Table 2.
Overview of the implemented control measures during VREfm outbreak period
| Overview of infection control measures during outbreak | ||
|---|---|---|
| 2015 | December (Phase I) |
Detection of the outbreak Single hospital-wide screening limited to patients admitted for at least 48 h |
| 2016 | January | Initiation of Outbreak Management Team (OMT) |
| Reporting outbreak to the national Early warning and response meeting of Hospital-acquired Infections and AntiMicrobial Resistance (SO-ZI/AMR) | ||
| Electronic labelling of VRE-positive patients (confirmed label) and patients with prior hospitalisation in het ADRZ hospital in from September 1, 2014, or prior hospitalisation in a nursing home or rehabilitation centre (‘VRE suspected’ label) | ||
| Informing local hospital personnel and patients, and surrounding hospitals and nursing homes | ||
| Introducing screening for VRE carriage on admission for all patients with electronic ‘VRE suspected’ label and patients from nursing homes or rehabilitation centres | ||
| Weekly hospital-wide VRE rectal screening limited to patients admitted for at least 48 h. In high risk departments (dialysis and ICU) all admitted patients are screened, regardless of the admission time | ||
| Start of cleaning and disinfection (250 ppm chlorine) of the entire hospital: wards are cleaned one by one, whereby patients are temporarily transferred to other (not yet cleaned) parts of the same or other wards | ||
| Introduction of disinfectant wipes for contact surfaces in patient rooms and general areas | ||
| Start of mandatory plenary training sessions for all healthcare workers on general precautions and cleaning issues | ||
| Clear division of cleaning tasks for healthcare workers and cleaning personnel | ||
| February | After cleaning of the ward: release rooms previously occupied by VRE positive patients after cleaning and disinfection based on environmental cultures | |
| March (Phase II) | Audits of adherence to infection control and cleaning protocols by infection control department | |
| Implementing screening and isolation protocol for ‘high risk’ patients (direct contacts of VRE carriers, mostly roommates) | ||
| Reintroducing of cleaning and disinfection (250 ppm chlorine) of the entire hospital: departments are cleaned one by one, whereby patients are temporarily transferred to other (not yet cleaned) departments | ||
| Intensifying communication to healthcare workers and managers | ||
| November (Phase III) | Screening for VRE carriage upon admission limited to only patients with prior hospitalisation in het ADRZ hospital in period December 1, 2015–November 14, 2016 | |
| Monthly hospital-wide VRE rectal screening limited to patients admitted for at least 48 h. In high risk departments (dialysis and ICU) all admitted patients are screened, regardless of the admission time | ||
| 2017 | February (End of the outbreak) | Removing all outbreak related ‘VRE suspected’ labels in the electronic patient system |
| Start hospital-wide VRE rectal screening limited to patients admitted for at least 7 days | ||