Expanded Screening Protocols Improve Early Detection of Candida auris at Mount Sinai Brooklyn

Candida auris

(Adobe Stock 812879449 by peterschreiber.media

“Candida auris (C auris) is an emerging global infectious disease threat, and screening practices for identification of C auris are inconsistent across health care facilities,” the authors of a new study wrote.

The study, published in the American Journal of Infection Control (AJIC), highlights the effectiveness of expanded screening protocols for detecting C auris at Mount Sinai Brooklyn. C auris, a drug-resistant fungal pathogen, is highly transmissible in hospital settings, making early detection crucial for infection prevention. Triggered by a 2022 outbreak investigation involving 9 cases, the hospital revised its protocols to screen all patients admitted from skilled nursing facilities or those with recent stays.

Under the new protocols, 591 patients were screened, compared to just 34 under the old system. The positivity rate rose from 1.8% to 2.4%, with 8 additional cases identified that would have been missed using the previous approach. Early detection enabled the hospital to implement isolation and disinfection measures quickly, preventing further spread of C auris.

The study’s key findings included:

• Expanded screening flagged lower-risk patients while isolating only high-risk cases.
• Test results returned within 3 days minimized delays in infection control.
• More expansive screening identified 8 cases that posed significant risks to patient safety and the hospital environment.

This method highlights the necessity of proactive screening to lessen the risk of C auris, improve patient safety, and minimize hospital outbreaks.

To learn more, Infection Control Today^® (ICT^®) contacted Waleed Javaid, MD, MBA, MS, FACP, FIDSA, FSHEA, a member of this study.

ICT: What prompted Mount Sinai Brooklyn to adjust its C auris screening protocols, and what were the biggest challenges in implementing the new, broader screening approach?

Waleed Javaid, MD, MBA, MS, FACP, FIDSA, FSHEA: Prompt to Adjust Screening protocols: Mount Sinai Brooklyn decided to adjust its C auris screening protocols following an outbreak investigation in September 2022. A patient admitted from a skilled nursing facility (SNF) developed a bloodstream infection with C auris but did not meet the existing high-risk screening criteria. The subsequent investigation revealed multiple colonized cases and highlighted the need for earlier identification to prevent nosocomial transmission.

ICT: Can you explain how the expanded screening protocols have impacted patient outcomes and overall infection prevention in the hospital?

WJ: Impact on patient outcomes and infection prevention The expanded screening protocols have significantly impacted infection prevention. By identifying more colonized patients earlier, the hospital reduced the risk of nosocomial transmission and limited the need for extensive outbreak investigations. The approach also improved the hospital’s ability to implement timely isolation and disinfection measures, which helped prevent further spread within the facility.

ICT: What were the key differences between the old screening criteria and the new protocols, and why were these changes considered necessary?

WJ: Key differences between old and new protocols The original screening criteria focused on patients admitted from a limited number of ventilator-capable SNFs, primarily those with tracheostomies or ventilator-dependent. The new protocol broadened the scope to include all patients admitted from any SNF, regardless of ventilator status. This change was crucial because it addressed the detection of additional colonization cases that could contribute to environmental and patient-to-patient transmission.

ICT: Given the resource-intensive nature of broader screening, how did the hospital balance practicality with thorough patient safety measures?

WJ: Balancing practicality and patient safety Given the resource demands of expanded screening, the hospital adopted a 2-tiered risk stratification system. High-risk patients (with tracheostomies or ventilator dependency) were placed on strict transmission-based precautions, while low-risk patients were not isolated but still screened. This approach allowed efficient use of resources while maintaining a focus on patient safety and infection control.

ICT: Were there any surprises during the studies? What were they?

WJ: Surprises during the study One unexpected finding was the identification of colonized patients who did not exhibit traditional high-risk characteristics (such as being ventilator-dependent or having a tracheostomy). Additionally, the study found a significant reduction in secondary colonization cases linked to clinical C auris cases after the expanded screening was implemented.

ICT: What lessons or insights from this study could be valuable for other healthcare facilities aiming to improve their screening and prevention measures for drug-resistant pathogens like C auris?

WJ: Valuable insights for other facilities Other health care facilities can learn from the importance of early and comprehensive screening to prevent outbreaks of drug-resistant pathogens like C auris. Collaboration across clinical, laboratory, and administrative teams is critical for a successful protocol. Additionally, tailoring screening strategies to local prevalence and risk factors while maintaining operational efficiency is a key takeaway.