Control of vancomycin-resistant enterococci in a hospital: a five-year experience in a Taiwanese teaching hospital

In order to prevent transmission of hospital-acquired vancomycin-resistant enterococci (VRE), the infection control team (ICT) of the National Taiwan University Hospital (NTUH) introduced practical guidelines from January 1997 to June 2000. All patients at NTUH found to be infected or colonized with VRE were placed in strict contact and cohort isolation. Surveillance cultures were obtained from other patients in close proximity in order to determine any spread of VRE. If identified, these patients were also placed in contact and cohort isolation, and their isolates were subjected to antimicrobial susceptibility testing and molecular typing by pulsed-field gel electrophoresis. During this period, 20 patients were found to have VRE. Based on typing results, there were three occasions where the same VRE strain had spread between index patients and roommates or patients staying in neighbouring rooms. No further spread occurred after applying strict contact isolation for these patients. The hospital-acquired VRE infection rate was around 0.03 to 0.09 per 1000 discharges during the intervention period. After July 2000, however, members of the ICT did not actively monitor or implement any interventions to control VRE. The rate then increased to 0.20 per 1000 discharges in 2001. This study suggests that interventions for the control of VRE, based on the guidelines from the Hospital Infection Control Practice Advisory Committee, are effective for control of VRE spread. Failure to adhere to these guidelines may result in an increase in hospital-acquired VRE.

Time and money for vocational rehabilitation of clients with mild, moderate, and severe mental retardation

Mildly, moderately, and severely mentally retarded vocational rehabilitation clients comprised a random national sample of 600 clients. One-half of the sample had been closed (services completed) "rehabilitated", and half had been closed "nonrehabilitated." Variables selected for analyses were time in referral, training, and rehabilitation process; dollars in evaluation, facilities, all services, and earnings. Rehabilitated clients tended to require more time in referral, less moneys for extended evaluation and rehabilitation facilities, and earned more per week than the nonrehabilitated clients. Severely mentally retarded clients required more time in training and higher costs for extended evaluation, rehabilitation facilities, and all services than the moderately or mildly retarded groups. A consistent interaction across five variables indicated that the greatest amounts of service in time and money went to the nonrehabilitated severely retarded group.