Memorial Hermann Hospital, with locations in Houston, Texas and Texas Medical Center, has effectively curtailed the spread of the notorious and emergent multidrug-resistant fungus, Candida auris (C auris), by implementing an innovative and targeted isolation and screening protocol. This strategic approach shows promise in enhancing patient safety by minimizing exposure to healthcare-associated infections.
C auris poses a virulent threat to public health, given its resistance to conventional antifungal treatments and its tenacious persistence on surfaces. C auris cases have seen an alarming spike, particularly in the past two years necessitating novel healthcare strategies for its containment.
LaRhonda Daniels and Marco Medina, infection preventionists at Memorial Hermann Hospital in Houston and Texas Medical Center respectively, presented a poster on the adopted protocol at the 2024 Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference & Exposition. The presentation, titled “Implementation of Admission Screening for Candida auris to Prevent Exposure and Spread,” proposed the novel protocol as a feasible response to the escalating C auris crisis.
Under the protocol, patients showing high-risk factors and admitted to the medical intensive care unit (ICU) underwent a physician-ordered groin swab culture for C auris. High-risk factors included previous care within the past year at a long-term care or rehabilitation facility, medical treatment abroad, or a previous history of C auris infliction. These high-risk patients were then placed in isolation, thus significantly mitigating the need for extensive surveillance investigations suggested by the CDC.
With guidance from the chief epidemiologist and the Centers for Disease Control and Prevention (CDC), procedures were established to monitor screening criteria, environmental cleanup, and isolation precautions. With the steadily escalating number of C auris cases in the community and healthcare facilities, rapid response to prevent further spread within the hospital was crucial.
The primary goal of the initiative was to prevent any outbreak of C auris within the hospital premises. The team developed comprehensive educational materials underlining the importance of personal protective equipment (PPE), environmental cleaning, and rigorous surveillance to prevent future outbreaks. An effective screening process was piloted in several high-risk units, and by October 2023, an automated admission screening process utilizing the electronic medical record (EMR) system was put into operation.
The manual screening process, in place from January to March 2023, led to the collection of 820 screening cultures, unearthing 17 positive cases. By promptly isolating, this process successfully curtailed potential exposure to other patients. The automatic screening, active between October 2023 and March 2024, collected 300 cultures and identified 10 positive patients. The automation and proactive contact precautions potentially prevented almost 650 additional follow-up swabs.
It became evident from the manual procedure that regular surveillance remained critical to gauge the extent of the spread and implement proper isolation strategies. The automatic procedure underscored issues in disseminating education and compliance, suggesting a need for ongoing reeducation and notifications to target high-risk individuals.
Through the careful execution of targeted screening and isolation protocols, Memorial Hermann Hospital has demonstrated remarkable success in preventing the spread of Candida auris. By promptly identifying and isolating at-risk patients upon admission, the potential for hospital outbreaks has been significantly curtailed. The integration of automated screening tools into the EMR system, along with comprehensive physician and staff education, has further streamlined the process, providing a robust, replicable model for other healthcare facilities grappling with similar challenges.
Memorial Hermann Hospital’s strategy exemplifies the profound potential of targeted infection prevention measures in safeguarding patient health and impeding the spread of healthcare-associated infections.