Management of vancomycin-resistant Enterococcus faecium in Dutch healthcare institutes: a nationwide survey

• Published in: The Journal of hospital infection 2025-01, Vol.155, p.51-59
• Main Authors: Mulder, M., Vendrik, K.E.W., van Kessel, S.A.M., Notermans, D.W., Schoffelen, A.F., Flipse, J., Hendrickx, A.P.A., van der Zwet, W.C., Schneeberger-van der Linden, C.
• Format: Article
• Language: English
• Subjects: Hospital procedures; Infection control; Long-term care facility procedures; Vancomycin-resistant Enterococcus faecium; VRE
• ISSN: 0195-6701; 1532-2939; 1532-2939
• DOI: 10.1016/j.jhin.2024.09.028

Vancomycin-resistant Enterococcus faecium (VREfm) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VREfm management are available. Most available guidelines are written towards the hospital setting and only few on long-term care facilities (LTCFs). Moreover, not all aspects of VREfm management are covered, recommendations differ and the level of compliance to these guidelines is unknown. The aim of this study was to get insight into the routine VREfm policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures. Online questionnaires were sent to representatives of Dutch hospitals and LTCFs. The questionnaire included questions regarding the definition of VRE, screening, diagnostics, patient isolation, cleaning procedures, VREfm clearance and VREfm outbreaks. The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VREfm outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VREfm screening versus 50% of the LTCFs. VREfm-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VREfm-positive patients are in place in 84% of the hospitals and in 51% of LTCFs. The details of these measures differ substantially between healthcare facilities. This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VREfm management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VREfm data on a regional/national level.