Table 1 Protocol of vancomycin-resistant enterococci decolonization*

1.

Patient was managed in isolation room A and subjected to bowel preparation according to the protocol commonly used prior to colonoscopy examination: (i) ingestion of 2 liters of polyethylene glycol (Klean prep) over 6 hours to wash out the bowel content; (ii) taking fluid diet including rice water, clear soup, and fruit juice on the first day of decolonization.

2.

When the defecated bowel content became clear fluid, patient was transferred from isolation room A to B, which had been terminally disinfected with sodium hypochlorite 1,000 ppm.

3.

After transferal to isolation room B, a five-day course of medication with activity against VRE was given, including oral linezolid 600 mg every 12 hourly, orally-taken intravenous preparation of daptomycin 8 mg per kg daily.

4.

At the same time, the patient was cleansed with 4% chlorhexidine bath and shampoo, and oral chlorhexidine gargle for 5 days. Where possible, avoid use of other antibiotics treatment during the decolonization period.

5.

At the time of bathing, the patient’s clothes, underwear, and bed linens were replaced and sent for hot laundry daily. All personal belongings were disinfected to prevent re-colonization. The isolation room was thoroughly cleaned and disinfected by sodium hypochlorite 1,000 ppm twice daily.

6.

After completion of 5-day decolonization regimen, Lactobacillus rhamnosus GG 80 mg was given daily to replace the gut flora.

7.

All foods and drinks throughout the decolonization procedure must be boiled. All visitors and healthcare workers must comply with hand hygiene with alcohol based hand rub.