Management of vancomycin-resistant Enterococcus faecium in Dutch health care institutes: a nation-wide survey

Background: Vancomycin-resistant Enterococcus faecium (VRE _fm) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VRE _fm 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 VRE _fm 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 VRE _fm policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures. Methods: 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, VRE _fm clearance and VRE _fm outbreaks. Findings: The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VRE _fm outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VRE _fm screening versus 50% of the LTCFs. VRE _fm-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VRE _fm-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. Conclusion: This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VRE _fm management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VRE _fm data on a regional/national level.