Background: The utility of active surveillance and contact isolation of VRE colonized individuals has not been established in non-outbreak and hyperendemic settings. The practice is onerous and resource intensive, with a hospital wide impact on patient flow. There is growing body of evidence suggesting that routine isolation of VRE colonized patients may not be beneficial. At MSKCC, VRE colonization rates in BMT and ICU units are ~ 33 %, individuals with colonization only account for 80 % of all new VRE cases. Active surveillance had not shown any significant reduction in incident VRE.
Aim: Analyze the first year after discontinuation of active surveillance and routine contact precautions for VRE in the ICU. Outcomes assessed were house wide VRE BSI rate, unit specific BSI rates, and VRE related nosocomial outbreaks. VRE-specific isolation days were simultaneously monitored.
Methods: Beginning in Sep 2015, we discontinued active VRE surveillance and isolation of colonized individuals in our 20 bed ICU, followed a year later by our 25-bed transplant unit. VRE BSI rates were observed for a 12-month period following these changes.
Results: The baseline house wide VRE BSI rate was 0.31/1000 patient days. After discontinuation of practice in ICU, the ICU rate remained unchanged over the following 12 months ( pre: 0.88/1000 patient days vs post: 0.77/1000 patient days; p value= 0.83). No significant difference was seen in house wide or unit specific rates after the policy was subsequently implemented in the BMT unit (Figure 1). No VRE related outbreaks were detected. There was a 50% absolute reduction in isolation days for VRE between the pre- and post-intervention periods.
Conclusion: Discontinuation of active surveillance and contact isolation of colonized individuals did not result in an increase in incidence of VRE BSI rates in a hyperendemic setting. A reduction in isolation beds facilitated patient flow, especially access to critical care services.
M. Kamboj, None
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