Vancomycin-Resistant Enterococcus (VRE) Primary Bacteremia Associated with Dialysis Catheter Access

Vancomycin-Resistant Enterococcus (VRE) Primary Bacteremia Associated with Dialysis Catheter Access Page E40 P. Ghazarian*, M. Fulton, H. Goodpasture Close Close preview | Purchase PDF (58 K) | Related articles | Related reference work articles AbstractAbstract Abstract BACKGROUND: From April 1998 to March 2000, nine patients at Via Christi Regional Medical Center (VCRMC) experienced VRE primary bacteremia (PB). Seven of these infections occurred between May 1, 1999, and March 1, 2000. Six were dialysis patients who were cared for by one of the two dialysis providers at VCRMC. METHODS: Investigation included retrospective chart review of the infected patients, analysis of surveillance data, review of dialysis policies, and direct observations of the dialysis procedures for both providers. RESULTS: Both providers had similar patient volumes. There was no statistical difference in the VRE colonization rate between the two. The seven strains of VRE were different by pulsed-field gel electrophoresis. The policies for VRE patient care were similar. Observation of the dialysis units found both to be crowded with less-than-optimal facilities for handwashing, storage, and adequate spatial separation of patients. Breaks in technique and variance from stated polices were the same for both providers. The major difference identified was that the dialysis provider with no cases VRE PB used sterile dressings and sterile gloves during the dressing change, whereas the other provider did not. CONCLUSIONS: The affected provider group implemented sterile dressings and sterile gloves during dressing changes. The incidence of VRE PB disappeared and has not reoccurred in more than 18 months of follow-up. Although we did not perform environmental cultures, VRE is known to contaminate the environment. Touch contamination during dressing changes under less-than-optimal conditions may lead to PB. Using sterile technique may prevent cross-contamination in dialysis setting.