DJ Shannon MPH CIC Infection Preventionist Eskenazi Health Objectives 2 Understand the importance of Candida auris detection and surveillance Identify global and US dissemination of ID: 774622
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Slide1
Catching up with Candida auris
DJ Shannon, MPH, CIC
Infection
Preventionist
Eskenazi
Health
Slide2Objectives
2
Understand the importance of
Candida
auris
detection and surveillance
Identify global and US dissemination of
Candida
auris
Describe
infection prevention challenges regarding
Candida
auris
Illustrate
appropriate containment strategies for
Candida
auris
Slide33
Background
Candida auris
is an emerging fungus
Often multidrug-resistant
Difficult to identify
Healthcare-associated outbreaks have been reported
Slide4Candida auris is Weird
4
Slide5Phylogeny
5
Slide6Candida Behavior
Candida albicans
6
Candida auris
Not very environmentally persistentEasily identifiedEasily killed with QuatsColonizes the skin, mouth, gut, vagina Causes thrush, bloodstream infections, and candidal vaginitisNot resistantTransmission not typical
Very environmentally persistent
Difficult to identify
Not easily killed
Colonizes the groin and axilla
Opportunistic infections in the blood and other invasive sources
Very resistant
Transmitted in healthcare settings via direct contact
Slide77
Why do we care?
Limited antifungal options
Multiple global introductions
Laboratory
detection
challenges
Slide8Antifungals and Resistance
8
Azoles
Echinocandins
Amphotericin B
Slide9Antifungals and Resistance
9
You can’t touch this
Azoles
Candida
Help us
Echinocandins
You’re our only hope
Slide1010
Multiple Global Introductions
First identified in 2009
Isolates have emerged simultaneously but are genetically differentPublication assessed the genetic relatedness between US isolates and non-US isolates
Slide11Multiple Global Introductions
11
Slide12Multiple Global Introductions
12
Slide13Global Dissemination
13
Adapted from CDC
Data as of July 31, 2019
Slide14US Dissemination
14
Case definitionClinical confirmed:Person with confirmatory laboratory evidence from a clinical specimen collected for the purpose of diagnosing or treating disease in the normal course of careColonized confirmed:Person with confirmatory laboratory evidence from a swab collected for the purpose of screening C. auris colonization regardless of site swabbed
Number of infection cases identified
2309
Number of colonized cases identified
Total number of cases identified
1540
769
Adapted from CDC/CSTE
Data as of July 31, 2019
Slide15US Dissemination
15
Adapted from CDC
Data as of July 31, 2019
Slide16Laboratory Detection Challenges
16
Identification methods can misidentify C. aurisWork with your lab staff to ensure current methodd
Identification MethodOrganism C. auris can be misidentified asVitek 2 YSTCandida haemuloniiCandida duobushaemuloniiAPI 20CRhodotorula glutinisCandida sakeBD Phoenix yeast identification systemCandida haemuloniiCandida catenulataMicroScanCandida famataCandida guilliermondiiCandida lusitaniaeCandida parapsilosisRapID Yeast PlusCandida parapsilosis
Adapted from CDC
Slide17Laboratory Detection Challenges
17
Contact state and local health departments
Adapted from CDC
Slide18Clinical Implications
18
Typically affects those patients who:Have tracheostomiesAre ventilator-dependentAre colonized with other MDROsHave recently received antibiotics and/or antifungalsCan be colonized or have an invasive infection
Slide19Prevention and Control
19
Contact Precautions
Hand Hygiene
Environmental Cleaning
Inter-facility Communication
Colonization Screening
Surveillance
Slide20Contact Precautions
20
Single patient room using contact precautions
If
cohorting
is necessary, place patients with similar MDROs together
Duration of colonization is unknown
Months to indefinite
Slide21Removal of Contact Precautions
21
Wait 3 months since last identificationWait until patient is off antifungal medications for at least one weekWait at least 48 hours after administration of topical antiseptic (e.g., chlorhexidine)Culture the axilla and groinIn addition, culture and sites previously positive (e.g., urine)If positive, remain in contact precautions and re-evaluate in 3 monthsIf negative, wait at least one week and repeat process. Consider removing patient from contact precautions after 2 consecutive negative screenings
Adapted from CDC
Slide22Environmental Cleaning
22
Candida auris is environmentally persistentIdentified on high touch surfaces, windowsills, glucometers, ultrasound machines, code cartsQuats may not be effectiveData is limited for UV and fogging disinfection methodsCDC recommends using an EPA List K disinfectantPublished literature* suggests the following products:Oxivir TbClorox Healthcare Hydrogen PeroxidePrime Sani-ClothSuper Sani-Cloth
*Cadnum, et al., 2018
*Rutala, et al., 2017
Slide23Colonization Screening
23
Who should we consider screening?
Close healthcare contacts
Patients who had an overnight stay in a healthcare facility outside the US
Patients during suspicion of ongoing transmission
Slide24Colonization Screening: Close healthcare contacts
24
Close healthcare contacts include:RoommatesPatients whose care overlapped on the same unit with the index patient for at least three daysHigh acuity patients in the same unitHealthcare facilities should collaborate with public health as needed to conduct colonization screening
Slide25Colonization Screening: International Healthcare
25
Consider screening those patients with an overnight stay in a healthcare facility outside the US in the previous year
Focus efforts on those countries with documented
C.
auris
cases (e.g.,):
India
Kenya
Kuwait
Pakistan
South Africa
United Arab Emirates
Venezuela
Slide26Colonization Screening: Ongoing Transmission
26
If ongoing transmission is suspected, collaborate with public health to conduct point prevalence surveys as needed/recommended
Point prevalence survey: every patient on a unit is screened to detect colonization status
Slide2727
Getting Your Facility Prepared
Slide28Getting Your Facility Prepared
28
Work with environmental services
Identify appropriate
cleaning
agent and cleaning process
Work with lab
Know your identification abilities/challenges and set up appropriate notification from lab to IPC
Establish response process
Isolation/
cohorting
EMR ‘flag’
Educate frontline staff
Know your public
health
contacts
Consider screening high risk patients
Slide29THANK YOU!
DJ Shannon, MPH, CICInfection PreventionistEskenazi Health
Email:
david.shannon@eskenazihealth.edu