498. Management of a Regional Outbreak of VanA Vancomycin-Resistant Enterococcus faecium (VRE) Colonization
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A

A VRE outbreak has emerged in the Teaching Hospital of Nancy (CHUN) and secondarily spread in other facilities in the Lorraine region. In July 2007, a specific task force (TF) was designed. The French guidelines to control beginning VRE outbreak were first presented to managers and infection control practitioners of the institutions concerned by VRE: cohorting of colonized patients in dedicated wards with dedicated staff, cohorting of “contact”, enlarged screening policy, emphasis on hand hygiene and optimized use of antibiotics. Because many institutions were yet concerned, without buildings and/or staff availability, implementation of such cohortings in each institution no longer seemed feasible and adequate. During 4 months, the TF visited every institution concerned by VRE and new “adapted” measures, based on the national recommendations but adjusted to local particularities (staffing, technical means, finances) were suggested, then collectively validated (regional meeting, end of October 2007) and finally recorded in a booklet which was sent to every institution in the region. A call centre was also created by TF to give advises. An accurate management of transfers was set up by TF to avoid any gap in communication of VRE status (colonized and “contact”). In each institution, a dedicated member was designed to declare to the TF every new case of VRE. Because circulate a nominative list of patients concerned by VRE is impossible considering respect of the “medical secret”, a list of the wards dealing with VRE-patients was set up, updated weekly and circulated to every facility in Lorraine, allowing any receiving facility to optimise its screening and probabilistic isolation policy. Conclusion: the partner’s network created between TF and in each institution, elaboration of “adapted” measures and management of transfers were the crucial steps to allow, after 18 months, the successful management of this outbreak [> 1000 cases reported in 35 institutions, including 50% in CHUN].
Vincent Gendrin, MD1, Sandrine Henard, MD1, Nathalie Jouzeau, Nurse2, Christian Rabaud, MD, PhD3, Loic Simon, PharmD2, Nathalie Vernier, Nurse2 and  S. Henard, None..
V. Gendrin, None..
L. Simon, None..
N. Jouzeau, None..
N. Vernier, None..
C. Rabaud, None., (1)Infectious Diseases Department, University Hospital, Nancy, France, (2)CClin Est, Nancy, France, (3)university hospital center of Nancy