What is VRE?
VRE is Vancomycin-Resistant Enterococcus.

Enterococcus are bacteria that live in the digestive and genital tracts. They are normally benign and don't cause any problems in healthy people.

Vancomycin is a powerful antibiotic that is often the antibiotic of last resort. It is generally limited to use against bacteria that are already resistant to penicillin and other antibiotics.

Vancomycin-Resistant Enterococcus is a mutant strain of Enterococcus that originally developed in individuals who were exposed to the antibiotic. It was first identified in Europe in 1986, and in the U.S. in 1988.

Why is it dangerous?
It is not dangerous in healthy people with strong immune systems, where the balance of healthy flora in their digestive tract helps keep VRE from getting out of control.

VRE is dangerous because it cannot be controlled with antibiotics, and it causes life-threatening infections in people with compromised immune systems - the very young, the very old, and the very ill.

It is especially dangerous because it can easily transmit the resistance genes to other, more dangerous bacteria, such as staph and strep. Two cases of vancomycin-resistant staph have been identified in the U.S. in the last two months. These could cause serious infections even in otherwise healthy people.

How can it affect me?
Although VRE generally doesn't affect healthy people, anyone who comes in contact with the bacteria can become a carrier. Once you become a carrier, you can easily spread the bacteria to friends and family. In addition, if you become a chronic carrier of VRE, you could easily become infected when you are older or in declining health.

The spread of VRE isn't thoroughly documented or understood, but estimates from Europe are that 3.5% to 5% of the population may be carriers of VRE. VRE first appeared in the U.S. on the East Coast and spread to the West Coast. It is likely that carrier rates in those areas will take a couple of years to catch up to the European carrier rates.

It's particular important to avoid becoming a carrier if you share a home with those at risk - the very young, the very old or the very ill.

How can I be exposed to it?
You can be exposed to VRE by coming in contact with a contaminated object or person, or by eating contaminated food.

In Hospitals - The most likely place to pick up VRE is in hospitals, since this is where VRE tends to originate. In the U.S., all reported cases of VRE were acquired in a hospital. (This is according to the information currently publicly available - this information changes rapidly.)

VRE has been cultured from hospital equipment, doorknobs, and bedrails. It has also been cultured on the hands of hospital personnel. Anyone who frequents hospitals should be considered at risk for carrying VRE.

Of course, you can be exposed to VRE by a single visit to the hospital, but people who work in hospitals (even administrative personnel) are at much higher risk for being exposed and becoming a carrier.

How can I avoid it?
Fastidious hygiene is the best way to avoid ingesting VRE and becoming a carrier. VRE is a robust bacteria and has been found on hospital personnel's hands after five seconds of hand washing. It is recommended that you wash your hands for twenty seconds with an antibacterial soap every time before you eat. (Note that this means right before you eat. If you are eating in a restaurant and have been handling the menu, you could have picked up VRE. Wash your hands thoroughly before you pick up that piece of bread.)

Note that the most likely place to pick up VRE is probably the door handle of the rest room. Consider using the towel you dried your hands with as a protective shield when you open the door.

Avoid hospitals, as this is the only documented source of VRE in the U.S. If you do go to a hospital to visit someone, maintain fastidious hygiene throughout your visit. Avoid eating while at the hospital, and especially avoid eating hospital food.

In general, avoid taking antibiotics. You don't want to become a breeding ground for an antibiotic-resistant infection.

What if I need hospital treatment?
First, consider your options. Is it possible to receive treatment in the caregiver's office or in an outpatient surgery center?

If a hospital stay is absolutely necessary, it is probably wise to ask thorough questions about the hospital infection situation. Request written information about the hospital's record regarding VRE - how many infections have there been? When was the most recent infection? How many people were infected? How often are hospital personnel tested for VRE carrier status? How many staff are known to be VRE carriers?

It's best to request that this information be provided in written form, and dated and signed by your caregiver. This way your caregiver will know that you are serious about getting accurate information.

Consider asking all the hospitals in your area. You may be surprised at the variance of infection rates. In particular, university and teaching hospitals have much higher rates of infection than community hospitals, and it may be possible to arrange to stay at the hospital with the lower infection rate.

As a patient in a hospital, you have to decide how paranoid you want to be about the possibility of exposure to VRE. It's probably safest to avoid eating any raw vegetables from the hospital kitchen. Wash your hands thoroughly before eating, and avoid eating any foods with your hands.

It's certainly safest to have anyone who touches you put on sterile gloves first, but this is unlikely to be their standard procedure.

Request a copy of their guidelines for avoiding hospital-acquired infections, and remind hospital personnel to abide by those guidelines.

What if I've been in a hospital recently?
You might want to call the hospital and ask about the infection situation there prior to and during your stay.

If the hospital has a history of VRE, consider the possibility that you might have been exposed during your stay, and you might now be a carrier.

Those who are VRE carriers are unlikely to know it. It is possible to be cultured to find out if you are a VRE carrier, but this is unlikely to be covered by a health plan.

If you think there's a possibility that you were exposed to VRE and might be a carrier, you should maintain fastidious hygiene in order to avoid spreading the bacteria. It is important to wash your hands for twenty seconds with an antibacterial soap every time after using the toilet. This will reduce the chance that you will spread VRE to others with whom you come in contact. Be especially fastidious if you are regularly in contact with those at risk - the very young, the very old, or the very ill.

If you are certain that you were exposed to VRE or suspect that you may have become a carrier, it is essential to maintain your own good health in order to avoid developing a serious infection.

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