Should states publicize names of hospitals that have treated patients with C. auris?
Last year, New York became the first state to publicly name hospitals that have treated patients with C. auris, causing consternation among some experts.
Infectious Disease News asked Dana Mazo, MD, MSc, assistant professor of infectious diseases at Icahn School of Medicine at Mount Sinai, hospital epidemiologist at Mount Sinai Queens and member of the Infectious Disease Society of America, if this is a good idea.
Like all health care decisions, we need to weigh the benefits and risks of public reporting of facilities with patients infected with C. auris. Early in an outbreak, the risks are likely to outweigh the benefits.
The intended benefit of public reporting is to give patients information so that they can make informed health care choices. Patients want to know at which hospitals they would be at higher risk for contracting C. auris. Public reporting of facilities that have patients with C. auris, however, is unlikely to provide that information, especially early in an outbreak.
Presumably, patients would conclude that facilities included on a public reporting list would have a higher risk for transmission, but this may not be true. Facilities that do not report C. auris cases may have unidentified cases or may not be as comfortable with C. auris precautions procedures. Not all clinical labs have the ability to accurately identify C. auris and not all labs are looking for it by speciating all Candida or screening for C. auris colonization. In addition, most processes improve with repetition, so facilities with multiple C. auris cases are likely to do a better job of following precautions to prevent C. auris spread. Therefore, risks of contracting C. auris infection may actually be lower at facilities known to have cases.
Although the benefits are unclear, there are real risks to reporting if the public misunderstands a facility’s inclusion on the list to mean a greater risk for contracting C. auris. Patients who are sick may mistakenly avoid specific institutions, even if the facility would be the best place for them to receive care. If patients start avoiding institutions included on the public reporting list, facilities may begin to refuse transfer of known patients with C. auris. This behavior could prevent patients with C. auris from receiving the care they need, whether it is a procedure performed only at a tertiary care center or rehabilitation services at a skilled nursing facility.
The New York State Department of Health released a list of affected facilities 3 years into the outbreak in New York City. At this point, the list included the vast majority of hospitals in New York City, including several within the Mount Sinai Health System.
By this stage in the outbreak, there may be a benefit of public reporting to reassure patients that the expertise to handle patients with C. auris is available throughout the city. The existence of the list would also minimize the risks to patients because there were too many facilities to avoid. The impact of the list would have been different if it were released earlier in the outbreak.
Disclosure: Mazo reports no relevant financial disclosures.
Click here to read the Cover Story, “C. auris endures, raising questions about surveillance, reporting.”