Where a resident is colonised or infected with VRE and there are risk factors for transmission, or where basic personal hygiene practices may be compromised by cognitive or functional impairment, there is a risk that they could contaminate their environment. 

VRE is spread in a similar way to other MRO/MDROs

Ensure a risk assessment is performed before bed allocation and/or admission

Those with VRE should be cared for in a single rooms where possible, especially if they are faecally incontinent

Contact precautions will be required for those residents with risk factors for transmission

Strict adherence to hand hygiene protocols must be followed

Keep the environment clean and dust-free at all times, and use a two-step cleaning regimen if the resident is cared for under contact precautions.

Healthy people are probably at no greater risk of developing infection from VRE than they are from other bacteria that normally live in the bowel.

Hand hygiene

Proper hand hygiene is essential, and if the resident's cognitive state is impaired, employees caring for them must be responsible for this activity, especially after any toileting or contact with colonised/infected sites or devices.

Strict adherence to standard precautions is the recommended safe practice for all resident contact regardless of whether or not infection is present. 

Effective hand hygiene is the single most important means of preventing spread of VRE. 

Hand hygiene should be performed

When entering, or leaving the room

Before and after resident contact

Before and after dressings

Before and after wearing gloves

The use of gloves does not replace the need for hand decontamination. Hand hygiene should be performed before and after glove use. 

Plain liquid soap is adequate for hand washing and an antimicrobial handwash may be used before and after dressing wounds or if the resident is incontinent or has diarrhoea.

In the absence of sufficient or adequate hand washing facilities, and where hands are not visibly contaminated, an alcohol-based hand rub/sanitiser should be used for hand cleansing.