Rapid assessment, infection control measures are key to containing the spread of Candida Auris


Increased laboratory surveillance and infection prevention and control were in the identification and containment of. effective Candida auris Infections in Southern California, found a new study.

The study, published in Internal Medicine Annals and funded by the Centers for Disease Control and Prevention, assessed the prevalence of Cauris and infection control practices in 14 ventilated specialist nursing facilities (vSNFs) and three long-term acute care hospitals (LTACHs) in Southern California.

“Our research is an example of how strong public health measures combined with better infection control in long-term care can make a difference in the fight against. can do C. auris“Said lead author Ellora Karmarkar, MD, MSc, of the California Department of Health infection.

The multi-resistant yeast, which persists for weeks on the skin and surrounding surfaces of patients, has become more and more important in recent years. C. auris was identified in Orange County in February 2019 after a urine screen was performed, which prompted the investigation.

“When Candida auris was identified, we were concerned that it might be in many other facilities and not yet identified,” said Karmarkar. “We have proactively tested patients in several long-term care facilities and identified previously undetected cases, allowing for adequate infection prevention and control to prevent spread and careful follow-up. These efforts helped contain it Cauris in the region within a few months. “

Point prevalence surveys (PPS), post-discharge testing and assessments of infection prevention and control (IPC) practices were carried out in 17 facilities. PPSs were repeated every two weeks in facilities where Cauris was recognized and IPC support provided.

The investigation identified 44 other patients with Cauris in nine facilities, and the first bloodstream infection was reported in May 2019. As of October 2019, a total of 182 cases had been identified, including 81 isolates that were strongly related. The investigation identified gaps in hand hygiene, transmission-based precautions and environmental cleansing, and the outbreak was contained in two facilities by October 2019.

Karmarkar said there were two surprising results: “One: Over half, or 9, of the 17 facilities we examined had Cauris Cases; many that we would not have identified had we not searched Cauris. Second, under the right circumstances, and with proactive, intensive efforts that combine surveillance and infection prevention and control, we can increase the spread of Cauris. It’s not easy, but it can be done. “

Care facilities are common places for Cauris spread. Frequent transfers between facilities encourage the spread of the pathogen. Proactive surveillance was key to identifying the presence of C. auris Months before a bloodstream infection occurs.

“I think this research reflects our health system as a whole, not just LTACHs and vSNFs or other post-acute care facilities,” said Karmarkar. “Most clinicians already know that pathogens present in one healthcare facility can easily be passed on to others through patient transfers.

The study also highlighted the importance of adhering to infection prevention and control practices, including hand hygiene.

“So the bottom line: if you recognize Cauris If you have a patient, think carefully about where they might have been exposed, ”Karmarkar said. “If you see one case, many others are likely to go undetected. Don’t just think of your hospital or care facility, but also of the local network of facilities. Report the case to public health as soon as possible and consider working with your local health department sooner to find the best strategies for you Cauris Detection and containment, including stricter infection prevention and control procedures. “

Cauris has generated increasing interest as cases have become more common in recent years. Jeffrey Rybak, PharmD, PhD, Lecturer, Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, recently spoke about the challenges C. auris It is often drug resistant, newer and therefore difficult for labs to diagnose, and can spread quickly to healthcare.

Infection prevention experts at UCLA recently launched an initiative to establish strategies and protocols to control the pathogen, including risk assessment during admission screening, reminders of cleaning protocols and training for clinicians.

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