385. The Value Added From Candida auris Point Prevalence and Environmental Studies in New York State

Abstract

BackgroundAs of March 25 2018, 151 clinical cases of C. auris were diagnosed in NYS. We conducted point prevalence surveys (PPS) and environmental surveys (ES) to detect surveillance cases and assess the burden of environmental contamination in NYS healthcare facilities from September 12, 2016.MethodsA PPS was defined as culturing ≥2 individuals at a healthcare facility that diagnosed, cared for, or was near a facility with a C. auris case. ES involved environmental swabbing in facilities where cases resided or were admitted. Cultures and polymerase chain reaction (PCR) were performed at the NYS Wadsworth Center.ResultsAs of March 25, 2018, 81 PPS or ES had been conducted at 55 facilities. From these PPS, a total of 144 (6.1%) individuals were positive for C. auris by culture; 125 were PCR positive. The rates of culture positive C. auris identified patients varied by facility type: hospitals (38/767, 5.0%), long-term care facilities (LTCF) (88/1,404, 6.3%), long-term acute care (1/35, 2.9%), and co-located hospital and LTCF (17/138, 12.3%). The majority of the LTCF C. auris culture-positive cases (80/82) were identified in facilities that cared for ventilated patients. Rates in LTCF caring for ventilated patients were nearly 10 times as high as other LTCF [86/1,121 (7.7%) vs. 2/284 (0.7%)]. ES identified 86 (3.0%) samples positive by culture and 257 (8.9%) by PCR. Thirty-seven (67%) of the 55 facilities had at least one positive environmental sample by PCR or culture; many of these positive samples were from surfaces or equipment deemed to be “clean.” Over 1,900 person-hours were needed to conduct onsite PPS and ES that collected >4,200 human and >2,800 environmental samples and identified opportunities for improving basic infection prevention and environmental cleaning. Ten facilities, including the co-located hospital and LTCF, had multiple positive PPS or ES.ConclusionPPS conducted over 17 months detected many colonized individuals and C. auris in facility environments, likely indicating a silent reservoir for this organism beyond clinical cases, especially in LTCFs. Serial PPS and ES can help improve C. auris detection and inform subsequent infection prevention and control interventions. However, these efforts are resource intensive and can divert resources from other activities.Disclosures All authors: No reported disclosures.