What do you do to prevent VRE transmission?

…you are not alone, if the answer to this question is ‘nothing special’, based on survey published in ARIC! Dale Fisher’s team in Singapore put together a simple survey, asking the global IPC community what measures they have in place to prevent the transmission of VRE. There was a huge degree of variability, ranging from ‘nothing special’ to ‘the kitchen sink’!

We posted the link to the survey earlier in the year, so it’s good to see the results published (quite quickly actually, if you consider that the survey was only released in May). The survey was centered around three key questions: screening, cleaning, tagging carriers, and isolation. As you can see from the chart below, there was little consensus in any of the categories. Most agreed that you shouldn’t untag carriers (“Once positive, always positive”), that cleaning should be enhanced, and that targeted screening should be implemented. But some didn’t flag the patient record at all, and didn’t recommend any enhanced screening, or active surveillance.

Figure: Results from a survey of around 200 healthcare practitioners worldwide about their practices to prevent the transmission of VRE.

This survey touches on the difference between a ‘targeted’ (aka ‘vertical’) or ‘universal’ (aka ‘vertical’) approach to IPC. I tend to take a pretty pragmatic view here. If we were to implement a universal strategy of basic IPC for everybody, there would be little need for any targeted strategies. But we don’t, because to err is human, so we use targeted interventions to ensure that basic IPC is practiced when it REALLY matters!

Perhaps the bottom line here is that we need more evidence to understand what really works to prevent the transmission of VRE and other pathogens linked to HCAI!