March 05, 2021
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As cases of Candida auris continue to emerge in the U.S., institutions are learning what actions are needed to improve their preparedness and response to the aggressive and naturally resistant fungus.
As of November 30, 2020, nearly 1,600 clinical cases of C. auris were reported in the United States, and screening identified an additional 3,172 colonized patients, according to tracking by the CDC.
Diane Meyer
A study recently published in Infection Control & Hospital Epidemiology looked at the challenges faced by healthcare facilities that have experienced cases and outbreaks of C. auris in order to better prepare unpatched facilities.
For the study Diane Meyer, MPH, As a senior analyst at the Johns Hopkins Center for Health Safety and a research fellow at the Johns Hopkins Bloomberg School of Public Health, coworkers conducted qualitative interviews in health departments, long-term care facilities, acute hospitals, and health organizations in New York, Illinois, and California – three of the hardest hit states. They interviewed 84 health care workers who had experience preparing for or responding to C. auris.
The interviews revealed key issues such as surveillance and laboratory capacity, communication between interfaces and intra-facility, infection prevention and control (IPC), cleaning and disinfecting the environment, clinical management of cases, and media concerns and stigma.
Healio spoke to Meyer about the study and how facilities can better prepare for outbreaks of C. auris and other infections that could cause similar problems.
Healio: How did you determine who you would like to interview?
Meyer: The people surveyed were from states where large numbers of C. auris cases had occurred, including New York, California, and Illinois. They have all been involved in efforts to prepare for or respond to cases and outbreaks of C. auris, including in acute and long-term care settings. They were a multidisciplinary group and included infectious disease doctors and nurses, environmental services, emergency managers, epidemiologists, and others.
Healio: What challenges did the interviews identify?
Meyer: Interviewers discussed various challenges in preparing for and responding to C. auris, including the lack of laboratory capacity to test for C. auris, such as reconciling the need for surveillance with the ability to isolate those identified as positive, and how best to communicate the patient’s C. auris colonization status with other institutions; and how to ensure proper IPC to prevent nosocomial transmission.
Healio: What lessons have healthcare institutions that experienced C. auris learned?
Meyer: One of the key lessons the facilities learned was that the key to preventing C. auris outbreaks is “control of bread and butter infections.” In addition, members of the environmental services team are key members of the patient care team, and institutions must ensure that they support these team members with the appropriate staffing, education, and training so that they can contribute to the spread of nosocomial spread.
Healio: How can institutions that have not identified C. auris be better prepared for potential cases?
Meyer: Again, I think it all comes down to a proper IPC as well as strong surveillance systems. We need to ensure that healthcare facilities have the staff, education, training and care necessary to protect their patients. In addition, a strong multidisciplinary team or task force (including laboratory, infection control, hospital epi, infectious disease experts, nursing, EVS, possibly even public affairs) is essential for planning ahead and developing specific guidelines or guidelines.
Healio: Besides C. auris, what other major healthcare infections could pose similar challenges?
Meyer: You could draw many parallels between some of the challenges our respondents identified and other multidrug-resistant organisms as well as other infectious disease outbreaks like COVID-19. Again, poor IPC practices or a lack of efficient planning and operational considerations can expose vulnerable residents to risk of infection and increased morbidity and mortality, especially in long-term care facilities. It is imperative that we identify ways to improve IPC measures, including staffing and training, at these facilities to prevent further outbreaks.
We found C. auris useful to study because it is a relatively new organism for which little was initially known. This created problems communicating about the public health risk and raised questions about how best to disinfect transmission, control transmission, etc., and for which there were limited resources to test and otherwise respond. So it was an interesting proxy for investigating problems that might arise with other emerging infections.
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