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healthcare-associated infections (HAI) Program

Vancomycin-resistant Enterococci (VRE)​​

What are Enterococci?

Enterococci are germs (bacteria) that live normally in the human intestines and in the female genital tract.  When bacteria are present without causing an infection this is called colonization. All humans are colonized with enterococci, as they are with other organisms that are normally present in the gastrointestinal tract and on skin.  Occasionally, enterococci can cause an infection of the urinary tract, bloodstream, or skin wounds. This usually happens to people with previous medical problems.  Because enterococci are normally resistant to many antibiotics, vancomycin is often used to treat those infections.

What are Vancomycin-resistant Enterococci (VRE)?

Some enterococci are no longer killed by vancomycin and are known as vancomycin-resistant enterococci or VRE. These germs are often resistant to many antibiotics in addition to vancomycin. Most VRE infections occur in hospitals.

Who is at Risk of VRE Infections?

The following people are at an increased risk of becoming infected with VRE:

  • People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.
  • People who are hospitalized, especially when they receive antibiotics for long periods of time.
  • People with weakened immune systems such as patients in intensive care units, or in cancer or transplant wards.
  • People who have undergone surgical procedures, such as abdominal or chest surgery.
  • People with medical devices such as urinary catheters or intravenous (IV) catheters that stay in.
  • People who are colonized with VRE.

VRE does not pose a threat to someone who is healthy, as it is no more likely to cause an infection than the enterococci that are normally present in your intestines.  A person who is not taking antibiotics will not become colonized with VRE.

What is a VRE bloodstream infection (BSI)?

A VRE BSI is when a patient has a positive test for VRE in the blood along with evidence of an infection, such as a fever.  VRE BSIs usually occur in patients with the greatest risk of a VRE infection, such as following organ transplantation.

How is VRE spread?

VRE can be passed from person to person. VRE can get onto hands when they touch a person with VRE or after contact with contaminated surfaces or equipment.  Since VRE is present in the stool (feces) of someone who is colonized, the environment around a patient is more likely to be contaminated if they are using a bedpan and are incontinent.  Enterococci can remain alive for weeks unless the environment is cleaned and disinfected (treated with a chemical germicide).         

What are hospitals doing to prevent the spread of VRE?

Caregivers should clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient and may need to use gowns and gloves, and rooms and medical equipment should be cleaned and disinfected after use.  It is important for visitors to clean their hands before leaving the room of a patient in order to prevent the spread of VRE or any other germ a patient might have elsewhere in the hospital.  

What VRE information is reported to the California Department of Public Health and where can I find that information?

All California general acute care hospitals are required to report VRE bloodstream infection (BSI) cases that occur following hospitalization so that CDPH can calculate the rates of VRE BSI at each hospital and make that information available to the public (Health and Safety Code Section 1288.55).  The latest California hospitals VRE BSI report is available at the Annual HAI Report Page. Comparison of the rates of VRE BSI in different hospitals in this report should be avoided because differences may be due to variations in surveillance practices and/or laboratory testing methodology.

How patients and their advocates can help prevent infections?

  • Team up with your medical providers to prevent VRE infections.
  • Ask your provider if s/he washed their hands with soap and water or an alcohol-based hand rub before and after caring for you.
  • If you do not see your providers clean their hands, please ask them to do so.
  • Ask your provider if medical equipment was cleaned and disinfected before it was brought into your room.

If I or someone in my household has VRE, what can be done to prevent the spread of VRE?

  • Keep your hands clean, especially after using the bathroom or before preparing food. Use soap and water or use alcohol-based hand rubs.
  • Frequently clean areas of your home, such as your bathroom, that may become contaminated with VRE.
  • Wear gloves if you might come in contact with body fluids (such as stool or bandages from infected wounds) that could contain VRE. Always wash your hands after removing gloves.



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