Preventive measures stopped C. auris outbreaks at two California hospitals
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Two hospitals in California explained how they used preventive measures to successfully stop the spread of Candida auris.
Experts summarized the responses at the annual conference of the Association for Professionals in Infection Control and Epidemiology. Related studies were also published in the American Journal of Infection Control.
To prevent a potential C. auris outbreak at Scripps Memorial Hospital in La Jolla, infection preventionist Elizabeth Anne Jefferson, PhD, CIC, and colleagues flagged and isolated a patient who tested positive for the pathogen. Jefferson told Healio that it is essential C. auris is identified as early as possible because almost a third of isolates have multidrug resistance.
“Clinically this means that first-line antifungal treatment could fail and treatment options could be very limited,” Jefferson said. “It is important for clinicians to know if their laboratory can identify C. auris, and if not, then isolates need to be sent to other laboratories that can identify it. It is also important to get C. auris susceptibility testing to guide antifungal therapy. C. auris drug susceptibility can vary quite a bit depending on the region where it originated.”
Jefferson and colleagues initially identified one patient who had been hospitalized abroad with C. auris via the hospital’s carbapenemase-producing organism screening program. To prevent further spread, they placed the patient in isolation for 47 days and enacted cleaning measures, including the use of disinfectant and ultraviolet light to clean patient rooms. No C. auris colonization or clinical isolates were found in the following 6 months.
“It is important to know the patient risk factors for C. auris. Risk factors include patients who have received health care outside of the United States, especially in countries where C. auris is prevalent,” Jefferson said. “Patients on a mechanical ventilator who are being transferred from long-term acute-care facilities or from skilled nursing facilities are also high risk. Patients who fail to respond to empiric antifungal therapy and from whom an atypical or unidentified yeast is isolated are especially high risk for C. auris.”
In the summer of 2020, an existing notification system helped prevent another potential C. auris outbreak at University of California Los Angeles Health.
Urvashi Parti, MPH, a health infection preventionist, and Shaunte C. Walton, MS, CIC, the health system’s director of clinical epidemiology and infection prevention, told Healio that the results of their analysis highlight the “importance of active surveillance testing” to curb the spread of emerging diseases.
“The collaboration of active surveillance testing along with multilevel notifications in the
electronic medical records prevented cross-contamination in the health care environment,” they said. “Proactively identifying high-risk factors for an emerging infection prevents transmission when the appropriate steps are taken such as testing, isolation, and effective disinfection.”
Infection preventionists at UCLA used their EMR system to screen each incoming patient for COVID-19 and C. auris. Patients identified as high risk were flagged and tested, and notifications were sent to infection prevention, the lab, environmental services and nursing.
A total of 11 of 52 patients tested positive for C. auris and were placed in isolation.
Walton and Parti said that one of the study’s major limitations was the lack of previous research on C. auris.
“As the number of C. auris cases increase throughout the county, more analysis will become available,” they said.
California is one of four U.S. states that reported more than 100 clinical cases of C. auris between May 1, 2020, and April 30, 2021, according to tracking by the CDC.
References:
Jefferson EA. Am J Infect Control. 2021;doi:10.1016/j.ajic.2021.04.042.
Jefferson EA. Preventing a Candida auris outbreak at an acute care hospital during the COVID-19 pandemic. Presented at: APIC 2021; June 28-30, 2021 (virtual meeting).
Parti U, et al. Am J Infect Control. 2021;doi:10.1016/j.ajic.2021.04.032.
Parti U, et al. The importance of information technology and surveillance to prevent the spread of Candida auris. Presented at: APIC 2021; June 28-30, 2021 (virtual meeting).
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Jefferson EA. Preventing a Candida auris outbreak at an acute care hospital during the COVID-19 pandemic. Presented at: APIC 2021; June 28-30, 2021 (virtual meeting).
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