Nursing Interventions to Decrease the Colonization of Vancomycin-resistant Enterococcus (VRE) in Hospitalized Children

Background: There have been concerted efforts in the past few years to manage hospital infections of vancomycin resistant enterococcus (VRE) with the implementation of grouped nursing interventions in the sensitive group of hospitalized children. Aim: Literature review of the implementation of behavioural grouped nursing interventions aimed at decreasing the frequency of VRE colonization /infection in hospitalized children. Method: Literature search of the electronic databases (Medline/PubMed, Cinahl, Scopus, HEAL Link) and critical analysis of the relevant articles for the years 1996-2011. The Medical Subject Headings terms and the keywords included: “VRE”, “vancomycin resistant enterococcus”, “vancomycin resistant enterococcus and children”, “VRE and children”, “VRE colonization and children”, “VRE infection and children”. The initial number of articles retrieved was 5,988, of which 15 fulfilled the eligibility criteria: (a) The studies were written in the English language and published in peer reviewed journals, (b) the sample of the studies consisted of children in-patients, and (c) the studies had explicit methodology and results. A scale for quality estimation of was used in order to evaluate the quality of the studies. Results: Of the studies reviewed, 20% were not randomized with a control group and were rated ≥ 60%. These studies showed a significant reduction or elimination of VRE with the implementation of grouped nursing interventions. Behavioural interventions described in these studies included education and the use of a multidisciplinary team. In 66.7% of the studies 5 nursing interventions were applied for the reduction of colonization of VRE, while in 33.3% of the studies less than 5 interventions. In 80% of the studies there was simultaneous implementation of all interventions for the reduction of colonization of VRE with no randomization, and measurements were made only after implementation; 41.6% of these report elimination of VRE, 41.6% significant reduction and 16.8% reduction. Conclusions: There is strong evidence about the value of grouped nursing interventions for the reduction of colonization of VRE in hospitalized children. Many studies had methodological limitations and further testing of the application of these interventions is strongly recommended.