South Australian hospital battles to contain superbug VRE

The cancer ward at the Royal Adelaide Hospital (RAH) in South Australia is currently battling to cope with an antibiotic-resistant bacteria called Vanocomycin-resistant Enterococci (VRE), a form of bacteria which lives in the gut.

The superbug is resistant to antibiotics and has affected cancer patients on a number of wards.

The Health Department says 31 people at the RAH are now known to be carriers of VRE but none are as yet sick because of it, however it is a serious concern because many have cancer and the superbug, while harmless in healthy people, is potentially lethal to patients who are seriously ill.

Chief medical officer Professor Paddy Phillips says two patients with diarrhoea are believed to have introduced the bug into the hospital and precautions are being taken for the patients involved - the patients affected have been isolated and extra cleaning is being done to prevent any further spread of the bacteria.

The SA Government says the outbreak highlights the need for its planned new city hospital and Health Minister John Hill says providing single rooms with separate bathrooms is the best way of controlling the bacteria.

Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment and can sometimes cause infections.

Vancomycin is an antibiotic that is often used to treat infections caused by Enterococci, but in some instances, Enterococci have become resistant to the drug and so are called vancomycin-resistant Enterococci (VRE) - most VRE infections occur in people in hospitals.

VRE can cause infections of the urinary tract, the bloodstream or of wounds and people most at risk of getting VRE are:-

• People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time
• People who are hospitalized, particularly when they receive antibiotic treatment for long 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 with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters.
• People who are colonized with VRE (bacteria are present, but have no symptoms of an infection).

According to the Centers for Disease Control and Prevention (CDC) in the United States, Enterococci cause about 1 of every 8 infections in hospitals and only about 30% of these are VRE.

People who are colonized with VRE do not usually need treatment and most VRE infections can be treated with antibiotics other than vancomycin.

Laboratory testing of the VRE can determine which antibiotics will work - for people who get VRE infections in their bladder and have urinary catheters, removal of the catheter when it is no longer needed can also help get rid of the infection.

VRE is often passed from person to person by the hands of caregivers, after they have contact with other people with VRE or after contact with contaminated surfaces.

VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE and is not usually spread through the air by coughing or sneezing.

The spread of VRE can be prevented by always keeping the hands clean - washing them with soap and water after using the toilet and before preparing food and after contact with persons who have VRE.

Keeping areas of the home such as toilets clean, is important as is wearing gloves if you come in contact with body fluids that may contain VRE, such as stool or bandages from infected wounds and always washing the hands after removing gloves.