Addressing Candida auris: Effective Screening and Isolation Protocols at Memorial Hermann Hospital

LaRhonda Daniels, CIC; Marco Medina, MPH; Valerie Ausborn, MPH, CIC, and Luis Ostrosky-Zeichner, MD, FACP

Candida auris is an emerging multidrug-resistant fungus that poses significant threats due to its resistance to common antifungal drugs and persistence on surfaces. Clinical cases of C auris have surged in recent years, with a notable spike in the past 2 years. In response to the rising prevalence of C auris in the community and the resulting active cases within health care systems, Memorial Hermann Hospital in Houston, Texas, and Memorial Hermann Hospital Texas Medical Center adopted targeted screening and isolation protocols to prevent exposure and potential spread among patients.

To describe the study of the adopted screening, LaRhonda Daniels, CIC, infection preventionist (IP) at Memorial Hermann Hospital, and Marco Medina, MPH, IP for Memorial Hermann Hospital Texas Medical Center, presented a poster titled “Implementation of Admission Screening for Candida auris to Prevent Exposure and Spread” at the 2024 Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference & Exposition in San Antonio, Texas, held from June 3 to 5. Other authors included Valerie Ausborn, MPH, CIC, and Luis Ostrosky-Zeichner, MD, FACP.

Patients admitted to the medical intensive care unit (ICU) with high-risk factors were subjected to a physician-ordered groin swab culture for C auris. High-risk factors included recent care within the past 12 months at a long-term or rehabilitation facility, recent healthcare from another country, or a medical history of C auris. These patients were placed in contact isolation to mitigate the need for extensive surveillance investigations recommended by the CDC.

Using input from the chief epidemiologist and CDC guidance, the authors established and monitored isolation precautions, environmental cleaning, and screening criteria. Given the surging number of C auris cases in the community and local health care facilities, immediate response was crucial to mitigate the severity and spread of C auris within the hospital setting.

The main objective was to prevent an outbreak of C auris on the hospital campus. The team created thorough guidance and educational materials that emphasized personal protective equipment (PPE), environmental cleaning, and surveillance methods to reduce or prevent future outbreaks. The manual screening process was tested in several high-risk units. By October 2023, an automatic admission screening process using the electronic medical record (EMR) system was put in place.

During the manual screening process, 820 screening cultures were collected between January 2023 and March 2023, leading to the identification of 17 cases. The process helped prevent exposure by isolating at-risk patients promptly. Between October 2023 and March 2024, 300 automatic admission screening cultures were collected. This identified 10 positive patients and prevented approximately 650 additional surveillance swabs by taking proactive contact precautions.

During the manual process, it became evident that consistent surveillance screening was necessary to identify the severity of the spread and ensure proper isolation. The automatic process revealed challenges in education dissemination and compliance, highlighting the need for ongoing reeducation and notification to capture individuals who fall within the high-risk criteria.

Implementing an admission screening protocol for C auris at Memorial Hermann Hospital has proven to be a highly effective strategy in reducing patient exposure and preventing the spread of this dangerous fungus. By identifying and isolating at-risk patients upon admission, the hospitals have successfully minimized the risk of outbreaks and ensured the safety of their patients. Integrating an automatic screening tool in the EMR system and comprehensively educating physicians and staff have further streamlined the process, making it a robust model for other health care facilities facing similar challenges.

Memorial Hermann Hospital's strategic approach to C auris screening and isolation is a testament to the effectiveness of targeted infection prevention measures in safeguarding patient health and preventing the spread of health care-associated infections.