Impact of a new hospital with close to 100% single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonization or infection: a genomic surveillance study

B Blane; F Coll; K Raven; O Allen; A R M Kappeler; S Pai; R A Floto; S J Peacock; T Gouliouris

doi:10.1016/j.jhin.2023.06.025

Impact of a new hospital with close to 100% single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonization or infection: a genomic surveillance study

J Hosp Infect. 2023 Sep:139:192-200. doi: 10.1016/j.jhin.2023.06.025. Epub 2023 Jul 12.

Authors

B Blane¹, F Coll², K Raven³, O Allen⁴, A R M Kappeler⁴, S Pai⁴, R A Floto⁵, S J Peacock⁶, T Gouliouris⁶

Affiliations

¹ Department of Medicine, Addenbrooke's Hospital, Cambridge, UK. Electronic address: eb544@medschl.cam.ac.uk.
² Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
³ Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
⁴ Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
⁵ Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
⁶ Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK.

PMID: 37451408
DOI: 10.1016/j.jhin.2023.06.025

Abstract

Background: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of nosocomial infection, driven by its ability to spread between patients and persist in the hospital environment.

Aim: To investigate the impact of a long-established cardiothoracic hospital moving to new premises with close to 100% single-occupancy rooms on the rates of environmental contamination and infection or colonization by VRE.

Methods: Prospective environmental surveillance for VRE was conducted at five time-points between April and November 2019, once in the original building, and four times in the new building. Incidence rate ratios (IRRs) of VRE infection/colonization were determined for the one-year period before and after the hospital move, and compared to a nearby hospital.

Findings: In the original location, the first environmental screen found 29% VRE positivity. The following four screens in the new location showed a significant reduction in positivity (1-6%; P<0.0001). The VRE infection/colonization rates were halved in the new location (IRR: 0.56; 95% confidence interval: 0.38-0.84), compared to the original location, contrasting with an increase in a nearby hospital (1.62; 1.17-2.27) over the same time-period. Genomic analysis of the environmental isolates was consistent with reduced transmission in the new hospital.

Conclusion: The use of single-occupancy rooms was associated with reduced environmental contamination with VRE, and lower transmission and isolation of VRE from clinical samples. The cost-effectiveness of single-occupancy room hospitals in reducing healthcare-associated infections should be reassessed in the context of operational costs of emerging pandemic and increasing antimicrobial resistance threats.

Keywords: Colonization; Environment; Genomics; Infection; Single occupancy; Vancomycin-resistant enterococci.

MeSH terms

Cross Infection* / epidemiology
Cross Infection* / prevention & control
Enterococcus faecium* / genetics
Genomics
Gram-Positive Bacterial Infections* / epidemiology
Gram-Positive Bacterial Infections* / prevention & control
Hospitals
Humans
Incidence
Prospective Studies
Vancomycin
Vancomycin-Resistant Enterococci* / genetics

Substances

Vancomycin