Vancomycin-resistant Enterococci (VRE)

What is vancomycin-resistant enterococci?

Enterococci are bacteria (germs) that commonly live in the gastrointestinal tract (bowel) and urinary system of most people without causing illness. The term used to describe this is ‘colonisation’. However, like many organisms, enterococci can sometimes invade other parts of the body and cause infection.

Vancomycin is an antibiotic used to treat infections caused by enterococci. When enterococci are exposed to vancomycin, they sometimes develop ways to stop the antibiotic working, and this has led to the development of ‘vancomycin resistant enterococci’ (VRE).

How do you get VRE?

The following people are at an increased risk of becoming infected with VRE including those:

• who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.
• who are hospitalised, particularly when they receive antibiotic treatment for long periods of time.
• with weakened immune systems such as patients in Intensive Care Units, or in cancer or transplant wards
• receiving dialysis
• who have undergone surgical procedures such as abdominal or chest surgery.
• with medical devices that stay in for some time such as urinary catheters or intravenous catheters.
• who are colonised with VRE

VRE can be spread from person to person through contact with hands or equipment with VRE on them or from touching contaminated environmental surfaces. VRE is not usually spread through the air by coughing or sneezing.

What are healthcare facilities doing to prevent spread

Infection prevention and control (IPC) measures are actions taken at healthcare facilities to prevent or stop diseases from spreading. Healthcare facilities use the same IPC measures for patients colonised or infected to help prevent spread of VRE to others.

If you are colonised or infected with VRE, you will still receive the same level of care in hospital. Healthcare providers can help stop it from spreading with these actions:

• performing frequent handwashing or using an alcohol-based hand rub when providing care to you
• a sign will be placed on your door to remind others of the precautions they need to follow, for example, to wear a gown and gloves when providing care
• being cared for in a single room with your own bathroom 
• frequent cleaning and disinfection of your room, bathroom and medical equipment
• ensuring visitors clean their hands with alcohol-based hand rubs or soap and water. In addition, visitors should avoid using your bathroom or visit other patients in hospital immediately after visiting you.

For patients living in settings like nursing homes, long-term measures are taken based on the facility's policy.

Screening

Screening patients for VRE is an important way to prevent or stop outbreaks in healthcare facilities and keep patients safe. Patients who are colonised with VRE may not know it because they do not have any symptoms.

If someone has a history of being in a hospital or residential care facility, overseas or outside of Western Australia (WA) in the last 12 months, a specimen to look for VRE (either a stool sample or a rectal swab) will be collected when they are admitted to hospital. Screening results for VRE are used to help guide infection prevention and control strategies in healthcare facilities, which helps prevent it from spreading.

Notification

Vancomycin resistant enterococci are a notifiable condition in WA. This means healthcare providers and laboratories must inform the Department of Health of your diagnosis. Notification is confidential.

If you test positive for VRE an alert will be placed in your medical record to let your healthcare provider know you have VRE. This alert can be seen in all public hospitals in WA. Should you go to a private hospital, or another healthcare provider, e.g. your local doctor, you need to tell them you have VRE. There is no need to tell other community services or businesses that are not health care services e.g. swimming pools, gyms or schools that you have VRE.

Can VRE be treated?

People colonised with VRE do not need to have any treatment or antibiotics.

The period of colonisation of VRE in the bowel varies and depends on several factors, such as your overall health and whether you need to continue taking antibiotics for any reason. Because of this, you may be screened when admitted to hospital again to see if you are still carrying VRE. If VRE is not found following three samples or after four years after your last positive test you may be cleared and the alert on your medical record removed.

Most VRE infections can be treated with antibiotics other than vancomycin. Laboratory testing of the VRE can determine which antibiotics will work.

There is no vaccination available to prevent you from acquiring VRE or treatment to eliminate VRE from your body.

What will happen when I go home?

There is no need to take special precautions at home, but it is important that you and your family continue to practice good hygiene including:

• always wash your hands with soap and water:
  • after going to the toilet
  • before preparing meals and eating food
  • before and after touching any wounds or lesions or medical devices you may have.
• use your own towels and face cloths and do not share them
• do not share grooming items, such as brushes, nail scissors, or razors
• cover any skin wounds if possible.

No special cleaning is required in your home and your clothing may be laundered as usual, along with the rest of the household laundry. All eating utensils and dishes can be washed in the normal way. You can return to work.

More information

• If you are in hospital, you can ask to speak to the infection prevention control nurse.
• See your doctor.
• Ring healthdirect Australia on 1800 022 222.

Remember

• Bacteria known as vancomycin-resistant enterococci (VRE) are resistant to some powerful antibiotics.
• VRE are usually spread from person to person through contact with infected people or people who carry the bacteria without it causing infection within themselves.

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.