While environmental concerning cleaning to eliminate environmental contamination is very important in preventing the spread of microorganisms, a study reports that despite frequent room cleanings, nosocomial transmission of VRE was shown to be associated with room contamination [13]. There were VRE contaminations detected on patient room door handle and shared room telephones in the surface cultures obtained in the beginning of our study, which were not found in the repeat environmental cultures obtained after the scoring was implemented and the trainings offered. A decrease in the number of patients with VRE colonization along with the decreased environmental contamination demonstrates the importance of environmental cleanliness.

Patient-to-patient transmission is also likely to happen via direct or indirect contact with contaminated hands, contaminated surfaces, or medical devices [3]. Therefore it is crucial to have clean surfaces and to form the hand washing habit. Duckro et al. have demonstrated that VRE are transmitted through health personnel’s’ hands [14]. On the other hand, numerous studies show that hand washing compliance can be very low [3, 15]. With the scoring table used in our study, especially hand washing related discrepancies were identified and the personnel were trained primarily on hand washing. Among the vancomycin resistant strains of enterococci, Enterococcus faecium and Enterococcus faecalis were the most frequently isolated ones [16]. These are usually resistant to VanA gene. The most common type of enterococci in the colonization that occurred in our hospital’s Pediatric Ward was Enterococcus faiecum.

VRE colonization/infection is observed more frequently in some patient groups and some VRE risk definitions have been attempted at. Long-term antibiotic (vancomycin, cephalosporins, and antianaerop agents) use, presence of neutropenia, prolonged hospital stays, and intensive care unit hospitalizations are identified risk factors. Patients staying at the hematology-oncology department are in the risk group [17]. There was a history of long-term antibiotic use in 20 (58.8%), chronic renal diseases in 7 (20.6%), and long-term catheter use in 4 (11.8%) of the patients in our study. According to the demographic data, 58.8% and 20.6% of the patients had significantly high history of long-term antibiotic use and chronic renal diseases, respectively. VRE colonization that occurred after detection of urinary tract Drug_discovery infections associated with VRE among the patients staying at the Pediatrics Ward, and to control this colonization, HICC started to take precautions based on the suggestions of HICPAC of CDC on how to control the spread of VRE [4].