Vancomycin-Resistant Enterococcus

About the organism 

Vancomycin resistant enterococci are specific types of antimicrobial-resistant bacteria that are resistant to vancomycin. Enterococci are bacteria that are normally present in the intestinal tract of all people and in the female genital tract. It is also often found in the environment.

VRE can sometimes cause infections in the urinary tract, the bloodstream, or in wounds associated with catheters or surgical procedures. The following persons are at an increased risk of becoming infected with VRE:

  • People who have been previously treated with 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 abdominal or chest surgeries
  • People with medical devices that stay in for some time, such as urinary catheters or central intravenous catheters
  • People who have clostridium difficile diarrhea
  • People who are colonized with VRE

VRE is often passed from person to person by the contaminated hands of caregivers. VRE can get onto a caregiver's hands 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. VRE is not spread through the air by coughing or sneezing.

Infection prevention and control 

If you see the EPIC VRE FYI alert screen in a patient's chart, please make sure the patient is on contact precautions. Clinicians should notify the Department of Infection Prevention and Control if a patient with VRE or a history of VRE is identified but no FYI alert appears in EPIC

VRE is a hearty organism capable of surviving on environmental surfaces for extended periods of time and can easily move from inanimate objects to the hands of healthcare workers or support staff and then possibly to the patients. Therefore it is important that healthcare workers maintain a clean environment and good hand hygiene practices. Be sure to wash your hands and place all inpatients that have a history of VRE (or a positive VRE culture) in contact precautions. contact precautions for VRE means:

  • Placing patient in a private room (or in a room with another VRE patient)
  • Following hand hygiene
  • Maintaining clean patient environment/ equipment,
  • Wearing personal protective equipment (PPE) when entering room (gowns and gloves)
  • Only transporting patient out of room for essential tests/ services
  • See the contact precautions policy for more information.

For patients in the ambulatory setting, staff need to follow standard precautions when caring for patients with VRE. standard precautions for outpatients with VRE means:

  • Following hand hygiene at all times
  • Wearing PPE  if there is risk/potential for exposure to infectious substances
  • Provide covering or dressing for the patient in order to cover and contain draining lesions
  • Prioritize the placement of these patients into the examination/ procedure room so as to minimize the risk of transmission in shared areas

See the standard precautions policy for more information.

See the transmission based isolation precautions Policy for more information.

See the Patient Isolation Grid for more information.

See the patient deisolation grid for more information.

If you have questions about a patient's VRE status, you can call the Infection Prevention and Control Department's mainline at 503 494-6694.