Risk of environmental and healthcare worker contamination with vancomycin-resistant enterococci during outpatient procedures and hemodialysis

Objective. To assess the risk of environmental and healthcare worker ( HCW) contamination with vancomycin-resistant enterococci ( VRE) during outpatient procedures performed on fecally continent patients currently colonized with VRE ( cVRE) or previously colonized with VRE ( pVRE). Design. Observational study. Setting. Outpatient consultation and radiology rooms and the hemodialysis unit in a university teaching hospital. Patients. Fecally continent cVRE and pVRE patients. Interventions. Both cVRE and pVRE patients attended standardized mock outpatient consultations and routine hemodialysis sessions in an area that had been thoroughly cleaned and microbiologically confirmed to be free of VRE contamination. After each session, the patient, environment, and participating HCW were tested for VRE contamination. Results. Fourteen cVRE patients participated in 49 mock outpatient consultation sessions and radiology sessions or 26 actual hemodialysis sessions, and 7 pVRE patients participated in 28 outpatient consultation sessions. Sessions with cVRE patients had higher rates of contamination of the environment ( chair cultures were positive for VRE in 36% of outpatient consultation sessions, 58% of hemodialysis sessions; couch cultures were positive in 48% of outpatient consultation sessions, 42% of radiology sessions, and 45% of hemodialysis sessions), contamination of HCW gowns ( gown cultures were positive in 20% of outpatient consultation sessions, 4% of radiology sessions, and 30% of hemodialysis sessions), and contamination of patients' own hands ( hand cultures were positive in 36% of outpatient consultation sessions, 25% of radiology sessions, and 54% of hemodialysis sessions). Overall, contamination rates associated with pVRE patients attendance at outpatient consultations were 12% of those noted for cVRE patients ( odds ratio, 0.10; 95% confidence interval, 0.03-0.42; P = .001). Conclusions. Given the nature of the contamination risk posed by fecally continent cVRE patients undergoing outpatient procedures, infection control measures should focus on effective HCW and patient hand hygiene and chair and couch cleaning, to minimize transmission of VRE.