Vancomycin Resistant Enterococci (VRE)

Enterococci are bacteria that live in the digestive tract (or gut) and urinary system of most people and usually do not cause illness. The term used to describe this is ‘colonisation’. However, like most bacteria, enterococci can sometimes invade other parts of the body and cause infection.

Vancomycin is a very strong antibiotic often used to treat complicated infections when other antibiotics do not work. When enterococci are exposed to vancomycin, the bacteria sometimes develop ways that reduce the effectiveness of the antibiotic. This is known as resistance. This has led to the development of ‘Vancomycin Resistant Enterococci’ (VRE). 

Who is at risk of a VRE infection? 

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

• People who have been previously treated with the antibiotic vancomycin or other antibiotics for prolonged periods of time
• People with weakened immune systems such as patients in intensive care units, or in cancer or transplant wards
• People who have undergone surgical procedures such as abdominal or chest surgery
• People using medical equipment that stay in the body for some time such as a urinary catheter or an IV drip
• People who are colonised with VRE

How does VRE spread? 

In healthcare facilities, VRE may be passed from person to person by the hands of healthcare workers and caregivers after they have been in contact with other people who are colonised or infected with VRE. It can also be spread to people if they have touched surfaces that are contaminated with VRE. VRE is not usually spread through the air from coughing or sneezing. 

Why are you being screened or tested for VRE? 

Healthcare workers may want to test you to see if you are carrying VRE so that they can protect you from VRE infection (especially if you are going to have surgery) and provide the right treatment if you do develop a VRE infection. This will also help the healthcare workers to protect other patients, especially those having surgical procedures where VRE may cause serious infections. 

There may be a policy in place in your healthcare facility to routinely take a sample or swab from patients who are at risk of having VRE. 

Why is it important to identify VRE? 

Infections caused by VRE are uncommon but are difficult to treat, so it is important that VRE is not spread between patients. VRE can cause infections in many parts of the body, usually the urinary tract, wounds or bloodstream. 

How is a VRE infection diagnosed? 

VRE can be detected by sending samples from urine, faeces and/or wounds to laboratories for testing. VRE is a notifiable condition in some states and territories, which means doctors, healthcare facilities and laboratories must confidentially inform the Public Health Unit of your diagnosis.

How is a VRE infection treated? 

Most VRE infections can be treated with antibiotics other than vancomycin. Laboratory testing of the VRE can determine which other antibiotics can be used to treat an infection. If you are colonised with VRE, meaning that you do not have an infection but the organism is living harmlessly on or in your body, no treatment is needed. However, it is good to be aware of this so you can advise healthcare workers if you are going to be treated or admitted to healthcare facility. 

What will happen when you are in a healthcare facility? 

If you have VRE and are in a healthcare facility, it is likely that extra precautions will be used when caring for you to prevent the spread of VRE to others. You might be put in a single room with dedicated toilet facilities to help reduce the risk of VRE spreading. Healthcare workers may wear personal protective equipment (PPE) such as gloves and an apron or gown when providing personal care to you. Your visitors may also be instructed to wear PPE while visiting you, and to clean their hands when they leave. These precautions are taken to make sure that VRE is not spread to other patients or visitors. 

What can you do to help prevent the spread of VRE? 

Effective hand hygiene is the single most effective action to reduce healthcare-associated infections, such as VRE. This involves applying an alcohol‑based handrub to the surface of hands (including liquids, gels and foams) or washing hands with the use of a water and soap or a soap solution, either non-antimicrobial or antimicrobial. This needs to be completed frequently and thoroughly to reduce risk of spreading bacteria. It is particularly important that you perform hand hygiene after going to the toilet.

If you are a visitor or a carer 

There are a range of actions visitors and carers can take to minimise the risk of giving a patient an infection or catching an infection from healthcare facilities. For example:

• Do not visit someone in a healthcare facility if you feel unwell, have a cold, have been vomiting or have had diarrhea recently. Wait until you feel better
• Practice good hand hygiene by washing your hands well with soap and water or alcohol‑based hand rub:
  • After entering a healthcare facility and when you leave the facility
  • Before touching a patient or their food
  • After you leave a patient’s room
• Be careful not to touch dressings, drips or other equipment around the hospital bed
• Avoid bringing a large number of visitors at one time to visit someone. Always check visiting arrangements with the healthcare workers
• Do not use the patient’s toilet or bathroom, use the visitor facilities
• You may be asked to wear gloves and an apron or gown when visiting a patient in a healthcare facility. Follow instructions provided by healthcare workers about any extra precautions that may be needed.

Do you need to do anything different when you go home? 

It is important to maintain good personal hygiene including good hand hygiene practices (especially after going to the toilet) after you leave the healthcare facility. Your healthcare worker will let you know if anything else is required before you are discharged. 

What about next time you go to a healthcare facility? 

If you need to go to a healthcare facility again, it is important to tell your nurse or doctor that you have previously had VRE. They will check to see if you need to be screened again for VRE, or if any extra precautions need to be taken.