Expanded C. auris screening helps NYC hospital catch more cases
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Key takeaways:
- A hospital expanded C. auris screening protocols after discovering a colonized patient who had been there for 70 days.
- Several cases were caught that otherwise would have been missed.
A New York hospital expanded its Candida auris screening protocols after a patient tested positive for the fungal pathogen 2 months after being admitted, catching other cases that would have previously been missed, according to a study.
The patient had been transferred from a skilled nursing facility (SNF) and was determined to be at low risk for C. auris, but when the hospital expanded its screening program, it found more infections that researchers said would have been missed under the previous protocols.
“Early identification of patients colonized with C. auris allows us to protect other patients and helps to prevent the spread of the pathogen to the hospital environment and shared equipment,” Scott Lorin, MD, president of Mount Sinai Brooklyn and lead author of the study, said in a press release.
C. auris was first identified in Japan in 2009, and from 2011 to 2013, it emerged simultaneously in Africa, Asia and South America. Health care environments where colonized patients are being treated can be contaminated with C. auris within hours, making it essential to identify it quickly to prevent an outbreak, experts say.
Studies have shown that active C. auris screening programs and standard infection control practices can prevent outbreaks, but a survey earlier this year found that less than half of participating health care facilities conducted C. auris screening.
According to the new study, a patient was transferred to Mount Sinai Brooklyn from an SNF that cares for patients with C. auris and treated for 70 days before being admitted to the hospital. The patient was not initially screened for the fungus until admission because they did not meet the hospital’s high-risk criteria.
After the patient tested positive, the hospital identified and screened 118 potential contacts with exposure to the patient or equipment that had been near the patient, and eight more patients were found to be colonized. There was no spread of C. auris from the eight additional patients, according to the study.
As a result of the eight additional colonized patients, the facility expanded its screening criteria to include any admitted patient who had recently stayed at an SNF.
Lorin and colleagues analyzed data from two study periods at the hospital: from Jan. 1, 2022, through Sept. 30, 2022, before expansion of C. auris screening criteria; and from Oct. 1, 2022, through Sept. 30, 2023, after the criteria was expanded.
During the first phase, high-risk patients were described as having a tracheostomy or being ventilator-dependent with a stay at an SNF within the previous 30 days, or transferred directly to the hospital from the facility, according to the study.
During this period, the hospital identified 34 patients for screening, with two (5.9%) testing positive. During the second phase, however, 557 patients — all transferred to the hospital from an SNF — were screened, revealing 12 colonized patients (2.2%), according to the study.
Further analysis showed that, during the full study, 137 patients had been transferred to the hospital from a designated ventilator-capable SNF, 51 of whom were considered high risk during both study phases because they had a tracheostomy or needed a ventilator. Among these, nine (17.7%) were colonized.
Among the 137 patients coming from a ventilator-capable SNF, 111 met the phase 1 screening protocol and 26 were screened because of the expanded protocol. Of the 26 screened after the protocol was expanded, two (7.7%) were colonized with the fungus, according to the study.
Lorin and colleagues concluded that standard C. auris screening should be considered by all hospitals for all patients with a recent stay in or direct transfer from an SNF, and specifically in places where C. auris has been detected.
“Notably, we saw no spread of this infection from the eight patients identified by the expanded screening protocols who would have been missed by our prior protocol,” Lorin said. “When you consider how many other people they came into contact with during their hospital stays, that’s a lot of patients kept safer by the implementation of broader screening.”
References:
- Cheng A, et al. Am J Infect Control. 2024;doi:10/1016.j.ajic.2024.08.027.
- Study shows broader screening methods help prevent spread of dangerous fungal pathogen in hospitals. https://apic.org/news/study-shows-broader-screening-methods-help-prevent-spread-of-dangerous-fungal-pathogen-in-hospitals/. Published Oct. 31, 2024. Accessed Nov. 13, 2024.
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