DS 37 - The Role of Cleaning and Disinfection in the Prevention of Ongoing Candida Auris Transmission in a Surgical Intensive Care Unit

Background: Candida auris (C. auris) is an emerging multidrug-resistant fungal pathogen that spreads easily between hospitalized patients. Research shows that C. auris can contaminate the environment and survive on hospital surfaces for over two weeks. We describe an epidemiological investigation to limit spread and curb transmission of C. auris in a surgical intensive care unit (SICU).

Methods: After identification of a hospital acquired C. auris bacteremia on November 20, 2022, three rounds of point prevalence screening (PPS) were performed on potentially exposed patients in the SICU. The medical record was flagged for discharged patients that had contact with a C. auris case or potentially contaminated room to alert staff to screen upon readmission. In partnership with public health, an infection prevention risk assessment of the SICU was performed. A line list displaying room locations and risk factors was created.

Results: PPS was conducted from November 29, 2022 to December 20, 2022 and revealed an additional 3 positive patients out of 60 screened. An additional case with a link to the SICU was identified through public health. Two flagged patients screened positive when tested upon readmission. The infection prevention risk assessment revealed lapses in cleaning and disinfection practices. In total, 6 additional colonized patients were implicated in the outbreak investigation with 5 consecutive patients linked to one SICU room. Admissions to the room were halted while a protocol was established which emphasized removal of all disposable items, disinfection using an Environmental Protection Agency List P disinfectant, use of an electrostatic sprayer, and changing cubicle curtains upon discharge.

Conclusions: Ongoing C. auris transmission can occur when effective cleaning and disinfection practices are not followed. To prevent contamination of the environment and spread of C. auris, it is critical that all staff, including environmental services, are educated on proper cleaning and disinfection methods.