Congress Abstracts 2003

75

MANAGING VANCOMYCIN-RESISTANT ENTEROCOCCI IN IMMUNO-SUPPRESSED BLOOD AND MARROW STEM CELL TRANSPLANTATION PATIENTS IN THE OUTPATIENT SETTING: ARE WE DOING ENOUGH? Elaine Brannan, RN, MSN, AOCN^®, and Elsie Gumabong, RN, BSN, OCN^®, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Vancomycin-resistant enterococci (VRE) have emerged as prominent nosocomial pathogens in hospitals. The incidence of VRE has increased dramatically in immunosuppressed blood and marrow stem cell transplantation (BMSCT) patients. These patients are at high risk for colonization and development of infection with the most common sites, gastrointestinal and urinary tracts. Infection control recommendations are being practiced in the hospital setting and in the outpatient areas. This study is designed to determine if the present method of infection control is adequate to prevent horizontal transmission of VRE in the immunosuppressed allogeneic, matched unrelated, and cord blood BMSCT patients in the outpatient setting. All of these patients are followed post transplant from discharge until day 100 in the ambulatory treatment center (ATC). BMSCT patients are cultured by rectal swab on admission to the hospital and every 7 days during hospitalization. Patients who develop diarrhea or cystitis are also cultured. Those patients identified as VRE positive are placed in contact isolation. The patients and their caregivers are educated about infection control to prevent the transmission of VRE. In the outpatient setting, patients identified as VRE positive in the hospital continue weekly testing using the same methods. They continue the same infection control measures with the exception of usage of common bathroom facilities in the outpatient area. This study will monitor VRE negative patients to determine if they become infected or colonized. They will be cultured by rectal swab at day 30, 60, and 90 post transplantation and if they develop diarrhea, with diarrhea defined as 5 or more watery stools per day, and/or symptoms of cystitis. We will monitor all allogeneic, cord blood, and matched unrelated donor BMSCT patients seen in the ATC. The current census of BMSCT patients is 47. Four were identified as VRE positive while inpatients. The number of daily visits by this entire group is 25–35 per day. The length of the study will be 6 months. Findings will be reviewed at 3 months and analyzed at 6 months. The number of patients and length of time will provide information to determine if the current infection control procedure is adequate.