Key takeaways:
- Despite treating two patients with C. auris, a Tennessee dialysis facility saw no transmission to other patients.
- Standard infection prevention efforts were enough to detect colonization and prevent spread.
Standard infection prevention and control procedures prevented the spread of Candida auris at a Tennessee dialysis facility despite two patients there being colonized for up to 4 months during treatment, researchers reported.
C. auris was first reported in the United States in 2016 and has emerged as an important cause of hospital outbreaks. Cases in the U.S. increased 59% from 2019 to 2020 and 95% from 2020 to 2021, during which time 17 U.S. states identified their first cases of the fungal infection. The first C. auris cases in Tennessee were detected in 2021.
Two patients colonized with C. auris were treated at a Tennessee dialysis facility for up to 4 months without further transmission. Image: Adobe Stock
According to a study presented at the Society for Healthcare Epidemiology of America Spring Conference, it can be difficult for specialized outpatient health facilities like dialysis facilities to prevent C. auris transmission because patients are medically vulnerable, treated frequently and are difficult to isolate.
One Tennessee dialysis center found it had been treating a patient for 1 month before learning the patient was colonized with C. auris. Screening revealed that another patient colonized with C. auris had been receiving treatment for 4 months, unbeknownst to the facility.
“This facility was following their basic infection control practices that are expected of a dialysis facility, such as bloodborne pathogen control,” Carolyn Stover, MPH, CIC, CPH, codirector of the Tennessee Department of Health’s hospital-associated infections and antimicrobial resistance program, told Healio.
After the first patient was identified, the Tennessee Department of Health conducted two containment-driven screenings to determine if anyone else had been colonized.
According to Stover, the patient’s colonization status was unknown due to a breakdown in communication between the acute-care hospital where they had previously been treated and the dialysis facility.
Health department investigators conducted an initial point prevalence survey (PPS) to assess for ongoing transmission at the facility, which prioritized screening for a group of 12 patients who received dialysis at the same time as the index patient. Among these patients, one additional person tested positive for C. auris but was determined to be a known colonized patient whose status also had not been communicated to the facility.
The screening was then broadened to include 11 patients who received dialysis directly before the index patient was treated, at the request of the 11 patients.
A second PPS was conducted 7 weeks later, targeting the same two groups of patients, and no additional positives were detected.
Stover said dialysis facilities in many states refuse to treat patients with a history of C. auris colonization because they are worried about transmission. This study, however, suggests that adhering to standard infection prevention standards is good enough to prevent C. auris transmission, she said.
“This was a testament to their standard infection prevention control practices — doing them well and adhering to them, they were able have a C. auris patient and not have any transmission,” Stover said.
Sources/Disclosures
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Kurutz A, et al. Abstract 26. Presented at: Society for Healthcare Epidemiology of America Spring Conference; April 16-19; Houston.
Disclosures:
Stover reports no relevant financial disclosures.
