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Table 1 Overview of national and local IPC measures for VRE in Germany and the Netherlands

From: Infection prevention and control without borders: comparison of guidelines on multidrug-resistant organisms in the northern Dutch-German cross-border region

IPC measures

KRINKO-DE

KOL

SRI-NL^

UMCG^

screening criteria

patients at risk for VRE1

• patients at risk are defined (bone-marrow transplant unit (BMT) and haematology-oncology ward)

• contact patients that require isolation3

patients

• with recent healthcare facility stays abroad

• who had invasive procedures abroad

• come from another Dutch healthcare facility with an ongoing VRE outbreak

• stricter than NL-SRI rules

• patients at risk (ICU, haematology, gastroenterology)

• additional recommendations for refugees/asylum seekers, adopted child, long-stay and dialyzed patients.

• known / contact of VRE carrier

sampling site

rectal swab, stool

addition to KRINKO

• urine in case of a urinary catheter

• other previously positive sites (if applicable)

rectal swab, stool 4

same as SRI6

management of carriers

• contact isolation (single room)1

 o for all OR

 o carriers at increased risk of environmental contamination2

• cohort1

addition to KRINKO

• antiseptic whole-body washing

contact isolation (single room)

contact-plus isolation7

lifting the isolation

no recommendation

3 negative results on different days³ (1 week interval)

• 5 negative results5 (3 negatives suffice if PCR and cultivation are used)

• follow-up cultures if admitted to an institution within 1 year after carrier status termination

3 negative results starting 1 year after the last positive culture

readmission measures of a known VRE patient

no recommendation

contact isolation for patients:

• admitted to BMT or planning in next 6 weeks.

• with VRE infection, diarrhoea, or faecal incontinence.

contact isolation if the patient found to be positive less than 1 year ago

addition to SRI recommends contact-plus isolation to patients with

• last positive culture 1–5 years and > 5 years based on their number of negative cultures

recommended PPE for HCWs

gloves and gown

• only hand disinfection if no contact

• long-sleeved gowns for direct contact

• overcoat and trousers in case of very close contact.

gloves, long sleeve apron

same as SRI

  1. DE, Germany; HCW, healthcare worker; IPC, Infection Prevention and Control; KRINKO, Kommission für Krankenhaushygiene und Infektionsprävention; LVRE, linezolid-vancomycin resistant enterococci; NL, the Netherlands; PCR, polymerase chain reaction; PPE: personal protective equipment, SRI, Samenwerkingsverband Richtlijnen Infectiepreventie; UMCG, University Medical Center Groningen; KOL, Klinikum Oldenburg; VRE, vancomycin resistant enterococci
  2. ^ valid only for E. faecium
  3. 1 decision should be taken by the clinicians, hospital hygienists and clinical microbiologists of the hospitals
  4. 2 insufficient compliances with hygienic measures, acute diarrhoea, faecal incontinence
  5. 3 patients on the BMT unit or oncology ward, VRE infection requiring treatment, VRE colonisation with presence of diarrhoea or faecal incontinence, evidence of LRE/LVRE (colonisation and/or infection)
  6. 4 additional sampling of other anatomical locations if needed: skin, throat, urine or wounds
  7. 5 cultures are not reliable when using antibiotics that suppress the growth of highly resistant microorganisms in the 48 h before collection
  8. 6 the following cultures are required in specific situations: sputum culture in intubated patients and in patients giving up sputum, smear of wounds and skin lesions (e.g. eczema or psoriasis), urine culture in patients with indwelling catheters or suspected urinary tract infection, umbilical smear in neonates (as long as the umbilical stump has not dried in)
  9. 7 cleaning and disinfection of the room and waste are handled differently, the patient lies in a sluiced room with the doors closed, allowing better differentiation between the clean and dirty zone
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Antimicrobial Resistance & Infection Control

ISSN: 2047-2994

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