Presented at 2023 APIC Annual Conference

Background: Candida auris (C. auris) is a drug-resistant fungus that can spread easily between hospitalized patients and nursing home residents. To mitigate risk of C. auris spread, a nine-hospital healthcare system developed a C. auris screening tool in January 2020. Infection Preventionists (IPs) use the screening tool to determine which patients qualify for C. auris screening, looking specifically at the facility type where the patient came from. The IP then initiates the isolation and testing protocol with the bedside nurse and provider.

Methods: Over the course of three years, the hospital epidemiologist collected data on all screening events, such as date of lab testing and results, location of residence, and history of other multidrug resistant organisms (MDROs) to evaluate, educate, and report on the screening process. Epidemiological surveillance data were evaluated using pivot tables to identify possible epidemiological trends.

Results: Data analysis revealed three out of the thirty-five facilities had residents who tested positive for C. auris. Of the three facilities, all were skilled nursing facilities (SNFs), two of which provide ventilator care (v). The SNFs were de-identified with new labels – vSNF1, vSNF2, and SNF. Of the three facilities found to have C. auris positive residents (n=88), 3.4% (3/88) came from vSNF1, 5.7% (5/88) and 2.3% (2/88) were from vSNF2 and SNF, respectively. Outbreak clusters emerged from the pivot table using screening dates, which were organized into yearly quarters. The first two clusters occurred at the SNF and vSNF2 facilities during the same timespan from 2021Q2 to 2021Q4. No additional screens resulted positive in 2022 for both facilities. The third cluster occurred between 2022Q3 to 2022Q4 at vSNF1.

Conclusion: Receiving a positive C. auris result allows the IP department to promptly reach out to the facility where the patient came from and begin assisting with intervention needs and staff education, if requested. Additionally, all positive results are reported to the state department of health, who also duly assists with control measures necessary to mitigate risk and prevent future outbreaks.

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