CDC Discusses Candida auris: The Role of Infection Preventionists and EVS Staff

Preventing the spread of Candida auris (C auris) requires the efforts of not just infection preventionists (IPs) and environmental hygiene services (EVS), but also the entire facility or community. What specific measures should IPs and EVS take to address this issue?

Infection Control Today® (ICT^®), along with our colleague Chris Spivey, editorial director for Pharmaceutical Technology, Pharmaceutical Technology Europe, and BioPharm International, reached out for answers from Megan Lyman, MD, medical officer, Mycotic Diseases Branch, CDC, and Danielle A. Rankin, PhD, MPH, health scientist, Division of Healthcare Quality and Promotion, Prevention and Response Branch, Antimicrobial-Resistance Team, CDC.

This installment is the second in a series. The first is here. The third installment is here. The fourth installment is here.

ICT: We hear about C auris in the news, but how do you recognize it? What are the symptoms? What do you see?

Megan Lyman, MD: There aren't any specific signs or symptoms for C auris, which depends on the body site of where the infections are occurring. However, it's often similar to infections caused by bacteria and viruses. If you have a bloodstream infection, you might have a fever or sepsis. And if you have a wound infection from C auris, you might see redness, swelling, and drainage. It's difficult because no symptoms specifically point to C auris [because] it's similar to infections caused by other pathogens.

ICT: What can infection preventionists and environmental hygiene specialists do to help prevent this pathogen?

Danielle A. Rankin, PhD, MPH: There are many different infection control measures that can work and beyond the basics, I want to focus on 2 primary key points that we often recommend to our health care facilities for seeing C auris, and 1 of them is admission screening. Admission screening is important because we are able to identify patients or residents coming from long-term care facilities who are, as Megan indicated, asymptomatically colonized with C auris.

If we do asymptomatic colonization, we're able to detect when a patient with C auris is not showing those signs or symptoms. We know that asymptomatic colonization can also lead to a silent spread within a health care facility, often undetected, and so we see these larger outbreaks of C auris. When we do admission screening, we're able to have the facility place the patient or resident (depending on what facility type it is), if they screen positive for C auris, we recommend that those patients are placed on the appropriate transmission-based precautions. In acute care hospital settings, we recommend that contact precautions, which include gloves and gown, that health care providers ensure they're performing the appropriate hand hygiene, and that they have dedicated patient care equipment.

In nursing homes, that changes a little bit. We have what's called Enhanced Barrier Precautions, again, includes that glove and gown, but only apply those during high-risk patient care activities such as bathing, changing, or toileting a resident, and hand hygiene. In addition to an admission screen, we recommend infection preventionists and facilities with a case of C auris focus on conducting direct observations of those [basic] control practices. So that includes hand hygiene, personal protective equipment usage, and environmental cleaning. But specifically with hand hygiene, [IPs] want to make sure that they have those direct observations are being done during patient care, so you can then help coach staff, and where there are some opportunities for improvement of when hand hygiene could have occurred to limit the spread from environment to patient. Then for personal protection equipment use, ensuring that donning (or putting on the gown and gloves) is in the proper order and taking off [doffing] is reducing any contamination to the person themselves.

Then specifically with environmental cleaning [for] C auris [it is] essential. [If they have C auris] health care facilities should be using the disinfectants listed on Environmental Protection Agency’s Registered List P. [This is because] C auris is shown to contaminate the environment and can be difficult to remove without meticulous cleaning efforts.

Because of this, we also recommend that IPs pair up with their environmental services (EVS) management team to conduct direct observations of environmental cleaning, to ensure that from start to finish are hitting all high-touch surfaces. All environmental services staff are moving in a systematic method when they're cleaning the room. Either starting clockwise or counterclockwise in a room and from the outer perimeter and going into the patient zone, typically where the patient or resident bed is. In addition to that, while they're watching those items, make sure that staff are moving from cleaner to dirty surfaces so that they're not cross-contaminating within the room itself. It gets complex, but the direct observations help formulate those opportunities for improvement and one-on-one coaching with those staff members.