Vancomycin-Resistant Enterococci (VRE) are bacteria that have developed resistance to vancomycin, an antibiotic used to treat bacterial infections. These bacteria, normally found in the human intestines and female genital tract, become problematic when they acquire resistance to this medication. Understanding VRE spread is important for prevention. This article explores how VRE moves between individuals and environments.
Primary Modes of Transmission
VRE primarily spreads through direct and indirect contact. Direct contact involves the physical transfer of bacteria from one person to another. This happens through contaminated hands, particularly those of healthcare workers, or direct contact with infected body fluids like stool or wound drainage. Unlike some other pathogens, VRE does not spread through the air via coughing or sneezing.
Indirect contact also plays a significant role in VRE transmission. This occurs when a person touches surfaces or objects contaminated with bacteria. Common examples include medical equipment, bed rails, doorknobs, and other frequently touched environmental surfaces. VRE can survive on dry surfaces for extended periods, from days to months, acting as reservoirs for transmission.
Common Transmission Settings
VRE transmission occurs most frequently within healthcare environments. Hospitals, long-term care facilities, and nursing homes are settings where VRE can readily spread. This heightened risk is due to factors present in these locations. Patients are in close proximity, increasing opportunities for direct and indirect bacterial transfer.
The frequent use of antibiotics in healthcare settings can disrupt the natural balance of bacteria in patients, creating an environment where resistant strains like VRE can flourish. Shared medical equipment and the movement of healthcare personnel between patients also contribute to VRE spread within these facilities.
Vulnerability to Transmission
Certain factors increase an individual’s susceptibility to acquiring VRE if exposed to the bacteria. Patients undergoing prolonged hospitalization, particularly in intensive care units (ICUs), face a greater risk. Individuals with weakened immune systems, such as those with cancer or undergoing chemotherapy, are more vulnerable. Compromised natural defenses make it harder to fight off the bacteria.
Previous or prolonged antibiotic use, especially vancomycin, can disturb normal gut bacteria, allowing VRE to colonize and multiply more easily. Indwelling medical devices, such as urinary catheters or central intravenous lines, provide surfaces for bacteria to attach and serve as entry points for infection. Underlying medical conditions like kidney disease or diabetes, and surgical procedures, contribute to VRE acquisition susceptibility.
Controlling VRE Transmission
Controlling VRE spread involves implementing strategies to interrupt transmission pathways. Strict hand hygiene is a measure. Healthcare workers, patients, and visitors should regularly clean their hands with soap and water or an alcohol-based hand sanitizer to remove VRE. This prevents bacteria transfer.
Contact precautions are implemented for patients known to be colonized or infected with VRE. This involves healthcare personnel wearing gloves and gowns during patient contact. These barriers contain bacteria and prevent contamination. Thorough environmental cleaning and disinfection of patient rooms and shared equipment is important, given VRE’s ability to survive on surfaces. Finally, prudent antibiotic use, known as antibiotic stewardship, reduces the development and spread of antibiotic-resistant bacteria like VRE.