Candida Auris: A Team-Based Approach to Taming the Wild Yeast

Background Challenging to identify and not easily disinfected, Candida auris (C. auris) is a resistant fungus reported in healthcare outbreaks and exacerbated by the COVID-19 pandemic. An interdisciplinary, multimodal approach may reduce transmission risk. Our aim is to describe our screening protocol and how we streamlined processes in response to this growing public health threat. Methods Hospital Epidemiology (HE) partnered with multiple departments to enhance C. auris infection prevention and control (IPC) processes at a large academic medical center. Targeted admission screening of high-risk patients began in December 2021 with a laboratory developed molecular assay by Microbiology Laboratory using reagents tested on an open diagnostic system. This assay was sensitive, rapid (<24-hour turnaround), and allowed for high-volume testing. Wilcoxon-Mann-Whitney test was used for pre/post comparison. In February 2022, HE worked with Enterprise Information Services to create a real-time email system, alerting HE to admissions, discharges, or transfers. A workflow diagram designated roles and tasks. Results From December 2021-June 2022, 19 patients were identified using the molecular assay (766 screens, 2.5% positivity rate). A total of twenty-four patients were identified with C. auris (any source); 6.5-day median isolation time. This was a significant improvement from before December 2021 where 10 patients were passively identified with a median isolation time of 26.5 days (p-value = 0.0008). From February 2022-June 2022, HE received 48 results and 134 unit-change emails. Upon email receipt, the workflow diagram guided isolation flagging, order entry, public health reporting, and team communication with clinical staff, unit leadership, environmental services, case management, and receiving facilities. Fewer lapses have been reported since implementing new workflows. Conclusions HE continues to support compliance with screening, isolation precautions, environmental cleaning, and provider communication. We hope this slows the transmission of C. auris in our community and can be applied by facilities facing similar challenges. Challenging to identify and not easily disinfected, Candida auris (C. auris) is a resistant fungus reported in healthcare outbreaks and exacerbated by the COVID-19 pandemic. An interdisciplinary, multimodal approach may reduce transmission risk. Our aim is to describe our screening protocol and how we streamlined processes in response to this growing public health threat. Hospital Epidemiology (HE) partnered with multiple departments to enhance C. auris infection prevention and control (IPC) processes at a large academic medical center. Targeted admission screening of high-risk patients began in December 2021 with a laboratory developed molecular assay by Microbiology Laboratory using reagents tested on an open diagnostic system. This assay was sensitive, rapid (<24-hour turnaround), and allowed for high-volume testing. Wilcoxon-Mann-Whitney test was used for pre/post comparison. In February 2022, HE worked with Enterprise Information Services to create a real-time email system, alerting HE to admissions, discharges, or transfers. A workflow diagram designated roles and tasks. From December 2021-June 2022, 19 patients were identified using the molecular assay (766 screens, 2.5% positivity rate). A total of twenty-four patients were identified with C. auris (any source); 6.5-day median isolation time. This was a significant improvement from before December 2021 where 10 patients were passively identified with a median isolation time of 26.5 days (p-value = 0.0008). From February 2022-June 2022, HE received 48 results and 134 unit-change emails. Upon email receipt, the workflow diagram guided isolation flagging, order entry, public health reporting, and team communication with clinical staff, unit leadership, environmental services, case management, and receiving facilities. Fewer lapses have been reported since implementing new workflows. HE continues to support compliance with screening, isolation precautions, environmental cleaning, and provider communication. We hope this slows the transmission of C. auris in our community and can be applied by facilities facing similar challenges.