE.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.