Enhanced screening protocols for Candida auris improve hospital infection control

Mount Sinai Health SystemNov 1 2024

Mount Sinai researchers have enhanced hospital screening protocols for Candida auris, an often-drug-resistant fungal pathogen the Centers for Disease Control and Prevention considers an urgent global health threat. These new guidelines, published in an analysis in the American Journal of Infection Control on October 31, could promote early detection of the harmful fungus in high-risk patients and prevent hospital outbreaks.

C. auris, which emerged in New York City in 2016, is a fungus that can cause serious bloodstream, wound, and ear infections. It can affect the entire body and lead to severe complications, particularly in patients with weakened immune systems. The fungal pathogen can also spread easily in health care settings since it can survive on contaminated surfaces or medical devices for several weeks.

Experts at Mount Sinai have implemented expanded hospital admission screening protocols to identify patients with C. auris by screening all admitted patients who had lived in a nursing home within a month before admission, regardless of their specific risk factors. This enhanced screening was a shift from previous approaches that often vary across health care facilities and only screen people with more obvious risk factors, such as patients with a tracheostomy or those on a ventilator.

Our findings demonstrate a significant advancement in infection prevention and patient safety, particularly within skilled nursing facility transfers. Response to Candida auris requires vigilance, rapid diagnosis, appropriate treatment, and stringent infection control protocols to limit its spread in health care facilities."

Waleed Javaid, MD, MBA, MS, Corresponding Author, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and Director of Infection Prevention and Control at Mount Sinai Downtown

In the retrospective review, the researchers screened all 591 patients for C. auris who were admitted to Mount Sinai Brooklyn from a nursing home from January 2022 to September 2023. They used these expanded screening protocols for one year and compared outcomes for that year to the nine-month period prior to the screening change. The experts found that 14 cases, or 2.4 percent, of the cohort tested positive for C. auris. Nine cases were considered high risk, while five cases were considered low risk at the time of screening. Ultimately, the new expanded screening identified eight cases that would have gone undiagnosed under the prior protocol. More cases were caught early, enabling the Mount Sinai team to quickly implement appropriate isolation, contact, and disinfection precautions to prevent further outbreaks.

"Our study supports the need for hospitals to adopt expanded screening protocols to enhance infection control practices," said study co-author Scott Lorin, MD, MBA, President of Mount Sinai Brooklyn and Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) at Icahn Mount Sinai. "Broader screening not only identifies cases early, but also allows for targeted precautions, reducing the risk of hospital-based outbreaks. The implementation of proactive protocols, based on community prevalence rates, can be a key tool in controlling the spread of this emerging global health threat."