A New Era: Experiencing Epidemiologically Significant Organisms First-hand

Session Description : A new era is dawning in the world of infection prevention with the rapid emergence of two epidemiologically significant pathogens: Candida auris and New Delhi metallo-beta-lactamase carbapenem resistant organisms. It is becoming increasingly clear that infection preventionists and public health workers must learn how to recognize these pathogens and prevent their transmission in a myriad of settings, including hospitals, skilled nursing facilities, and community settings. These pathogens are extremely transmissible, inherently resistant to treatment, and can be detrimental to patients who acquire infection or colonization.

Our large acute care hospital has had experience with outbreak detection and mitigation involving both Candida auris and New Delhi metallo-beta-lactamase carbapenem resistant organisms. We experienced one outbreak of Candida auris involving a total of 6 patients, 5 of whom were colonized and asymptomatic. We experienced 2 distinct outbreaks of New Delhi metallo-beta-lactamase carbapenem resistant organisms totaling 19 patients involved.

Given the lack of current literature on this topic, a novel surveillance strategy was developed to identify potential transmission events. This was based on location and risk factors. Axilla and groin swabs were performed for Candida auris case finding and rectal swabs were performed for New-Delhi metallo-beta-lactamase case finding.

To prevent further transmission, enhanced contact precautions were enforced. This included an observer for personal protective equipment, logs for all persons entering and exiting the room, and increased environmental cleaning procedures.

Our biggest limitations were lack of established surveillance strategies and inability to whole-genome sequence all isolates. Our microbiology laboratory adapted to identify New-Delhi metallo-beta-lactamase cases as well as Candida auris. We have also implemented a system-wide surveillance strategy for identifying new Candida auris carriers using patient risk factors identified. Sharing our identification, prevention, and mitigation strategies is important to enhance the knowledge of other infection preventionists who do not have experience in this realm.