In an endeavor to enhance its infection control protocols, a hospital in New York has broadened the scope of its screening mechanism for the Candida auris fungal pathogen. This proactive move came about after a patient, initially classified as low-risk and admitted from a skilled nursing facility (SNF), tested positive for C. auris, two months post-admission. On extending the screening protocol, researchers were able to identify additional infections, which would likely have been overlooked with the previous screening norms.
C. auris is a formidable fungal pathogen, first discovered in Japan in 2009. Within a span of just two years (2011-2013), it concurrently emerged across three continents – Africa, Asia, and South America. The insidious spread and potency of C. auris in healthcare settings mandate swift detection, as hospitals could be contaminated within hours of treating colonized patients. In fact, studies indicate the efficacy of C. auris screening programs along with standard infection control practices in forestalling outbreaks. However, a recent survey revealed that less than 50% of healthcare institutions have introduced C. auris screening protocols.
The patient in question was brought to Mount Sinai Brooklyn from an SNF that catered to patients with C. auris infections and received treatment for 70 days prior to their official hospital admission. The hospital initially refrained from screening the individual for the fungal pathogen, as the patient failed to meet high-risk criteria. Post testing positive, contact tracing identified 118 possible contacts exposed either to the patient or equipment used by the individual. An additional 8 patients were found to have been colonized.
Facility-wide measures were taken to ensure that the C. auris exposure did not extend from these eight infected patients. Subsequent to these discoveries, Mount Sinai Brooklyn decided to augment its screening protocol to include any patient residing in an SNF.
Two distinct phases of the study conducted at the hospital validated the efficacy of extended screening. During the first phase (Jan 1, 2022 – Sept 30, 2022) prior to protocol enlargement, the high-risk category constituted patients with a tracheostomy or ones ventilator-dependent and hosted at an SNF within the previous 30 days or those directly admitted from these facilities, the hospital screened 34 patients, of which two (5.9%) tested positive. Comparatively, the second phase (Oct 1, 2022 – Sept 30, 2023) witnessed screening of 557 patients with all patients being admitted to the hospital from an SNF, identified 12 colonized patients (2.2%).
Additionally, prolonged analysis revealed that of the total of 137 patients transferred to the hospital from a ventilator-capable SNF during the complete study period. 51 (considered high-risk during both study phases) of these patients had a tracheostomy or needed a ventilator, nine (17.7%) were colonized. Among the 137 patients, 111 successfully met the phase 1 screening standards while 26 were screened based on the revised protocol. The latter group saw two colonizes (7.7%) with the fungus.
Concluding the study, researchers opined that all medical institutions must earnestly consider implementing standard C. auris screening protocols, particularly for patients with a recent stay or direct transfer from SNFs and more importantly in locations where C. auris has been officially detected. The lead author of the study, Scott Lorin, MD, president of Mount Sinai Brooklyn, affirmed that their expanded screening procedures have significantly enhanced patient safety by detecting infections among patients who were previously missed.
Tags: infection control, healthcare, C. auris, hospital protocol