• Reference Number: HEY-1345/2023
• Departments:
• Last Updated: 1 March 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, however may act as a starting point for discussion.

If after reading it, if you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is VRE?

Vancomycin Resistant Enterococci is commonly referred to as VRE. Enterococci are a type of bacteria (germs) that live in the gastrointestinal tract (bowels/gut) of most people and do not cause illness. This is called colonisation. Sometimes these bacteria can cause infection if they get into an area of the body where they are not normally found such as a wound, urinary tract, heart valves and bloodstream.

Vancomycin is a type of antibiotic used to treat enterococci. When enterococci become resistant to vancomycin, which means this antibiotic will no longer treat these bacteria, we refer to this as resistant. Bacteria are finding new ways to become resistant to antibiotics commonly used to treat infections.

VRE is sometimes referred to as Glycopeptide Resistant Enterococci (GRE). Glycopeptide antibiotics are a group of antibiotics (vancomycin and Teicoplanin) which are used to treat enterococci. Glycopeptide resistant enterococci are where these specific antibiotics no longer treat the bacteria infection.

VRE does not mean that your infection cannot be treated with antibiotics. It means there are only a few antibiotics that will work to treat the infection.

What is the difference between VRE infection and VRE colonisation?

Some people carry VRE in their gastrointestinal tract (bowels/gut) which means they are colonised, as they do not have any symptoms and/or not poorly. When someone is colonised with VRE there is no need to treat the bacteria with antibiotics, as they are colonised. If colonised patients were treated, this can cause further resistance to other antibiotics in future.

Who is at risk of VRE?

VRE is not normally identified in clinical swabs/samples e.g. urine, blood, or wound swabs however, in certain departments within our hospital; we are routinely screening for VRE.

People at risk of developing an infection with VRE include:

• People that have been in hospital for a long period of time
• People who have weakened immune systems e.g. transplant patients, patients in intensive care unit, dialysis patients
• Patients previously treated with vancomycin or Teicoplanin
• Patients with medical devices inserted e.g. catheters, central lines, surgical implanted devices, or drips
• Patients who have undergone surgery involving the chest or abdomen

How are you tested for VRE?

VRE is found by taking swabs and growing bacteria in a laboratory. The swabs for VRE are taken via the rectum (back passage). A dual swab (similar to a cotton bud however with two ends) is placed inside the rectum for faeces to be on the swabs. This allows the laboratory staff to analyses for any bacteria growth on the swabs. People with signs and symptoms of an infection may have swabs taken to see which bacteria is causing the infection, which may then show VRE.

However, sometimes VRE can get into other parts of the body and make someone feel unwell. This may be a time where swabs are taken from a wound or urine sample if someone has a catheter in place. When this occurs antibiotic treatment may be required.

Both colonised patients and infective (symptomatic) patients with VRE can spread the bacteria.

How is VRE spread?

VRE is spread by:

1. Direct person-to-person. This can be from patient to patient or from staff who have been nursing a patient who is infected or colonised with VRE and not washed their hands appropriately between patients and/or not worn appropriate personal protective equipment e.g. gloves and aprons.
2. This is through touching room surfaces or medical equipment which is contaminated and not cleaned appropriately
3. VRE that lives harmlessly in a person’s bowel (gut) can move to another area of their body e.g. into a wound.

What happens if I have an infection of VRE?

If you have an infection with VRE, you would present with similar symptoms as other bacterial infections:

• Fever
• Feeling generally unwell
• Fast Pulse (tachycardia)
• Redness, swelling, pain or heat at a specific site (where a medical device is inserted)

What happens if I have VRE?

If you are confirmed to have VRE from your samples, whilst you are in hospital, your clinical teams would take some extra precautions whilst caring for you:

1. Carry out a risk assessment to determine whether you should be moved to a single occupancy room (isolation) for the duration of your hospital stay
2. All clinical staff and visitors must wash their hands using soap and water or alcohol gel before going into your room and after leaving your room
3. All clinical staff providing you with direct care will be required to wear personal protective equipment e.g. gloves, apron etc.
4. Clean the room daily with a chlorine-based disinfectant (personal items should be kept to a minimum and stored in the drawers or cupboard provided to keep surfaces clear)
5. Clean any equipment that we take into your room with chlorine after each use and we may leave other equipment in your room for the duration of your hospital stay
6. Provide you with your own commode (a chair with a hidden toilet) to use if your isolation room does not have an en-suite
7. You should avoid touching your medical devices e.g. catheters, drip lines etc.
8. You should wash your hands with soap and water or use alcohol gel before entering and leaving your room. We ask you try not to leave your room and walk around areas, which have many other patients, such as canteen/ cafe etc.
9. You may notice a sign on your door which is to inform staff of an infection risk, however this does not specify the type of infection

Do visitors need to do anything differently?

VRE is not a problem for fit and healthy people, therefore family, friends and carers can visit you. To prevent the spread of VRE to other patients or elsewhere in the hospital, visitors must:

1. Always wash their hands with soap and water or alcohol gel before going into your room and after leaving your room
2. Do not eat food at your bed side
3. Do not use your en-suite bathroom, if you have one
4. Do not sit on your bed
5. Visitors who feel unwell should not visit you
6. Visitors who have had a recent infection or illness should discuss with your nursing team for advice before they visit you
7. Children and babies are more prone to any type of infection and are advised not to visit
8. Visitors can still touch you e.g. hold your hand etc. they must wash their hands before leaving your room with soap and water or alcohol gel

Will VRE delay my discharge home?

Having VRE should not delay your discharge home, however if you have a VRE infection, the clinical team will advise discharge when you are better, with some patients completing course of antibiotics once at home, some patients may require follow up as an outpatient.

If you are from a residential home, nursing home or have carers and have VRE your discharge should not be delayed to these facilities/circumstances – additional information may be provided to staff who care for you on discharge to ensure you and other service users are cared for safely.

You should inform anyone who provides you with care e.g. GP, district nurse, outpatient appointments, that you have VRE.

Will I always have VRE?

VRE will usually disappear from the infected areas (with or without antibiotics). However, as enterococci normally live in the bowel, you may remain VRE positive in your bowel without experiencing any problems (colonised).

Will VRE impact people I live with?

When you go home, we advise good hand and personal hygiene. Handwashing is very important to prevent these bacteria spreading, so you must wash your hands well after going to the toilet and before preparing and eating food. Any person looking after you must also regularly wash their hands.

Regularly change your bedsheets and do not share towels with others in your household. You can wash clothes and bed linen as normal at the hottest temperature suitable for the fabric and if soiled (dirty with faeces or urine) wash separately.  Try to ensure you regularly clean your toilets and bathrooms with your usual household cleaning products. You should continue to maintain your regular activities. This should help to prevent others living in your household contracting VRE.

What if I need to go back into hospital or go to hospital as an outpatient?

If you are admitted back into hospital or go to hospital for an outpatient appointment, it is important that you let the staff caring for you know that you are positive for VRE in the past. A record of this should be included in your electronic hospital notes. This will make sure that you receive the best care to reduce the risk of you developing a VRE infection. It might be helpful to take this leaflet with you to show the clinical team.

Who can I contact with any queries or concerns I may have?

If you, your family or carers have any questions or concerns surrounding VRE. Please contact Hull University Teaching Hospitals Infection Prevention and Control Team (IPCT) via the below contact routes:

Telephone: 01482 623967

Between 8am-4pm

Email: hyp-tr.huth-ipc@nhs.net

What does Hull University Teaching Hospitals do to prevent VRE spreading?

To prevent the spread of VRE in HUTH we are embedding the following:

• Education of our workforce
• Education of our patients
• Isolation precautions of patients infected or colonised with VRE
• Enhanced cleaning in ward areas
• Routine screening for VRE in high risk groups

Please use the space below to write any questions you may have for your clinical team or infection prevention control team.

This leaflet was produced by the Infection Prevention and Control Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in 2026.

Ref: HEY-1345/2023

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.