Vancomycin Resistant Enterococcus (VRE)

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• Public Health Ontario Information Sheet for Patients and Visitors

No exclusion necessary unless too ill to participate in regular activities.

Note: Exclusion guidelines may differ for healthcare workers. Follow the direction of your healthcare provider or occupational health at your workplace.

Infection Prevention and Control

Refer to PIDAC: Appendix D: Sample Investigation Protocols for MRSA and VRE in Acute Care Facilities for sample investigation protocols for VRE present at admission to acute care or suspected health care associated VRE.

Screening

All health care facilities should institute a screening program and targeted surveillance for VRE in order to implement infection prevention and control measures as early as possible to reduce the risk of transmission to others. Public Health Ontario's Antibiotic Resistant Organism (ARO) Risk Factor-Based Screening Guidance for All Health Care Settings checklist can be used or adapted by any health care setting as a screening tool for all AROs.

Additional Precautions

Initiate contact precautions upon receipt of positive culture result for VRE or with admission of flagged VRE positive client/patient/resident or high-risk individual pending culture results. In addition to routine practices, contact precautions include:

• For acute care – private/single room with a dedicated toilet and patient sink, gloves and gown when within the client/patient/room or bed space.
• For long-term care – placement of residents requiring contact precautions should be reviewed on a case by case basis. Gloves and gown are required for activities that involve direct care where the health care provider’s skin or clothing may come in direct contact with the resident or items in the resident’s room or bed space.
• For ambulatory care/clinic settings – place individuals in an examination room or cubicle as soon as possible. Gloves and gown are required for activities that involve direct care where the health care provider’s skin or clothing may come in direct contact with the individual or items in the examination room/cubicle.
• Dedicated equipment or adequate cleaning and disinfection of shared equipment, including transport equipment.

Refer to the PIDAC document Routine Practices and Additional Precautions in All Health Care Settings for additional information.

Cleaning and Disinfection

VRE can persist for prolonged periods of time in the health care environment and routine cleaning and disinfection often fails to remove VRE from surfaces. Careful, meticulous room cleaning and disinfection is recommended for patients/clients/residents on contact precautions, ensuring that there has been adequate cleaning and disinfection of rooms or bed space and shared equipment following client/patient/resident discharge or transfer. Use fresh supplies and equipment, consider double cleaning. Refer to the PIDAC document Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3^rd Edition for additional information.

Laboratory Testing

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