from the editor
from the editor
Broader Screening Methods Help Prevent Candida auris Transmission in Hospitals
I wanted to direct your attention to an excellent study describing the outcome of a shift in hospital screening protocols for Candida auris , which we know can spread quickly in the healthcare environment . A comparison of screening results and patient outcomes before and after the change at Mount Sinai Brooklyn demonstrated the value of broader screening of high-risk patients . This expanded screening caught more cases earlier , enabling infection prevention and control ( IP & C ) teams to isolate them before they could infect other patients or contaminate shared hospital equipment .
The impetus for the study was a case where a skilled nursing facility resident was moved to the hospital , being diagnosed with a C . auris infection two months later . The patient had not been screened for C . auris upon admission because the hospital ’ s screening protocols at the time classified the patient as low-risk . After diagnosis , the hospital conducted a full outbreak investigation , testing 118 people who were directly exposed to the patient or shared equipment with the patient . The investigation identified eight additional patients who tested positive for C . auris .
Given the time and resources required for the investigation , the hospital ’ s IP & C department adjusted its recommended C . auris screening protocols for new patients , expanding them to include all admissions from skilled nursing facilities or patients who had been in such a facility within the past month . After following the new protocols for one year , they compared outcomes for that year to the nine-month period prior to the screening change .
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The study spanned 591 patients who were screened for C . auris , including 34 patients with the old screening approach and 557 patients screened under the expanded protocol . The positivity rate increased from 1.8 percent to 2.4 percent , indicating that more cases were being detected with the broader screening approach . More specifically , the old criteria would have flagged 53 patients as high-risk , and nine of them would have tested positive for C . auris . The expanded protocol added 538 more patients , five of whom tested positive but would not have been identified through the old screening protocol . Ultimately , the new protocol identified eight cases that would have been missed , representing a significant threat to other patients and the hospital environment . Test results were returned within three days , allowing the team to identify cases quickly and implement appropriate isolation , contact , and disinfection precautions to prevent outbreaks .
“ 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 ,” said Scott Lorin , MD , president of Mount Sinai Brooklyn and an author of the study . “ 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 . 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 . This expanded screening protocol has allowed us to detect Candida auris cases earlier , helping us prevent potential hospital outbreaks .”
Additional details from the study include :
• The study was performed at an acute care hospital with 212 beds , where staff members have been caring for patients colonized with C . auris since the pathogen first emerged in New York City in 2016 .
• The hospital ’ s original screening framework called for testing patients with recent previous stays at nine specific skilled nursing facilities known to care for people with C . auris , of whom the highest-risk patients were considered those who were ventilator-dependent or admitted with a tracheostomy .
• Under the new screening guidelines , it was not practical for the hospital to isolate every patient while awaiting test results . Instead , the high-risk patients were isolated while the lower-risk patients ( those from a skilled nursing facility but without a tracheostomy or ventilator ) were treated using Standard Precautions until results were reported .
Until next time , bust those bugs !
Kelly M . Pyrek Editor & Publisher Kelly @ healthcarehygienemagazine . com
Reference : Cheng A , Brody KA , et al . Analysis of an expanded admission screening protocol for Candida auris at a New York City hospital . Am J Infect Control . Oct . 31 , 2024 . DOI : https :// www . sciencedirect . com / science / article / abs / pii / S0196655324007144 ? via % 3Dihub
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6 • www . healthcarehygienemagazine . com • november 2024