|Title:||Infection Prevention and Control of Vancomycin-Resistant Enterococci in Western Australian Healthcare Facilities (HCFs)|
|Document ID:||Operational Directive OD 0516/14|
|Date of issue:||Wednesday, 2 April 2014|
|Status:||NO LONGER APPLICABLE|
|Description:||Describes the requirements for the screening and management of VRE in WA HCFs. Incorporates management in residential care facilities|
|Applicable to:||Nursing, Medical, Allied Health, Laboratory staff|
|Period of effect:||from 13 March 2014 to 13 September 2019|
|Review date:||13 September 2019|
|Authorised by:||Professor Bryant Stokes, A/DIRECTOR GENERAL, Department of Health WA, 20-Mar-2014|
|Print version:||View print version|
Infection Prevention and Control of Vancomycin-Resistant Enterococci in Western Australian Healthcare Facilities (HCFs)
Compliance with this Operational Directive is mandatory for all public hospitals and those private healthcare facilities, including satellite haemodialysis units, contracted to provide services to public patients.
This Operational Directive (OD) describes the requirements for routine screening and the subsequent management of people identified with vancomycin-resistant enterococci (VRE) in Western Australian (WA) healthcare facilities (HCFs). Routine screening beyond the patient groups specified in this OD can only occur with the endorsement of the Chief Medical Officer. All acute care HCFs shall ensure their procedures are aligned with those described in the attached document Infection Prevention and Control of Vancomycin-Resistant Enterococci (VRE) in Western Australian Acute Care Healthcare Facilities. Guidance for the management of VRE-positive individuals in specific acute care settings and residential care facilities (RCFs) is also provided.
Enterococci are bacteria that are part of the normal flora of the human gastrointestinal tract and are inherently resistant to most antibiotics. Antibiotic therapy for enterococcal infections usually involves the use of penicillins and glycopeptides e.g. vancomycin. Although not highly pathogenic, these bacteria can be significant pathogens in immunocompromised patients. Most enterococcal infections are caused by a person’s own normal flora, however, transmission between patients in HCFs does occur. There are a number of different enterococci but those of importance in the context of vancomycin-resistance are Enterococcus faecium and Enterococcus faecalis.
The Centres for Disease Control and Prevention in the United States of America report that 33% of enterococci causing healthcare associated infections in their intensive care units are now from vancomycin-resistant strains.1
In Australia, data from national antimicrobial surveillance programs have shown a rapid increase in the number of clinical VRE isolates occurring in the eastern states since 2008. This trend is also reflected in WA data where an increase in clinical isolates has been reported, although rates have been significantly lower than elsewhere in Australia.2 This increasing prevalence is of concern due to the limited antimicrobial agents available to treat VRE infections. In addition, the vancomycin resistance gene has the potential to be transmitted to other more pathogenic organisms, such as Staphylococcus aureus.
2. INFECTION PREVENTION AND CONTROL
It is critical that all acute care HCFs implement appropriate infection prevention and control strategies for the identification, management and control of VRE in order to protect patients at increased risk of VRE infection and associated morbidity and mortality. Routine screening to identify VRE colonisation in wards/units that regularly admit higher-risk patients has been shown to be cost effective and may reduce morbidity and mortality in populations at higher risk of VRE acquisition and infection.3
The infection prevention and control strategies to be implemented for VRE screening and for the management of VRE colonised or infected (VRE-positive) patients are described in the attached document Infection Prevention and Control of Vancomycin-Resistant Enterococci (VRE) in Western Australian Healthcare Facilities.
3.1 Executive Directors of public and licensed private acute care HCFs funded to provide care for public patients, including satellite haemodialysis units, are responsible for ensuring implementation and compliance with this OD.
3.2 Governance bodies of WA RCFs are to ensure they have effective infection prevention and control programs in place that address the management of VRE‑positive patients.
3.3 All HCFs are to ensure their local infection prevention and control policies are aligned with the requirements described in this OD.
3.4 All acute care HCFs are to ensure higher-risk wards/units that require screening are identified, and that screening is performed in a timely manner in accordance with this OD.
3.5 All HCFs are to ensure that a high level of communication is maintained between facilities when transferring patients who are known to be either VRE positive or a physical contact of a VRE positive patient and who require VRE screening.
3.6 Outbreaks of VRE are to be reported to the Healthcare Associated Infection Unit (HAIU) located within the Communicable Disease Control Directorate (CDCD) via the on line outbreak notification process.
3.7 The HAIU is to regularly review the statewide VRE epidemiology and ensure that there is accurate and effective communication of this information to relevant clinical and governance stakeholders when required e.g. the Healthcare Infection Council of Western Australia Executive and to the infection prevention and control staff of private hospitals.
1. Hidron A, Edwards J, Patel J Horan T et al for the National Healthcare Safety Network. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centres for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008; 29:996-1011.
2. Coombs G, Pearson J, Christiansen K, et al, Australian Group on Antimicrobial Resistance Enterococcus Surveillance Program Annual Report, 2010 .CDI:2013 37 (3)
3. Cruickshank M and Ferguson J, editors. Reducing harm to patients from healthcare associated infection: the role of surveillance. Australian Commission on Safety and Quality in Healthcare 2008:146-148.
Professor Bryant Stokes
This circular last updated: Wednesday, 2 April 2014 at 2:23pm