Protected: GRE / VRE

GRE stands for Glycopeptide Resistant Enterococci. Enterococci are bacteria (germs) that are commonly found in the bowels (gut) of most humans. There are many different species of enterococci but only a few have the potential to cause infections in humans.

GRE are bacteria that are resistant to the group of antibiotics known as Glycopeptides. These include Vancomycin and Teicoplanin. GRE are sometimes referred to as VRE – which stands for Vancomycin Resistant Enterococci.

What infections does it cause?

GRE can cause wound infections and blood poisoning. However, it can also cause infections of the bile duct or urinary tract.

Are some people more at risk than others?

The main risk factors for GRE / VRE infections are:

• prolonged hospital stay
• antibiotic treatment
• intensive care treatment

If NIAS staff are aware that the patient has a previous history of GRE then this should be communicated to EAC and ED staff when transferring the patient to ensure effective patient care and management.

GRE can spread between patients either through contact with a patient known to have GRE or by touching the environment that has been occupied by a patient with GRE e.g. patient equipment, stretchers, hand rails, straps etc.

The risk increases if the patient is having diarrhea as the bacteria can live harmlessly in the gut.

It can also be spread through staff’s hands if staff do not adhere to the 5 moments of Hand Hygiene (HH) using the 7 step technique. It is also essential that staff use PPE appropriately ensuring that gloves are used and changed appropriately with HH.

• Hand Hygiene should be completed as per the 5 moments in line with usual practice.
• Eye protection should always be risk assessed and used with any patient where there is a risk of splashes including spitting and productive coughing.
• Gloves and Aprons should be worn.
• The patient should ideally be transported via ambulance (eg. PCS) with no other patients present where possible. Individual cases can be discussed with the IPC team and a risk assessment can be made.
• All equipment and the ambulance should have a deep clean paying particular attention to touch points.
• Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag.

Staff do not routinely need to be followed up after caring for a patient with GRE. Adherence to all IPC precautions is essential.

The IPC team can be contacted for further advice if a patient with a known history of GRE has been identified. The team will be able to help staff risk assess the patient and precautions required and to provide support where required.