Enterococci are important causes of nosocomial bacterial infection among hospitalized newborns. Review of the frequency of enterococcal bacteremia infection in the NICU at New York Hospital-Cornell Medical Center has demonstrated that 1.3 episodes/month occur in this unit. In 1989 the first episodes of infection due to vancomycin-resistant enterococci (VRE) were appreciated in this unit. By the end of 1993, 6 episodes of bacteremic infection due to VRE had occurred and approximately 10% of invasive enterococcal infections were being caused by these resistant organisms. Because of concern about the increasing frequency of these infections, surveillance of colonization and measures aimed at reducing colonization of newborns were instituted, including: 1) submission of“surveillance” rectal swab cultures for all babies every 2 weeks for detection of colonization by VRE; 2) isolation of any baby with a positive VRE culture from stool survey or clinical specimen; 3) strict cohorting of nursing care for babies with VRE isolates; 4) application of “wound and skin precautions” (gown and gloves for direct patient contact, use of mask for dressing changes of infected wounds, strict handwashing with chlorhexidine); 5) strict approval requirements by the hospital pharmacy for the use of vancomycin. Between October 1993 and October 1994, 5 infants were diagnosed as having VRE infections. Over that same period 28 VRE-isolates were recovered from the stools of 21 infants. The last isolate was recovered October 11, 1994. Between that date and December 31, 1995, VRE have not been isolated from surveillance stool cultures or clinical specimens from patients in this unit. This experience suggests that application of basic infection control measures including the limitation of the use of vancomycin can contain the spread of VRE infection and perhaps even eliminate VRE from this patient area.
