Q&A: Lessons from America’s C. auris outbreaks
As cases of Candida auris continue to occur in the United States, facilities are learning what measures are needed to improve their readiness for, and response to, the aggressive and naturally resistant fungus.
Almost 1,600 clinical cases of C. auris were reported in the U.S. as of Nov. 30, 2020, and screening identified an additional 3,172 colonized patients, according to tracking by the CDC.
A recent study published in Infection Control & Hospital Epidemiology explored the challenges faced by health care facilities that have experienced C. auris cases and outbreaks in an effort to better prepare facilities that have yet to see a case.
For the study, Diane Meyer, MPH, managing senior analyst at the Johns Hopkins Center for Health Security and research associate at the Johns Hopkins Bloomberg School of Public Health, and colleagues conducted qualitative interviews in health departments, long-term care facilities, acute-care hospitals and health care organizations in New York, Illinois and California — three of the hardest-hit states. They interviewed 84 health care workers who had experiences either preparing for or responding to C. auris.
The interviews revealed key themes, including surveillance and laboratory capacity, interfacility and intrafacility communication, infection prevention and control (IPC), environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma.
Healio spoke with Meyer about the study and how facilities can better prepare for C. auris outbreaks and other infections that could cause similar problems.
Healio: How did you determine who to interview?
Meyer: Individuals interviewed were from states that had experienced large numbers of C. auris cases, including New York, California and Illinois. They all had been involved in efforts to prepare for or respond to cases and outbreaks of C. auris, including in acute-care and long-term care facilities. They were a multidisciplinary group and included infectious disease physicians and nurses, environmental services, emergency managers, epidemiologists and others.
Healio: What challenges did the interviews identify?
Meyer: The interviewers discussed a variety of different challenges in preparing for and responding to C. auris, including the lack of laboratory capacity to test for C. auris, how to balance the need for surveillance with the capacity to isolate those identified as positive, how to best communicate patient’s C. auris colonization status with other facilities and how to ensure proper IPC to prevent nosocomial transmission.
Healio: What lessons have health care facilities that have experienced C. auris learned?
Meyer: One of the most important lessons that facilities conveyed was that the key to prevention of C. auris outbreaks is “bread and butter infection control.” Additionally, environmental service team members are critical members of the patient care team and facilities must ensure that they are supporting these team members in terms of adequate staffing, education and training so that they can help prevent nosocomial spread.
Healio: How can facilities that have not identified C. auris be better prepared for potential cases?
Meyer: Again, I think it all goes back to proper IPC, as well as strong surveillance systems. We need to make sure that health care facilities have the staff, education, training and supplies needed to protect their patients. Additionally, having a strong multidisciplinary team or task force (including lab, infection control, hospital epi, infectious diseases experts, nursing, EVS, perhaps even public affairs) are essential in planning ahead and developing any specific guidance or policies.
Healio: Besides C. auris, which other important health care infections could raise similar challenges?
Meyer: You could draw many parallels between some of the challenges noted by our interviewees and other multidrug-resistant organisms, as well as other infectious disease outbreaks such as COVID-19. Again, poor IPC practices or a lack of efficient planning and operational considerations can put vulnerable residents at risk of infection and increased morbidity and mortality, particularly in long-term care facilities. It is imperative that we identify ways to improve IPC measures, including staffing and training, within these facilities to prevent further outbreaks.
We thought C. auris was useful to study because it is a relatively new organism for which little was initially known, which created challenges in communicating about public health risk and raised questions about how best to disinfect, control transmission and so on and for which there were limited resources to test and otherwise respond. So, it was an interesting proxy for studying issues that might arise with other newly emerging infections.