QAPI 117 - An Automated Screening Strategy to Identify and Isolate High-risk Patients with Candida Auris Colonization upon Admission to Hospital

Background: Candida auris (CA) infection causes high mortality in frail population. CA is also easily transmissible, causes prolonged colonization, and is difficult to eradicate from the contaminated environment. This can lead to outbreaks of infection in healthcare facilities. We therefore sought to develop and validate a process to automatically and rapidly identify and isolate patients colonized with CA.

Methods: CA screening program was implemented in February 2022 at our 4-campus hospital system. We targeted patients who have resided within the past 90 days in nursing homes (NH), skilled nursing facilities (SNF), long term acute care facilities (LTAC) and inpatient rehabilitation centers (RHC).
The following process was developed: (i) patients were identified at the time of admission registration based on arrival from the above high-risk facilities; (ii) unique admission order sets were automatically loaded into EPIC electronic medical records (EMR); (iii) the order set placed the patient in transmission-based isolation precautions and ordered the staff to swab the axilla and groin for CA polymerase chain reaction (PCR) test at our microbiology laboratory; and (v) isolation was discontinued with negative result (available within 24 hours), patients with positive result were flagged in EMR with CA CONFIRMED status and continued isolation precautions indefinitely.

Results: Over a 21-month period, 3508 high-risk patients were identified upon admission; the number tested/month rose steadily. NH, RHC, SNF and LTAC accounted for 82.6%, 7.1%, 7%, and 3.2% patients, respectively. Ninety-five (2.7%) patients were colonized, the rates for these facilities were 2.4%, 1.6%, 2.9% and 11.5%, respectively. Presumed hospital acquired (and not present on admission) CA infection occurred in only 2 patients.

Conclusions: A comprehensive, automated and rapid system to identify and isolate high-risk patients was highly successful in preventing outbreaks of CA infections among hospitalized patients.