environmental hygiene
By Linda Homan , RN , BSN , CIC
The Critical Role of Environmental Hygiene in the Prevention and Control of Candida auris
In the wake of this new understanding that C . auris can be transmitted from personto-person , the Association for Professionals in Infection Control and Epidemiology
( APIC ) released a statement urging healthcare facilities to adopt aggressive infection prevention and control measures to stop the spread of C . auris in healthcare settings . 3
Candida auris is an emerging , multidrug- resistant fungi that is highly transmissible . The word “ auris ” is derived from the Latin word for ear , because this was the first body site in which the fungi was identified . 1 As with other Candida species , C . auris colonizes the skin , mucous membranes , gastrointestinal tract and the female genital tract . Five percent to 10 percent of susceptible patients develop invasive infections , such as bloodstream infections , with high mortality rates . Infections caused by this organism have been tracked carefully and , until recently , were thought to occur due to exposure to antifungal drugs rather than via person-to-person transmission . However , in July 2021 , the Centers for Disease Control and Prevention ( CDC ) released a report confirming transmission from patient to patient . 2
In the wake of this new understanding that C . auris can be transmitted from person to person , the Association for Professionals in Infection Control and Epidemiology ( APIC ) released a statement urging healthcare facilities to adopt aggressive infection prevention and control measures to stop the spread of C . auris in healthcare settings . 3 The most important prevention and control measures , as described by the CDC and reinforced by APIC , include : 4
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● Adherence to hand hygiene : Alcohol-based hand sanitizers are effective against C . auris , and are the preferred method for hand hygiene when hands are not visibly soiled .
● Transmission-based precautions are applied based on the setting , as with other multi-drug resistant organisms .
● Early identification and susceptibility testing , followed by coordinated communication between laboratory and clinical staff and between facilities is critical when C . auris is identified .
● Meticulous cleaning and disinfection of the patient care environment that is confirmed by increased environmental monitoring in patient care areas .
As we have seen with other pathogens of concern such as C . difficile , these guidelines reinforce the critical role that the environment plays in the transmission of C . auris . Studies have determined that this organism can survive on moist and dry surfaces for up to one month . 3 , 5 Even more challenging , there is evidence that it can survive in both wet and dry biofilms , making it harder to eradicate from the environment once it has been introduced . 6
In 2020 , the CDC created Core Components for Environmental Cleaning and Disinfection in Hospitals . 7 These core components outline an effective environmental hygiene program , and are more important than ever when faced with an emerging pathogen such as C . auris . Let ’ s look at these Core Components and how relate to management of C . auris :
Integrate EVS into the hospital safety culture .
Providing a clean patient environment is a cornerstone of a hospital ’ s safety culture . To prevent transmission of C . auris , frequent communication and collaboration between departments is critical . When patients are diagnosed or admitted with C . auris , the environmental services ( EVS ) department must be promptly notified so that C . auris protocols can be activated .
Educate and train .
When novel pathogens such as C . auris arise , all staff must be educated on the organism , its transmission , transmission-based precautions needed , and specific practices and products that must be incorporated to prevent transmission . Reinforce concepts with ongoing education with new healthcare personnel and as new guidance becomes available .
Select products that are effective against the organisms of concern .
There have been several studies that evaluate the efficacy of disinfectants against C . auris . 8 The Environmental Protection Agency ( EPA ) maintains List P , which includes all EPA-registered antimicrobial products with claims against Candida auris , along with their contact times . 9 Among the active ingredients that are effective are hydrogen peroxide / peracetic acid , dodecylbenzenesulfonic acid ( DDBSA ), hydrogen peroxide and sodium hypochlorite . If products on List P are not accessible or are otherwise unsuitable , interim CDC guidance permits the use of an EPA-registered , hospital- grade disinfectant that is effective against C . difficile . Quaternary ammonium compounds ( QACs ) are widely used as disinfectants in healthcare ; however , data from recently published studies indicates that products whose only active ingredient is QAC are not effective against C . auris . 4 , 10 Regardless of the product selected , it is important to