Re: Vancomycin Resistant Enterococcus (VRE) Outbreak - Surgery Unit
Since April 5, 2015 there have now been 87 new acquired VRE cases attributed to the Surgery Unit. The unit will remain open with limited transfers for medical necessity. We are asking all departments that support the Surgery Unit to continue to practice outbreak protocols. Commitment to Routine Practices and hand hygiene are required at all times.
There has been 2 new cases of hospital acquired VRE on the Surgery Unit this week after implementing a switch to bleach for all cleaning.
Due to occupational health issues with housekeeping staff and patients refusing to have their room cleaned with bleach, the decision was made to switch back to Percept for cleaning. Clorox will continue to be used for bathroom cleaning and cleaning will continue to be performed as a two-step process twice per day.
Precautionary measures have been implemented for the Surgery Unit, including a limit of 2 visitors (at a time) per patient, and access to the unit through the West entrance only
All units: Ensure that VRE screening is being performed appropriately.
The following Infection Control Measures will need to be in place:
Clients already on Contact Precautions
All unit and all unit support services:
Gown and gloves are required for all direct care for patients on contact precautions.
Implement strict use and proper removal of appropriate personal protective equipment (PPE).
Patients on contact precautions are to remain in their room, unless medically necessary tests are required.
Clients not on Contact Precautions
All unit staff and all unit support services:
Use routine practices (do not have to gown, glove unless deemed necessary)
Adherence to hand hygiene.
Food and Nutrition Services :
Implement hand hygiene for each client tray drop off and pick up
Additional Infection Control Measures
Limit of 2 visitors per client at one time
Implement strict hand hygiene for all staff and clients
Concentrate staff to specific units as much as possible.
Use PPE (gowns and gloves) appropriately.
Unit kitchens are closed to client and visitor access (only staff can access kitchen areas for clients).
Dedicate equipment to individual clients that are positive.
If using non-dedicated equipment, ensure proper cleaning and disinfection between clients (bleach wipes).
No unit specific client or staff traffic between outbreak units and other units and facilities.
Staff may leave the outbreak units for breaks as usual after removing all PPE and performing hand hygiene.
Unit staff working on the Surgery Unit are dedicated to the unit for the duration of their shift (i.e., cannot be floated to other units after their shift has started and/or may not extend their shift unless they remain on the Surgery Unit for the extension). After the staff member has completed their shift, they may return the following day to a different unit provided they have a clean uniform.
Screening of Clients
All clients admitted should have admission VRE swab sent within 24 hours.
All clients transferred to a non-outbreak unit will be placed on contact precautions until client is cleared with two swabs one week apart. Screening swab should be taken prior to transfer and receiving unit to take second swab one week later. Client to remain on precautions until 2 negative swabs obtained.
Clients who are leaving the unit for tests or procedures shall be on contact precautions during that time off the unit.
Clients may be discharged home—discharge screening swab required on discharge.
Contacts of a new VRE + Client
Any contacts of a new VRE + client will be placed on contact precautions until client is cleared with two swabs one week apart.
Housekeeping will increase cleaning and disinfection using the 2 Step Cleaning process twice per day (Double-Double) with Percept
If using non-dedicated equipment, ensure proper cleaning and disinfection between clients
Increase environmental auditing to three times a week.
Bathrooms to be cleaned with bleach
No transfers to or from outbreak units to other units unless medically necessary.
Limit transfers within unit.
Visitors shall wash their hands using soap and water OR alcohol-based hand rub before and after visiting.
Visitors shall only visit their family member and not other clients.