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The role of the environment in transmission of VRE

Reviewed by Cindy Noyes, MD, University of Vermont Medical Center; Burlington, VT

Tan and colleagues describe an outbreak of vancomycin-resistant Enterococcus (VRE) in one of their medicine hospital wards in Toronto, Canada. The investigators discovered 41 new nosocomial VRE acquisitions, all confirmed to be type 17 by whole genome sequencing.  Due to a COVID-19 surge in the region, the VRE exposed patients were transferred to an entirely different unit in efforts to create a new surge ward.  The outbreak unit was terminally cleaned with sodium hypochlorite and then used to treat non-VRE exposed surgical patients from April 22, 2021 to May 18, 2021.  All patients (both exposed and non-exposed) were screened for VRE on admission, weekly and at discharge.  The authors found that none of the exposed patients developed VRE on the non-outbreak unit, whereas 4 patients acquired VRE while on the outbreak unit.  Staff hand hygiene compliance was monitored and found to be higher on the outbreak unit as compared to the non-outbreak unit.   Although environmental cultures were negative, the authors suggest this to be proof of concept that the environment may act as a reservoir for VRE and that cleaning may be a key component with regard to controlling transmission. 

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