Isolation Guidelines


University Heart Grand OpeningMatch DayTomorrow. Every Day.The Manning Family Fund for a Healthier Mississippi
  • Vancomycin Resistant Enterococcus (VRE)

    Isolation requirements

    • Disease: Vancomycin Resistant Enterococcus (VRE)
    • Category: Contact
    • Placement: Patients known to be infected or colonized with VRE shall NOT be placed in rooms adjacent to patients with methicillin resistant staph aureus (MRSA).
    • Infective material: Infection/colonization at any site implies diffuse skin colonization - consider all items in patient's room potentially contaminated.
    • Duration of isolation:
      • For health care settings, patients who are colonized or infected with MDROs or VRE are to remain in isolation for duration of hospital stay.
      • Patients effected with VRE may be removed if they meet the following criteria (and then only by the hospital epidemiologist or his designee):
        • Eight weeks after a patient’s last positive culture, a follow-up surveillance culture of stool or peri-rectal region may be obtained to screen for clearance. The patient does not need to be off antibiotics prior to being cultured, but such therapy makes clearance less likely.
        • If the initial stool/peri-rectal culture is negative for VRE, two additional stool or peri-rectal cultures should be obtained at least one week apart. Three negative cultures are required to discontinue contact isolation. Infection Control must be called (4-2188) prior to discontinuation of isolation.
    • Comments: E. faecium and E. faecalis require Contact Precautions. Use Standard Precautions for E. gallinarum, E. casseliflavus or E.. flavescens. (An exception exists for the Bone Marrow Transplant Unit where Contact Precautions are required.) See VRE Information Sheet and VRE Information Sheet for Patients and Families for more information.

    Class 2

    This is a Class 2 reportable disease.

    • Class 2: Diseases or conditions of public health importance of which individual cases shall be reported by mail, telephone or electronically, within 1 week of diagnosis. In outbreaks or other unusual circumstances they shall be reported the same as Class 1. Class 2 diseases and conditions are those for which an immediate public health response is not needed for individual cases.

    Reporting hotline

    • 1-800-556-0003, 8 a.m.-5 p.m. Monday-Friday
    • To report inside Jackson telephone area or for consultative services: (601) 576-7725, 8 a.m.-5 p.m. Monday-Friday 
    • Class 1 conditions may be reported nights, weekends and holidays by calling (601) 576-7400.

    Protocol

    The following protocol will be utilized to control and prevent nosocomial transmission of VRE.

    • All enterococci isolates will be screened for vancomycin resistance. The patient’s primary physician and the infection control practitioners are to be notified immediately by the lab if VRE is identified.
    • All patients infected or colonized with VRE will be placed in contact precautions. Gown and gloves are worn prior to entering the room and removed before exiting, followed by handwashing with an antiseptic soap. VRE can extensively contaminate environmental surfaces. Anyone entering the room must be so attired. After removing gown and gloves no contact should be made with environmental surfaces. All trash should be placed in red infectious waste containers.
    • All VRE infected/colonized patients are to be placed in contact precautions on the unit where VRE is identified. Patients with VRE in the respiratory tract should be placed on contact precautions. Patients infected/colonized may be cohorted in the same room.
    • Roommate(s) of the VRE infected/colonized patient will be transferred to a private room(s) on the unit where the VRE has been identified. These patients will be placed on contact precautions as per #2 above until surveillance cultures for VRE return negative.
    • Isolation may be discontinued only with the consent of the hospital epidemiologist or his designee. Negative cultures for VRE must be obtained from all recognized sites of infection/colonization on three consecutive occasions, taken one week apart. Even with these negative cultures, patients may be kept in isolation at the discretion of the hospital epidemiologist or his designee.
    • Surveillance cultures to be done on VRE infected/colonized patients and patients who shared rooms with the patient consists of rectal swab, culture of urine from patients with indwelling urinary catheters, intravascular devices, decubitus ulcers, wounds and other sites at the discretion of the hospital epidemiologist or his designee.
    • Disposable patient care equipment that is used in a VRE patient’s room should be disposed of in infectious waste upon discharge.
    • Environmental cultures will be done periodically in rooms occupied with VRE infected/colonized patients by the hospital ppidemiologist or his designee. These sites will include, but may not be limited to: 1) bedside tables, 2) over-bed tables, 3) the floor, 4) bedside rails, 5) foot of bed. Additional cultures obtained will be at the discretion of the hospital epidemiologist or his designee.
    • In extreme circumstances (i.e., and outbreak) where transmission via health care providers, suspected employees may be requested to submit to screening cultures of skin, wound, hands and the rectum.
    • Periodically, at the discretion of the hospital epidemiologist, cross-sectional culture prevalence studies may be performed on patients at high risk for VRE. Such patients include, but are not limited to, patients residing in Intensive Care Units or patients receiving cancer chemotherapy or hemodialysis.
    • Inter-unit movement of VRE infected/colonized patients will be limited as possible. Transfer of a patient to another unit will occur only if the best medical interest of the VRE infected/colonized patient.
    • Patient(s) placed in room(s) previously housing VRE infected/colonized patient(s) should be immuno-competent. If item #6 above reveals any positive cultures for VRE, surveillance cultures may be performed on the present occupant of the room(s).
    • Non-critical items (i.e., stethoscope, rectal thermometer, etc.) should be dedicated to a single patient (or cohort of patients) infected/colonized with VRE. Stethoscopes, BP cuffs, etc. should be decontaminated with alcohol upon patient discharge. Disposable thermometers are to be utilized.
    • Isolation rooms will be cleaned with all surfaces thoroughly disinfected at the time of patient discharge. Environmental cultures may be performed following this cleaning. Cleaning will include replacement of bedside curtains. Rooms will be available immediately for occupancy after terminal cleaning.
    • Epidemiologic studies have shown that the overuse of vancomycin is associated with the emergence and spread of VRE. For this reason, the Pharmacy and Therapeutics Committee has adopted restrictions on the usage of vancomycin in accordance with recommendations formulated by the Centers for Disease Control and Prevention (MMWR Vol. 44 No. RR-12). Further restrictions on the use of other antibiotics may be proposed as information from clinical studies become available.
    • Initiate the following precautions to prevent the transmission of VRE:
      • strict handwashing
      • utilize personal protective equipment
      • utilize isolation precautions
    • Ensure that after glove and gown removal and handwashing, clothing and hands do not contact environmental surfaces in the patient’s room that are potentially contaminated with VRE (e.g., a door know or curtain).
    • When VRE is isolated from a baby in the nursery, either infection or colonization, the infant will immediately be placed on contact precautions (mask for respiratory procedure). The room in which the baby resides will be immediately closed to further admissions until the index case (and any subsequent cases in the room) are discharged. Other infants in the room who cannot be discharged from the hospital will have rectal and skin cultures for VRE performed weekly as long as the index case resides in the room. When possible, VRE colonized or infected babies should be transferred toBatson Children’s Hospital for single-room isolation. If multiple vases of VRE occur in the nurseries, then there will be an attempt to cohort such babies.
    • Patients known to be infected or colonized with VRE shall be placed on the surgical schedule as the last case of the day. Following thorough terminal cleaning and disinfection, the room may be used for all surgeries the following morning. Patients known to be infected or colonized with VRE shall NOT be placed in rooms adjacent to patients with methicillin resistant staph aureus (MRSA).