Vancomycin-Resistant Enterococcus (VRE)

On the way to work today, I saw the rising Sun. Although, that's nothing special in general, but this morning it felt like I haven't seen the morning Sun in quite a while, and it felt good. I guess I never really realised how much the Sun brightens up the day...

Anyway today's post is on something that has gotten me very irritated with the Singapore healthcare system, and specifically the Singapore General Hospital (SGH). Its about the recent cases of Vancomycin-Resistant Enterococcus (VRE). I'm sure those of you who have been watching the news would have noticed the 50+ cases of VRE identified at SGH.

Now to appreciate the situation better, I went to check up on VRE, to see if we should get worried. So what is VRE? Vancomycin-Resistant Enterococcus is a mutant strain of Enterococcus that originally developed in individuals who were exposed to the antibiotic. Vancomycin is a powerful antibiotic that is often the antibiotic of last resort, and is generally limited to use against bacteria that are already resistant to penicillin and other antibiotics. VRE does not pose a threat to healthy people. However, it does pose a threat to those with weak immue systems, like the young, the old and the very ill.

The catch here is that healthy people can become carriers for the disease, with no symptoms whatsoever. Once you become a carrier, you can stay infected anywhere from a few days, to years and even for life (chronic carrier). If you become a chronic carrier, VRE will become a timebomb living within your body, just waiting for your immune system to get weak. Also, a carrier could pass VRE to other people with weak immune systems in the general public, people who are living outside the hospital, people who have chronic diseases.

Another danger of VRE is its ability to pass its antibiotic resistant genes to other, more dangerous bacteria like staph and strep. These 2 bacteria can cause serious infections even in healthy individuals and, once resistant to Vancomycin there's few antibiotics that can be used to treat the infection other than a few new (and very expensive) antibiotics.

Why am I so concerned about this? Well, for one its because SGH and the Ministry of Health seem to want to downplay the seriousness of this. Secondly, my girlfriend is working in SGH in a ward with infected patients, and thirdly, (for those of you who know) my mom isn't exactly the healthiest person on Earth.

Why am I so irritated? Cos SGH identified VRE cases quite a while ago (I personally suspect much earlier than the publicly announced March), and yet hospital administration let it spread. The worse thing is that is has been allowed to spread between wards (about 8 I think). Now, how can a "world-class" hospital with experience in handling SARS let a bacteria such as VRE run amok in its wards, and yet still allow new patient admissions and visitors to these very same wards. I don't know about you, but I would consider such actions very irresponsible.

Whoever it was that let the media know about VRE has done a very good thing. Why? Cos now SGH is forced to do tests on all its patients - something it has refused to do previously. Without the media, I think that SGH would have simply kept to its irresponsible ways and continue to allow VRE to spread, hoping that it would somehow die down on its own.

So for those of you who have any trip planned to SGH, please try to postphone it, even though the chances of catching VRE is (supposedly) low. But if it can't be avoided, like my mom's doctor appointments, do take the following precautions:

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.

Click here for more on VRE.