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Let’s Be Free of Vancomycin Resistant Enterococcus (VRE)

Project Added:
25 May 2015
Last updated:
27 May 2015

Let’s Be Free of Vancomycin Resistant Enterococcus (VRE)


The project implemented measures to deal with nosocomial infections, including increased swabbing, improved cleaning services, cleaning surveillance tools, personal hygiene packs and patient questionnaires.

This project was a finalist in the Harry Collins category of the 2014 NSW Health Awards.  Download a poster from the 2014 NSW Health Awards.


To reduce Vancomycin Resistant Enterococcus (VRE) transmission in patients admitted to the haematology and oncology units of St George Hospital.


  • Reduces risk of healthcare-associated infections.
  • Provides better health outcomes for patients.
  • Improves patient flow due to reduced length of stay (LoS).
  • Improves efficiency and productivity in haematology and oncology units.

Project Status

Project status: Implemented - the initiative is ready for implementation, is currently being implemented piloted or tested.
Project dates:  June 2013 - June 2014.


VRE blood stream infections (BSIs) are a serious cause of morbidity and mortality in immunosuppressed patients, resulting in significantly increased LoS and overall costs. Eradication of VRE is difficult once endemic.

The median LoS for infected patients at St George Hospital prior to the project was 22 days, versus four days for patients without a BSI.

A VRE screening program was introduced to St George Hospital in 2010. A VRE census report undertaken between October 2010 and November 2011 showed that 38% of admissions were either in contact with VRE (25%) or swabbed positive (13%), resulting in up to 33% of admissions to wards 4E and 4N requiring isolation due to VRE colonisation.

Of these contacts, 50% subsequently were found to be VRE positive. This represented a significant burden in terms of isolation and management of infected patients, as well as cleaning and monitoring potential development of BSIs.


  • A mist disinfection system (Deprox) was implemented to deal with nosocomial infections.
  • Cleaning surveillance tools (Dazo) were used to identify cleaning surfaces and provide feedback to cleaning teams.
  • Chlorhexidine hand washes, antimicrobial curtains and antibacterial wipes in toilets were stocked on the wards.
  • Personal hygiene packs were created and distributed, including individual tourniquets, blood pressure cuffs, stethoscopes and alcohol-based hand rubs.
  • Increased VRE screening for immunosuppressed patients was undertaken, to identify and treat contaminated patients in a timely manner. Screening was increased from monthly to on admission, weekly and on discharge.
  • Patient education was undertaken to increase the profile of healthcare-associated infections, including a revised patient information leaflet, patient questionnaire and a new program on the patient television channel.
  • The patient flow unit was engaged to ensure that new leukaemic patients received a single room in the wards.
  • Cleaning audits were undertaken to monitor compliance with new measures and assess results.
  • Cleaning management was changed in the hospital, with improved staff education and cleaning services.


  • Between June 2013 and May 2014, rates of VRE BSIs on wards 4E and 4N reduced from 3.6% to 0.6%.
  • The number of VRE positive swabs during patient screening was reduced from 27.3% of 517 swabs to 11.1% of 1838 swabs.
  • Successful eradication was achieved in some units.
  • It was recognised that single rooms with individual toilets was important for this high-risk immunocompromised patient cohort and a planned exchange of wards is underway to further reduce rates of BSI.
  • Improvements to performance and service agreements with cleaning services led to a 60% improvement in cleaning processes and alignment with Nation Safety and Quality Health Service (NQSHS) Standard 3.
  • There was improved teamwork between the haematology, oncology, infectious diseases and infection control departments, as well as hospital operations and cleaning services.
  • The patient education program has been approved by community representatives and is now in the process of being implemented.
  • Patient questionnaires are reviewed on a regular basis, to assess feedback on the measures implemented.
  • As a result of increased screening and patient isolation, there was a noticeable reduction in bed movements, which resulted in less disruption and inefficiency in the service. This led to more time available to spend on other areas of patient care.

Lessons Learnt 

Investment in new technology may contribute to keeping patients safer.

Further Reading 

  • Blood and Marrow Transplant Network NSW. External Cleaning Audit Report for St George Hospital on behalf of Infection Prevention Australia; May 2014.
  • Song X, Srinivasan A, Plaut D, Perl T. Effect of nosocomial vancomycin-resistant enterococcal bacteraemia on mortality, length of stay, and costs. Infection Control and Hospital Epidemiology 2003; 24(4): 251-257.
  • Timmers GJ, van der Zwet WC, Simoons-Smit IM et al. Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic. British Journal of Haematology 2002; 116: 826-833.
  • Hanna H, Umphrey J, Tarrand J et al. Management of an outbreak of vancomycin-resistant enterococci in the medical intensive care unit of a cancer center. Infection Control and Hospital Epidemiology 2001; 22: 217-219.


Dr Shir-jing Ho
Staff Specialist Haematologist, St George Hospital
South Eastern Sydney Local Health District (SESLHD)
Phone: 02 9113 3851

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