Nosocomial transmission of vancomycin-resistant Enterococci (VRE) occurred in Kyushu University Hospital in March 2004. A strain of E. Faecium of the Van B type was isolated from a stool sample of a patient, after which VRE was detected from other five patients in the same ward up to August 2004. Correct infection control for VRE was not initially performed because the strain was misidentified as E. casseliflavus. Pulsed-field gel electrophoresis (PFGE) revealed that all the VRE strains were closely related, so transmission was considered to be nosocomial. All six patients colonized with VRE were female and were comparatively active. They used shared bathrooms. None of the patients shared a room with any of the other patients colonized with VRE. Therefore, we speculate that a contaminated toilet seat was the probable route of transmission. Our strategy of care to prevent contact with possible sites of infection, cleaning susceptible environments, especially the bathrooms, and strengthening hand hygiene adherence successfully led to the end of the outbreak.
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