EOC 67 - Candida Auris Mitigation in an Oncological Intensive Care Unit Setting

Background: Candida auris is an emerging multidrug-resistant fungus associated with outbreaks in healthcare settings. Chronically ill patients can become colonized with C. auris with subsequent transmission to other patients and contamination of the healthcare environment where it persists on high-touch surfaces. Following identification of a clinically infected patient with biliary drains in the intensive care unit (ICU) and a patient newly positive on surveillance screening, an investigation was initiated starting with environmental culturing.

Methods: After completion of a literature review, high-touch surfaces inside the patient room and shared mobile equipment housed in the ICU were identified and swabbed. Polyurethane sponges with a neutralizing buffer were used to sample the environment and subsequently cultured on selected liquid media. Media that appeared cloudy were then tested for qualitative reverse transcription-polymerase chain reaction (RT-PCR) detection of C. auris.

Results: Five environmental swabs resulted as culture positive for C. auris: patient bed panels, an equipment tower behind the patient bed, the inside of a supply drawer, a line procedure cart housed on the unit, and a pupillometer. While awaiting results, a third case with recent ICU admission was identified on surveillance screening. Infection Prevention and Control coordinated thorough cleaning of all patient rooms and shared equipment in the ICU with stakeholders whose teams are responsible for cleaning and disinfection with bleach. Bleach cleaning was continued until negative environmental cultures were obtained from implicated areas.

Conclusions: Existing literature and evidence have identified that ambiguous cleaning responsibility has led to outbreaks of pathogens that can remain in the environment for long periods of time. This investigation found that a patient with drains who is infected with a C. auris can create increased opportunities for cross-contamination. Prompt response must be coordinated across multidisciplinary groups to permit cleaning, re-education, and reconciliation of equipment responsibilities.