A nurse cares for a client newly admitted with a positive surveillance culture for vancomycin-resistant enterococcus (VRE) of the rectum. Which infection prevention measures should the nurse implement? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
VRE is a multidrug-resistant organism (MDRO) transmitted by direct or indirect contact. CDC contact precautions: private room or cohort, gown and gloves on entry, dedicated equipment. Free ambulation in hallway is contraindicated for active MDRO precautions; the client may ambulate within the room or with cohort-specific protocols. Negative-pressure airborne isolation is for true airborne pathogens (TB, measles, varicella) — VRE is contact, not airborne.
Clinical Judgment VRE is contact-transmitted MDRO: private room or cohort, gown and gloves on entry, dedicated equipment. Hand hygiene with alcohol-based sanitizer or soap and water is acceptable (unlike C. diff which requires soap and water only). Surface disinfection with EPA-registered hospital-grade disinfectant.
Memory Tip VRE: Contact + Gown/Gloves + Dedicated equipment. Alcohol OK (unlike C. diff)
KR vs U CDC and Korean Society for Healthcare-Associated Infection Control share the same VRE protocol. Both jurisdictions report VRE bloodstream infections to surveillance systems and use active surveillance cultures in high-risk units (ICU, transplant).
Clinical Practice GuideCDC contact precautions for MDROs (MRSA, VRE, CRE):- Private room or cohort with same MDRO- Gown and gloves for every room entry- Dedicated equipment; if shared, disinfect between clients with EPA-registered product- Hand hygiene: alcohol-based sanitizer or soap and water (alcohol effective for MRSA/VRE/CRE; soap and water mandatory only for C. diff and norovirus due to spores)- Environmental cleaning: high-touch surfaces with EPA-registered hospital disinfectant- Active surveillance in high-risk units (ICU, transplant, dialysis)- Discontinue per facility protocol with negative cultures (typically 2-3 negative)
CautionVRE bloodstream infections in immunocompromised clients carry mortality up to 40 percent. Linezolid or daptomycin are typical first-line treatments; consult ID specialist. Hand hygiene compliance audit is the single most effective MDRO control intervention.
VRE — Vancomycin-resistant enterococcus, MDRO. Most often E. faecium or E. faecalis. Colonizes GI tract and skin; bloodstream infection in immunocompromised clients. Contact precautions, dedicated equipment, hand hygiene with alcohol or soap and water.
MDRO — Multidrug-resistant organism. Includes MRSA, VRE, ESBL-producing organisms, CRE, MDR Pseudomonas/Acinetobacter, MDR-TB. CDC and Korean infection control require contact precautions; some require enhanced precautions per facility policy.
Active surveillance culture — Routine screening of asymptomatic high-risk clients (ICU admission, transplant, recent hospitalization) for MDROs. Positive screen triggers contact precautions, decolonization protocols, and isolation. Reduces transmission and bloodstream infection rates.