Controlling an emerging fungal threat: The Partners for Patient Safety program

July 13, 2023Update on Candida auris:

On 7/13/23, a Candida auris case in King County was reported to Public Health – Seattle & King County. This is believed to be the first locally acquired case in Washington State. The person is a Pierce County resident who was transferred to Kindred-First Hill from St. Joseph’s Hospital in Pierce County. The patient screened positive for C. auris on admission testing at the King County facility. The patient has been in appropriate precautions for C. auris during their entire stay. 

As our blog below describes, Public Health – Seattle & King County has been working with Kindred- First Hill on the Partners for Patient Safety Program for many months, with the expectation that C. auris would eventually be found in Washington State. Early identification is key to control the spread of C. auris so that prevention strategies can be in place before it becomes widespread, and we are pleased that the program is working as designed to identify cases early.

Original post from December, 2022

You may have heard about antibiotic resistance in which bacterial infections cannot be controlled with standard antibiotics. Certain types of fungi, which can also colonize the body and lead to infections like bacteria do, can similarly be resistant to treatment. When these organisms are resistant to several different antibiotics, they are called multi-drug resistant organisms (MDROs). A new program underway in King County is aimed at early identification of these organisms with the goal of mitigating the spread of these MDROs in healthcare settings including those that serve the most vulnerable.

A key project goal is to implement a surveillance system to identify and mitigate the spread of an emerging, often multi-drug resistant fungus called Candida auris or C. auris.  We talked with Claire Brostrom-Smith from Public Health – Seattle & King County, Marisa D’Angeli from Washington Department of Health, and Ron Csech from Kindred Hospital Seattle First Hill to learn more. 

Claire Brostrom-Smith is the Healthcare Associated Infections Program Manager at Public Health.

Claire, let’s talk about C. auris. What is it?

C. auris is a fungus that can cause serious infections in people. While cases were previously more common in other countries, the number of C. auris infections identified in the U.S has been increasing. Antifungal medicines commonly used to treat fungal infections often don’t work for C. auris. In fact, some C. auris infections have been resistant to all three of the main types of antifungal medicines.

Why is C. auris so dangerous and who is most at risk?

C. auris can be present and spread in the body without the patient having any symptoms. When this happens, it’s called “colonization.” However, approximately 5 to 10% of patients “colonized” with C. auris will eventually develop invasive infections that can be very serious.  In fact, more than 45% of people with invasive infections die within the first 30 days.

People at highest risk in the U.S. are typically patients who are in long-term acute care settings. They tend to be very ill and have devices such as central venous catheters or endotracheal tubes. Some patients are on mechanical ventilators for a variety of reasons, such as traumatic brain injuries and strokes.

Marisa D’Angeli is the Medical Epidemiologist for the Washington state Department of Health’s Healthcare Associated Infections and Antimicrobial Resistance Program.

Dr. D’Angeli, what is the goal of the new program?

C. auris spreads very easily, even when a patient doesn’t have symptoms. The new Partners for Patient Safety program is aimed at finding the fungus – before symptoms develop – and limit transmission to others where possible. We’ll do this through routine screening of all patients. If we can identify dangerous microbes like C. auris (and other MDROs) before invasive infections develop, we’ll have the best chance of protecting patients.

We’re thrilled that Kindred Hospital is partnering with DOH and PHSKC to screen patients at a specific point in time for colonization with C. auris and other MDROs. It will be the first hospital in the state to do widespread screening of patients who are not showing symptoms. This program is aimed at limiting the spread of C. auris in the facility to the extent possible –  before it gains a foothold. Our goal is to get on top of this and make sure this doesn’t become an emergency.

Are other acute care medical institutions joining the program also?

We are encouraging all high-risk healthcare facilities in Washington to demonstrate their commitment to proactive measures to keep their patients safe by joining the program. It’s only by working together that we can improve infection prevention in Washington.

It’s important to know that other hospitals such as Harborview Medical Center do screen according to current CDC guidelines, which call for screening of patients who are healthcare contacts of known cases or have had an overnight stay in a healthcare facility outside of the U.S.

Ron Csech is an Infection Prevention and Control practitioner at Kindred Hospital Seattle First Hill. Kindred is the first facility to join the Partners for Patient Safety program.

Ron, tell us why Kindred was excited to join the program?

Our healthcare team is dedicated to preventing the spread of multidrug resistant organisms and appreciate the support from our local and state Public Health authorities to add C. auris to our existing screening process. We believe that expanding our testing capabilities for every patient in our care and our partnership with Public Health is the right thing to do for our patients and their communities.

How do you test for C. auris?

C. auris is difficult to identify. Screening involves an underarm and groin swab. Samples are sent to the Washington Public Health Laboratory for specialized analysis. This is necessary because not every lab can distinguish among different species of this type of fungus.

Claire, back to you. What will happen once C. auris is identified at healthcare settings like Kindred?

C. auris is especially difficult to eliminate in healthcare settings because it can persist on some surfaces for weeks or longer. If the fungus is identified in patients, the healthcare facility must do particularly careful cleaning and monitoring to ensure that patients, staff, and equipment are not inadvertently spreading the fungus from patient to patient.

Do you expect that Kindred – and other facilities that join the program – will find C. auris?

C. auris has not yet been identified in Washington state, but we expect we will find it as more screening is done at Kindred and at other facilities when they join the Partners for Patient Safety program. As Marisa said, early identification is key to control the spread and put mitigation strategies in place before it becomes a big problem. And the only way to do that is to test early and regularly.

What are the long-term goals of the Partners for Patient Safety: Early Detection and Infection Prevention Program?

In addition to saving lives here in King County and Washington state, this program will also provide evidence that will add to our collective knowledge about how C. auris spreads, including how often it causes an invasive infection. This program may help CDC decide whether to update guidance for all similar acute care settings.

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Originally published December 28, 2022