Vancomycin Resistant Enterococcus in the Neonatal Intensive Care and Special Care Nursery

Dr Ming Chen1, Dr Patiyan Andersson2, Ms Fiona Kimber1, Ms Wendy Beckingham1, Dr Margaret Broom1, Dr Margaret McLeod1, Dr Nick Coatsworth1
1The Canberra Hospital, Garran , Australia,

2Health Emergency Management Branch Immunisation Branch Office of Health Protection Department of Health Canberra, Garran, Australia

Introduction

Vancomycin Resistant Enterococci (VRE) is most commonly reported in Neonatal Intensive Care Units (NICU) in infants whose clinical specimens have shown a colonisation of VRE, the precursor to a potentially life threatening infection. We describe an episode of VRE colonisation in a NICU and outline the screening program undertaken. Routine screening at another hospital detected a positive VRE on an infant on rectal swab who was transferred from our NICU. Within the next month, three further infants tested positive at our institution.

Methods

Governed by a high level management team, a nursery wide screening program was completed. The program consisted of weekly screening of all babies in the department. The program concluded after ten weeks when no new positive babies were detected for three consecutive weeks. Environmental surface screening was performed which involved five ‘high touch’ points. These included x ray machine, phones, breast pumps, sinks and lights. Bed movements of infants were recorded for ten weeks.

Results

Initial surveillance performed by multidisciplinary staff identified eight positive infants. A total of 14/257 (5.44%) infants tested positive for VRE from when the first case was noted. Two babies who were initially negative at the start of screening became positive on further screening. No positive cultures were seen eight weeks post initial screening. Review of bed movements highlighted a disproportionate number of moves. No environmental sources of VRE were identified.

Conclusion

This study has shown surveillance is a key contributor in the resolution of a VRE colonisation in a NICU.


Biography:

Ming is a Paediatric Registrar at the Canberra Hospital.