May 14, 2019

How OU Medical Center contained C. auris—the drug-resistant fungus that's considered almost 'unbeatable'

Daily Briefing

    For OU Medical Center in Oklahoma City, quick identification and strict adherence to infection control helped clinicians contain a case of the highly contagious drug-resistant fungus Candida auris (C. auris) when it appeared in the hospital about two years ago, Steven Ross Johnson reports for Modern Healthcare.

    From outbreaks to hurricanes: How can hospitals prepare for disasters?

    What is C. auris?

    In recent years, hospitals in the United States and abroad have been grappling C. auris, a little-known drug-resistant fungus that can cause deadly bloodstream, middle ear, and wound infections. CDC estimates more than 90% of C. auris infections are resistant to at last one antifungal drug, while 30% are resistant to at least two major drugs.

    The infections typically are not dangerous for young, healthy individuals, but they can be fatal for high-risk patients, such as those who have diabetes, were recently on antibiotics, or recently had surgery. According to CDC, nearly half of patients who contract C. auris die within 90 days.

    The earliest known case of C. auris in the United States occurred in May 2013, but since then, there have been more than 600 U.S. cases in 12 states, according to CDC data. Unlike other fungal infections, C. auris spreads quickly from one patient to others and to hospital staff, but public health officials have yet to determine how exactly it spreads—and how to effectively treat and eliminate C. auris.

    Lynn Sosa, Connecticut's deputy state epidemiologist, said she now views C. auris as "the top" threat among antibiotic-resistant infections. "It's pretty much unbeatable and difficult to identify," she said.

    According to Ross Johnson, only a small number of facilities that have successfully contained C. auris—and OU is one of them.

    How OU contained C. Auris

    OU encountered a case of C. Auris in April 2017. The patient, who the hospital discovered had other drug-resistant infections, was isolated upon arrival, according to Linda Salinas, an epidemiologist and chief quality officer at OU Medical Center.

    Identifying C. Auris quickly is key to containing it, Ross Johnson reports, and unlike many facilities, OU had technology onsite to identify the fungal infection within 24 hours of admitting the patient, Ross Johnson reports.

    OU used matrix-assisted laser desorption ionization imaging—an ionization technique that creates ions from large molecules to analyze biomolecules and identify the fungus, Ross Johnson reports. Salinas said the ability to quickly detect the fungus "was the first step to our success."

    According to Ross Johnson, few hospitals have such technology onsite, and instead, must wait for days for a local or state health department to identify a potentially dangerous organism and send it to CDC for confirmation.

    Once doctors had the correct diagnosis they deployed a rapid response to contain the fungus and prevent it from spreading to other patients or providers.

    The hospital's infection-control team deployed a disinfection protocol similar to the protocol used for cases of Clostridium difficile. Cleaning crews applied bleach to all surfaces in the patient's room twice daily. In addition, CDC infectious disease workers came to OU to educate clinicians about how to handle devices and how to wear the proper protective gear when interacting with the patient. To reduce the likelihood of transmission, the hospital had only one nurse per shift in the patient's room.

    The hospital also increased scrutiny on hand hygiene and washed the patient's bed linen separately from other hospital laundry, Ross Johnson reports.

    "These are protocols that have been a part of our infection-control plan for many years," Salinas said.

    C. auris patient goes home

    Together, these practices enabled the hospital to keep the fungal infection contained to just the one patient, who was discharged within a week of admission.

    Salinas noted that having a lab onsite was a key part in OU's successful containment, but she also noted that hospitals can reduce the risk of transmission by following their infection-control processes every time they face at threat like this (Ross Johnson, Modern Healthcare, 5/11).

    From outbreaks to hurricanes: How can hospitals prepare for disasters?

    Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

    Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.

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