Healthcare Hygiene magazine October 2019

New antifungals (e.g., SCY-078, APX001A/APX001, and rezafungin) have been tested with success but they are not available to date for clinical use.” Resilience and mechanisms of transmission Cortegiani, et al. (2019) explain that, “Unlike others Candida species, C. auris can colonize different anatomical sites (e.g., skin, skin, rectum, axilla, stool) and contaminate hospital equipment and surfaces, creating a vicious cycle of acquisition, spreading, and infection, particularly in ICUs. Indeed, bed, chairs, and monitoring tools (e.g., pulse oximeters, temperature probes) were contaminated during outbreaks. Recently, Eyre et al. published the results of a patients’ and hospital environmental screening program in Oxford, UK, after 70 patients (66 admitted to a neuro-ICU) were identified as being colonized or infected by C. auris. Seven patients developed an invasive infection during hospital stay. C. auris was detected mainly on skin-surface axillary temperature probes and other reusable tools. In patients monitored with skin-surface temperature probes, the risk of C. auris infection/colonization was seven times higher. Adoption of specific bundles of infection control had no significant effects until removal of the temperature probes. Recent studies have confirmed that C. auris can form biofilms, with a high variation of capacity of production depending on the C. auris strain considered. Biofilm may present reduced susceptibility to hydrogen peroxide and chlorhexidine. Quaternary ammonium compounds and cationic surface-active products seem to be ineffective against C. auris. Chlorine-based products appear to be the most effective for environmental surface disinfection. Chlorine-based disinfectants (at a concentration of 1,000 ppm), hydrogen- perox- ide, or other disinfectants with documented fungicidal activity are recommended for environmental cleaning by the European CDC (ECDC).” Implementation of infection prevention and control measures Cortegiani, et al. (2019): say that, “Usually, outbreaks follow an exponential increase in the number of affected patients. It is mandatory to trace contacts with the aim to achieve early identification and screening of possible colonized patients that might be responsible for persistence of C. auris. Patients potentially or already colonized should be placed in single rooms with contact isolation precautions. Screening should be applied for contacts and patients previously hospitalized in healthcare settings where C. auris isolation was confirmed. Hand hygiene (with alcohol or chlorhexidine handrubs), wearing of protective clothing, and skin and environmental/equipment decontamination should be performed to prevent ongoing transmission.” Global surveillance Cortegiani, et al. (2019) emphasize that the emergence of C. auris and progres- sive spread of infections caused by other resistant pathogens has strengthened the need for a surveillance network for antimicrobial resistance globally for critically ill patients’ safety. The researchers observe, “It is hard to predict future C. auris diffusion. There will be outbreaks also in countries in which C. auris has been not reported yet? Will new MDR clones continue to emerge? Will we be able to apply effective antifungal stewardship programs and control measures?” So much about C. auris is still unchartered territory, and as Rhodes and Fisher (2019) observe, “The global emergence of C. auris testifies to the unmapped nature of Kingdom Fungi and represents a new nosocomial threat that will require enhanced infection control across diverse healthcare and community settings.” The researchers add, “Currently, nothing is known about the origins and initial emergence of C. auris; its propensity to survive on inanimate objects within the hospital alongside resistance to disinfection protocols suggests the existence of an unknown non-human environmental reservoir. However, similar to other Candida species, the true nature of C. auris’ ancestral reservoirs currently remains elusive. The detection of clonal C. auris isolates on multiple continents simultaneously with distinct geographical antifungal resistance mechanisms suggests at least four independent emergence events followed by clonal expan- sion and the ongoing evolution of resistance in response to antifungal therapy … As sequencing technology develops, it is likely rapid sequencing of C. auris www.healthcarehygienemagazine.com • october 2019 Get “In the Zone” for Hand Hygiene Compliance • Sonar technology creates Patient Protection Zones which – unlike RFID or BlueTooth – are easily shaped and won’t travel through walls • System flexibility promotes creation of micro Protection Zones • Network partner, AT&T ® , provides secure data transmission flexibility • 5-minute installation doesn’t require external power supply • System expedites transition from "foam-in, foam-out" to W.H.O. 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Healthcare Hygiene magazine October 2019 | Page 17