Preventing a Candida Auris Outbreak in the Health Care Setting

Although the emerging Candida auris (C auris) fungal infection is still relatively rare in terms of incidence rates, when it occurs in the health care setting, it can quickly take hold and become an outbreak if infection prevention measures are not taken.

So, when infection preventionists (IP) at UCLA were informed of C auris outbreaks on the east coast of the United States, they jumped at the opportunity to take a proactive approach to ensuring that if their health care facilities saw the infection, they would be prepared with strategies and protocols in place.

Shaunte Walton, MS, CIC, Health System Director of Clinical Epidemiology & Infection Prevention at UCLA Health and Urvashi Parti, MPH, infection preventionist at UCLA Health are part of a team that began by meeting with stakeholders and leadership to discuss how they wanted to proceed.

This type of initiative required a paradigm shift going from reactive medicine to proactive. At that point in time, the west coast was not experiencing any outbreaks.

And addressing Candida auris in a health care setting is a massive undertaking between diagnostics, cleaning protocols, and the buy-in from leadership to invest in implementing hygiene measures.

“We were very fortunate at UCLA Health to have senior leaders who supported this process,” Walton stated.

One of the things the IP team implemented was a Candida auris risk assessment in the admissions screening. “This screening is completed at both the UCLA Health facilities so that is Ronald Reagan UCLA Medical Center and Santa Monica Medical Center,” Parti said. “The screening includes high risk factors for C auris.”

The IP team collaborated with other teams such as the EMR team to set up the system to flag high-risk patients, have these patients tested appropriately, and subsequent notifications sent to infection prevention, environmental services, the lab, and nursing staffs. The system also places a hold in a C auris patient’s chart prior to discharge or transfer to enable communication with the health department and receiving facilities about the patient's C auris status.

The EMR system triggers reminders for cleaning protocols which include testing of environmental surfaces after terminal cleaning to ensure that a patient's room is clear of the organism.

In addition to the risk assessment screening and EMR-related strategies, the IP team provided education to the clinical teams on emerging organisms and high-risk factors to be aware of, how to handle if a patient with high-risk factors comes to the facility, isolation protocols and procured the appropriate disinfectants to clean this difficult fungal infection.

And when C auris began surging in Southern California in March of 2020, the UCLA team felt they were prepared to deal with the emerging infection if they saw it at their facilities.

In the ensuing months, California has seen the third highest number of C auris cases in the US behind only New York and Illinois. According to the US Centers for Disease Control and Prevention, the state has had 187 clinical cases between June 1, 2020 and May 31, 2020.

Since July 2020, UCLA Health has tested 52 patients for C auris with 11 positive results. These patients were placed in isolation to prevent transmission. With their protocols in place, UCLA Health was able to prevent hospital acquired Candida auris infections at their facilities.

Contagion spoke with Walton and Parti about some of the specific protective measures in place, the differences in infection prevention in COVID-19 and C auris, and shared some of the resources they relied on for guidance and best practices.