HospitalsOctober 30, 2019

C. auris on the Rise: Keeping a Watchful Eye on the Emerging Pathogen

by David St. Clair, Chairman and CFO, Halosil International

In October, a single introduction of Candida auris (C. auris) in a southern California healthcare facility led to over 180 colonized patients across three long-term acute care hospitals (LTACH) and six skilled nursing facilities with ventilator units. Like many outbreaks of the deadly fungal infection, the cause was linked back to uncovered gaps in disinfection practices. This marks just one of a series of U.S. cases of C. auris in recent months, which made headlines earlier in the year as an emerging pathogen, although records have traced cases back to as early as 1996 in South Korea.

The reason for the rising awareness of Candida auris is twofold. First, it is highly difficult to treat—with 90% of C. auris infections antibiotic resistant to at least one drug, and 30% to two or more drugs—and deadly, leading to invasive disease in 5-10% of patients and carrying a mortality rate of >45%. Second, C. auris pathogens are difficult to eradicate from surfaces and equipment. For instance, a number of common disinfectants like quaternary ammonium compounds (QACs) have proven inadequate when attempting to eradicate them from hospital rooms that house infected patients. In fact, some hospitals have had to resort to removing ceiling tiles and flooring to combat the deadly fungus.

Due to these factors, effectively eliminating C. auris spores from environments relies on a two-step process:

Step 1: Identify Cases of C. auris Promptly

One of the challenges of heading off C. auris pathogens before they spread is that it is difficult to identify cases with standard lab methods. As such, researchers have outlined key risk factors for contracting the pathogens that healthcare professions should look out for. These include long-term acute care hospitalizations, colonization with carbapenemase-producing organisms (CPOs), and hospitalization abroad. Keeping these risk factors in mind, health officials have outlined four surveillance strategies that can lead to early detection: 1) species identification of yeast from urine cultures from LTACHs; 2) screening patients with a CPO and hospitalization abroad; 3) LTACH C. auris point prevalence surveys; and 4) admission screening in acute and long-term care settings.

These surveillance efforts should be especially leveraged in environments that have been identified as high-risk or that have already experienced C. auris outbreaks. Recently, the New York Times pinpointed hospitals and nursing homes as prime breeding grounds for C. auris pathogens, which can likely be attributed to the close and confined quarters in which patients are kept and come into contact with infected surfaces and individuals. Since these healthcare facilities house vulnerable individuals who are already sick with other conditions or diseases, C. auris pathogens are able to be easily contracted via patients and surfaces. Nursing homes in New York alone have identified 396 infected individuals, and 496 that are carrying the germ without showing symptoms. In Chicago, 50% of patients living on dedicated ventilator floors in skilled nursing homes are infected with or carrying C. auris pathogens on their bodies.

Step 2: Implement an Effective Whole Room Disinfection Strategy

Once an outbreak of C. auris is identified, it is critical to isolate and disinfect the rooms, surfaces, and equipment that are contaminated with pathogens. These high-risk areas include bedside tables, bedrails, radiology, and physical therapy areas, while high-risk surfaces include mobile equipment, glucometers, temperature probes, blood pressure cuffs, ultrasound machines, nursing carts, and crash carts.

However, when it comes to eliminating C. auris pathogens, not just any disinfectant will do. C. auris pathogens have proven themselves to be so resistant, they can persist on surfaces and people for extended periods of time. That said, common disinfectants like QACs have demonstrated an inability to eliminate C. auris in the recommended routine disinfections. As such, the Centers for Disease Control and Prevention (CDC) has advised healthcare facilities to rely on sporicidal disinfectants registered under the EPA to eliminate C. difficile. While List K outlines a number of approved solutions, only dry fogging disinfection solutions eliminate the potential of human error that occurs when spray-and-wipe disinfectants are leveraged, ultimately reaching all of the spores lurking in cracks and crevices.

Keeping Pace with C. auris Pathogens

Better than turning to a whole room disinfection system only when active cases of C. auris are identified is disinfecting high-risk areas to the highest possible efficacy before outbreaks occur. That’s why leading healthcare facilities use HaloMist™—an dry-fogging disinfectant on the EPA’s List K—to disinfect stubborn pathogens like C. diff. By leveraging a proprietary hydrogen peroxide and silver ion-based formula, deployed via our HaloFogger^®, HaloMist™ eradicates pathogens like C. auris to achieve the highest possible standard for whole room disinfection on the market today.

Ready to eliminate C. auris pathogens in your healthcare environment? Contact Halosil today.