QAPI 133 - Implementation of Admission Screening for Candida Auris to Prevent Exposure and Spread

Background: Candida auris (C. auris) is a threatening multi-drug resistant invasive fungus, commonly resistant to antifungal drugs and difficult to eliminate on surfaces. Clinical cases of C. auris have increased in the past five years; a significant increase has been reported in the past two years. Due to increased prevalence in the community resulting in active cases within a healthcare system, admission screening and isolation was implemented to prevent exposure to patients and possible spread throughout a hospital.

Methods: Due to the patient population, patients admitted into a medical intensive care unit (ICU) with high risk factors received a physician-ordered groin swab culture for C. auris. High risk factors included: care within the past 12 months at a long-term or rehabilitation facility, healthcare from another country, or a medical history of C. auris. These patients were placed on contact isolation to reduce the need to conduct the Center of Diseases Control and Prevention’s (CDC) recommended surveillance investigation. Negative results removed isolation precautions. Positive results initiated enhanced contact isolation, requiring one to one nursing, and special environmental cleaning.

Results: More than thirty patients were screened upon admission between April to May. The admission screening prevented hundreds of potential exposures and surveillance testing of patients in units with a newly identified positive patient. This allowed laboratory services to provide quicker results and less burden on clinical staff. After continued observance of increased cases of C. auris, the screening questions were implemented for all ICU admissions.

Conclusions: Due to the success of identifying patients with risk factors for C. auris on admission, an automatic screening tool in the electronic medical record was implemented for a whole hospital system. Physicians and staff were educated to use the screening tool. Admission screening for C. auris has reduced exposure and spread, ultimately, keeping our patients safe.