Initiation of a Candida Auris Screening Program at a Large, Academic Medical Center

Abstract

Background Candida auris is an emerging, multi-drug resistant, fungal pathogen known to cause facility-wide outbreaks, significant mortality, and is environmentally persistent. Rapid identification and isolation of this fungus prevents it from becoming normal flora in the local community. Methods The screening program began on January 25, 2021, at a large, urban, academic medical center. All patients transferred from high-risk facilities (long term acute care (LTAC), acute care, skilled nursing facilities, and nursing homes) from local counties, were screened for Candida auris. Initial screenings were tested via culture. On March 8, 2021, we began screening with a polymerase chain reaction test, which turned around results within one business day. Collection technique of each screening specimen followed guidance from the Centers for Disease Control and Prevention. Patients were placed on contact isolation until results finalized negative. Education was provided to both the healthcare worker and the patient. Partners within Information Technology were able to automate the screening program so that an alert would fire to the nurse in the Emergency Department or Transfer Center for patients meeting high-risk criteria. Results Screening results between 1/25/21 to 3/7/21 resulted in no positive cultures. Between 3/8/21 – 8/31/21, 195 patients were screened for Candida Auris. Three patients resulted positive, for a rate of 1.5%, over the course of 6 months. All positives had recent history of LTAC residency. These results demonstrated a lack of widespread local community transmission of Candida Auris. Conclusions In collaboration with the state health department, we were able to narrow our screening program to only patients directly transferred from LTAC facilities or resided at LTACs within 60 days, thus reducing the need for isolation, impediments to bed flow, and cost for lab testing, all without sacrificing public health. Candida auris is an emerging, multi-drug resistant, fungal pathogen known to cause facility-wide outbreaks, significant mortality, and is environmentally persistent. Rapid identification and isolation of this fungus prevents it from becoming normal flora in the local community. The screening program began on January 25, 2021, at a large, urban, academic medical center. All patients transferred from high-risk facilities (long term acute care (LTAC), acute care, skilled nursing facilities, and nursing homes) from local counties, were screened for Candida auris. Initial screenings were tested via culture. On March 8, 2021, we began screening with a polymerase chain reaction test, which turned around results within one business day. Collection technique of each screening specimen followed guidance from the Centers for Disease Control and Prevention. Patients were placed on contact isolation until results finalized negative. Education was provided to both the healthcare worker and the patient. Partners within Information Technology were able to automate the screening program so that an alert would fire to the nurse in the Emergency Department or Transfer Center for patients meeting high-risk criteria. Screening results between 1/25/21 to 3/7/21 resulted in no positive cultures. Between 3/8/21 – 8/31/21, 195 patients were screened for Candida Auris. Three patients resulted positive, for a rate of 1.5%, over the course of 6 months. All positives had recent history of LTAC residency. These results demonstrated a lack of widespread local community transmission of Candida Auris. In collaboration with the state health department, we were able to narrow our screening program to only patients directly transferred from LTAC facilities or resided at LTACs within 60 days, thus reducing the need for isolation, impediments to bed flow, and cost for lab testing, all without sacrificing public health.