infection prevention
By Susan Singh , MPH CIC
The Role of Environmental Hygiene in the Prevention and Control of Candida auris Transmission
Many healthcare facilities around the world have reported surges of C . auris cases during the COVID-19 pandemic , most likely because of competing priorities and changes in infection prevention and control
( IP & C ) practices during the pandemic .”
Candida auris ( C . auris ) is a serious public health threat . First identified in Japan in 2009 , it is a multidrug-resistant fungus which has caused outbreaks in healthcare facilities . Infections caused by C . auris often do not respond to commonly used anti-fungal drugs , making them difficult to treat and leading to severe infections and high mortality .
Many healthcare facilities around the world have reported surges of C . auris cases during the COVID-19 pandemic , most likely because of competing priorities and changes in infection prevention and control ( IPC ) practices during the pandemic . Further compounding these contributing factors to C . auris transmission , C . auris persists in the healthcare environment on various fomites and surfaces for weeks . Several studies have looked at the survival range for C . auris on various surfaces ( Figure 1 ), suggesting that contaminated surfaces may be an important source of acquisition . C . auris frequently forms biofilms on surfaces . Research has shown that C . auris can survive on both wet and dry biofilms , making it harder to eradicate from the environment once it has been introduced .
Figure 1
Material Glass Plastics Steel
Survival Range 3 days > 14 days > 7 days
The fundamental element of cleaning to prevent transmission is highlighted in one outbreak investigation in the neurosciences intensive care unit at a hospital in the United Kingdom with a cluster of C . auris cases . Between Feb . 2 , 2015 , and Aug . 31 , 2017 , the unit identified 70 patients either colonized or infected with C . auris . The authors found an association of C . auris positivity with patients who had skin-surface axillary temperature monitoring via use of reusable probes . As the presumed source of C . auris , all temperature probes were removed from use . However , probe use was reestablished during the annual leave of a senior nurse , and C . auris acquisition continued . All probes were completely removed and cultured ; C . auris was isolated from four of five probes presumed to be recently used , while none of the five probes in storage grew C . auris .
Beyond proper cleaning and disinfection , C . auris prevention requires other IP & C practices . In July 2020 , a Florida acute-care hospital faced an outbreak of C . auris on its specialty care unit dedicated to COVID-19 patients . A cluster of three C . auris bloodstream infections and one urinary tract infection prompted a joint outbreak investigation by the Florida Department of Health and the Centers for Disease Control and Prevention ( CDC ). Various breaches were identified including healthcare personnel ( HCP ) using multiple gown and glove layers , extended use of the underlayer of personal protective equipment ( PPE ), gaps in cleaning and disinfection of shared medical equipment / environment , and low hand hygiene compliance . After implementing enhanced cleaning and disinfection practices , removing supplies from hallways , and discontinuing base PPE layer practices , C . auris transmission halted .
If C . auris has been identified at your facility , here are some examples of steps you can take to ensure a safe environment for patients / residents , healthcare workers , and visitors :
➊ Disinfectant selection and contact time : The disinfectant used for patient-care equipment and / or the environment should be listed on the Environmental Protection Agency ( EPA )’ s List P : Antimicrobial Products Registered with EPA for Claims Against C . auris . It is also imperative that the contact time for the disinfectant selected is strictly followed . If the surface being disinfected dries before the contact time , the surface must be wiped down again .
➋ Reusable patient care equipment : a .
b .
If possible , dedicate reusable patient-care equipment for each C . auris patient ( i . e ., bladder scanner , vital signs machine , stethoscope ). Observe the workflow of HCP to confirm “ dirty ” equipment is not brought outside the room ( i . e ., “ dirty ” glucometer machine being placed on the isolation cart outside patient room while the healthcare worker doffs PPE inside the patient room ). Develop a workflow to ensure contamination does not occur inside or outside the room .
➌ Audits : Initiate and / or increase the number of hand hygiene , PPE , and cleaning / disinfection audits . Provide real-time feedback and correction to non-compliant observations .
www . healthcarehygienemagazine . com • july 2022
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