Hospitals prevent deadly fungal infection during pandemic

As COVID-19 infections threatened to overwhelm hospitals in March 2020, infection control specialists worried not just about SARS-CoV-2 but also about other viral, bacterial and fungal diseases.

C. auris is a type of fungus that causes severe, often fatal infections and is resistant to most antifungal drugs. It can be carried on a patient’s skin and can survive on surfaces for more than a month, allowing it to spread easily among patients. Most hospital disinfectants cannot kill C. auris, making it difficult to eradicate from the healthcare environment. It is also easy to misidentify in lab tests.

In the midst of the COVID-19 pandemic, infection control experts at two Southern California hospitals – Scripps Memorial in La Jolla and UCLA Health in Los Angeles – took extreme measures to stop the spread of a deadly fungus. Their findings were shared at the Association for Professionals in Infection Control and Epidemiology’s (APIC) 48^th annual conference.

During the initial influx of COVID-19 patients, Dr Elizabeth A. Jefferson of Scripps Memorial was notified that her facility had received the first known case of C. auris in San Diego County. Initially flagged and isolated because the patient had received healthcare abroad, laboratory tests confirmed C. auris in a wound.

The patient remained hospitalised in isolation for 47 days, during which time the team implemented aggressive cleaning measures, including use of a disinfectant that was effective against C. auris and UV light for terminal cleaning of all patient rooms.

‘Education of staff was essential,’ said Dr Jefferson. ‘Staff had to clean and disinfect the room twice a day, and then clean any shared equipment, because if Candida auris sets up shop in your facility, it is extremely difficult to get rid of.’

As a result, there was no transmission of the fungal pathogen that has infected nearly 1,800 patients in 15 states and the District of Columbia since it was first detected in the U.S. in 2015.

When C. auris started to surge in Southern California during the summer of 2020, UCLA Health had already created a multi-level notification system designed to catch potential cases early and prevent transmission.

Collaborating with their electronic medical records (EMR) team and the lab, the infection preventionists made sure the EMR system was set up to screen every patient for both COVID and Candida auris when they entered the facility.

High-risk patients were flagged and tested with subsequent notifications sent to infection prevention, environmental services, the lab, and nursing. The system triggered reminders for stringent cleaning protocols which included testing of environmental surfaces after terminal cleaning to ensure that the patient’s room was clear of the organism.

‘Having an in-house lab that could test for C. auris and collaborating with the EMR team to build a set of screening steps into our EMR created a failsafe way to ensure we could monitor and track any suspected C. auris cases at our facility. This process was effective in prevention of cross contamination in the healthcare environment,’ said Dr Urvashi Parti, at UCLA Health.

‘The fact that these two teams recognised this threat and were able to mobilise so quickly and effectively while also on high alert for COVID is remarkable,’ said APIC 2021 President Ann Marie Pettis, ‘Their case studies demonstrate how important it is that hospitals, clinics, and long-term care facilities have enough infection preventionists and resources to train staff and monitor safety protocols so they can prevent harm on multiple fronts.’