Newly discovered, drug-resistant germs continue to pose an increasing and serious threat to healthcare workers and hospitalized patients around the world. These 'superbugs' can be most dangerous to those with a compromised immune system, such as the elderly, diabetics, newborns and persons that have an autoimmune disorder that leave the body with inadequate resources to fight against bacteria, viruses, and toxins. Healthcare workers and laboratory technicians that come into contact with the blood or body fluids of infected persons or any infectious materials are also at a high risk for coming into contact with these deadly pathogens.
According to CDC reports, there is an emerging threat to healthcare facilities from the global spread of Candida Auris (C Auris), a multidrug-resistant (MDR) yeast with limited treatment options and a high mortality rate.
Candida Auris - A Global Health Threat
Candida Auris was first isolated in 2009 from a Japanese patient's external ear discharge. Since that time, C auris infections have been reported in over a dozen countries across the globe, including the United Kingdom, South Africa, the far-eastern states of India, Columbia, Pakistan and as of February 28, 2019, 587 confirmed cases across 12 states in America since It was first detected. in 2016. These clinical case counts do not include the thousands of suspected U.S. patients that have been found to be colonized with C. auris by targeted screening in seven other states.
The initial spread of C Auris remains a mystery in that it emerged in so many different countries without any direct correlation between human, animal, or environment. Today, epidemiologist are certain that the present spread of C. Auris infections are mostly hospital-acquired, affecting mostly patient that have been in the hospital for several weeks, along with healthcare providers. The fungal infection has been isolated in the bloodstream, urine, the respiratory tract, and colonized within the wounds of patients of all ages that have a similar risk factor for infection with other forms of fungal Candida.
How C Auris is Spread?
The CDC is concerned about the spread of C Auris because it is resistant to the many antifungal drugs that are presently used to treat Candida infections. Successful diagnosis by culture of blood or other body fluids have been slow and difficult to develop because the fungus is difficult to identify when compared to other strains of Candida. For this reason, there have been many outbreaks in healthcare facilities, making it crucial to quickly identify and isolate patients that are C auris-positive. This way, suitable precautions can be taken - such as donning personal protective equipment and clothing (PPE).
Of most concern to healthcare workers is the fact that most Candida Auris Infections have been found in hospitalized patients. Consider the global concern when a foreign traveler has a lengthy hospital stay in another country, then returns to their home country with an unidentified C. auris infection. Once they seek follow-up care in their country of residence, these healthcare workers are at risk of coming into contact with the patient's bodily fluids - and are now in the path of a silent outbreak of a superbug infection.
Candida Auris can be spread in the following ways:
- Touch transfer from human to human
- Contact with blood and other bodily fluids
- Touching contaminated surfaces or clothing
- Contaminated patient equipment - ventilation units
What the CDC is Saying
Because C. auris is becoming more common and is spreading within healthcare facilities, the CDC is recommending that all healthcare settings prepare now for C. auris in their facility in the following 4 ways:
1. Establish laboratory yeast testing methods that can detect C. auris - and train healthcare workers to identify suspected C. auris in patients that may havmay be at risk for the infection. Suspected cultures that have been isolates should be sent to local public health departments for further positive identification.
2. Begin a surveillance and communication protocol between hospitals, long-term care facilities, and laboratories to immediately inform the proper staff when C Auris organisms have been identified.
3. Identify patients that are at a higher risk for C. Auris, such as those who have had lengthy stays in nursing homes or those who have had long-term treatment on a ventilation unit, in addition to patients that have been treated in healthcare facilities with cases of positive C Auris transmission.
4. Have a response plan to prevent the spread of Candida Auris infection among healthcare workers and environmental services staff using CDC recommended guidelines and protective clothing and equipment (PPE).
The CDC recommends that healthcare workers follow standard infection control precautions in all encounters where patient care puts workers at risk of contact with an infectious disease. Additionally, when a Multidrug-resistant organism (MDRO) such as Candida Auris is suspected, additional precautions should be taken. These include using masks when splash-generating procedures are performed or when burn wounds that may be heavily colonized are treated.
Factors That Influence PPE Selection
Standard infection control protocols include the following PPE:
- Gloves to prevent touch transmission
- Goggles to protect the eyes
- Gowns or aprons to protect clothing and skin
- Masks that cover the mouth and nose
- Face shields to protect against splash
- Respirator if needed to prevent airborne transmission
The primary factor that influences the type of PPE used to prevent the spread of C. Auri will depend upon the type of exposure that is anticipated. PPE selection will vary when patient care involves the possibility of large volumes of bodily fluids that may penetrate clothing when compared to a member of the nursing staff that is touching a patient to take vital signs.
Even when wearing patient care gloves, employees should be trained to limit the opportunities for "touch contamination" when treating Candida Auris patients, and to always work from 'clean to dirty' - remembering to touch clean surfaces before touching possibly contaminated areas.
Secondly, the durability or appropriateness of the PPE should be considered. For example, when a gown is selected, a determination should be made whether the protective gown needs to be fluid proof or fluid resistant. The FDA has established manufacturing and labeling standards that categorize medical gowns from Level 1 - minimum risk to Level 4, which is suitable when "pathogen resistance is needed or infectious diseases are suspected (non-airborne)".
Single-use, disposable and fluid-resistant gowns or coveralls may be suitable when evaluating a person who is not bleeding or vomiting, but may be under investigation for Candida Auris. While single use, impermeable gowns are recommended when a patient is confirmed unstable and under suspicion of a colonized C Auris infection.
The proper size and fit of PPE is crucial to giving healthcare workers the comfort and range of motion they require while attending to patients and still being protected from the transmission of infectious disease. Gloves that are too large will limit the dexterity of healthcare workers, while gloves that are too small will tear more easily. The proper donning and disposal of PPE - followed by handwashing is also important to preventing the spread of C Auris in healthcare facilities.
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