What is Vancomycin Resistant Enterococcus (VRE)

This page was reviewed or revised on Thursday, August 13, 2009.

Enterococcus is a common bacteria that is normally found in the bowel of healthy people. There are many types of enterococci. They are not aggressive bacteria and they rarely cause illness in healthy people. Vancomycin-Resistant Enterococcus is a form of this bacteria which has become resistant to treatment choices if people become infected with this bacteria. People may carry VRE in their body without showing any signs of the illness. These people are said to be colonized with the bacteria.

How is VRE spread?

VRE is transmitted from one person to another by direct or indirect contact. It is not spread through the air like the common cold or flu viruses. The bacteria is usually spread from one person to another on the hands of caregivers. Bacteria can be present on the caregiver’s hands either from touching contaminated material excreted by the infected person or from touching articles soiled by body fluids such as feces. Enterococci, including VRE, are normally found in the human bowel and are shed from the body through stool. Enterococci grow well on hands, and the organism can survive for weeks or months on various inanimate objects such as toilet seats, door handles, furniture and health care equipment such as the stethoscopes.

Who is most at risk of VRE infection?

Healthy people are unlikely to get VRE and if they do become colonized with the bacteria, they rarely become ill. People at risk for colonization or infection with VRE are usually found in hospitals and have an underlying medical condition which makes them susceptible to infection. These conditions include:

• Critically ill patients in Intensive Care Units
• Patients with severe underlying disease or problems with their immune system
• Patients who have had major surgery
• Patients with urinary catheters
• Patients who have received many antibiotics, particularly Vancomycin
• What is the Treatment for VRE?

VRE does not cause illness in healthy people. Treatment for VRE infection is difficult because the bacteria is resistant to most available antibiotics. Treatment plans will be determined by individual physicians.

How do we prevent VRE infection?

It is very important to prevent the spread of VRE from one person to another. If you have VRE, or someone you are living or visiting with has VRE, it is important to follow these precautions:

• Wash your hands. Proper handwashing is the most important way to prevent the spread of VRE and many other infections. The use of soap in pump dispensers with paper towels is the most effective way to remove organisms from you hands and prevent spread to others.
  
  
• Environmental cleaning. Because this bacteria can live for a long time on inanimate objects, extra cleaning of personal articles and equipment is very important. The bacteria is found in stool so toilets need special attention. They should not be shared with other people if possible. Regular cleaning with disinfectants or bleach (1 part bleach to 9 parts water concentration) is very important.
  
  
• Personal hygiene. People with VRE must use proper toilet hygiene. Ample paper should be used for cleansing and good handwashing afterwards is essential.
  
  
• Equipment. Equipment such as thermometers, blood pressure cuffs and articles for personal use must be left in the home and should not be shared with other people.
  
  
• Laundry and waste disposal. The bacteria is destroyed during the normal laundering process and all garbage can be put out for regular pick-up.
  
  
• Gloves and gowns. Gloves and gowns are not required for routine visits in the home. If gloves are used for cleaning, they should be discarded after use. Good handwashing must be practices following glove removal. Any gowns used in direct care must be left in the client’s room and laundered with other personal items.
  
  
• Client movement. Clients with VRE should not be restricted from moving freely throughout their home and the community. If the client is incontinent of feces, proper diapering is essential.