3 steps to subdue C. auris, per Mass General experts

From 2019 to 2021, 17 states reported their first case of Candida auris, a yeast fungal infection becoming more resistant to treatment. Three Massachusetts General Hospital experts told Becker's the three ways to contain the spread.

The fungal infection mainly spreads among vulnerable patients in hospitals, long-term care facilities and skilled nursing sites. Somewhere between 30 percent and 60 percent of people infected with C. auris die, but this estimate is based on limited information, according to the CDC. 

Three tactics to diminish the threat of C. auris:

1. Improving disinfection practices

The fundamentals of infection control measures, such as correct disinfection of equipment and hand hygiene, have fallen by the wayside, according to Erica Shenoy, MD, PhD.

For example, in a Florida hospital's COVID-19 specialty care unit in summer 2020, half of its 67 screened patients tested positive for C. auris, six colonized cases became infections and eight died within 30 days of screening. The CDC said "whether C. auris contributed to death is unknown," and the outbreak spurred an investigation.

There were numerous factors leading to the C. auris spread: Computers and medical equipment were not always disinfected between uses; the "multiple opportunities for contamination" when the healthcare staff took off their personal protective equipment; medical supplies were stored in open bins in hallways; and observed lapses in hand hygiene. 

"[For] pathogens that spread through contact, your tools are hand hygiene, really good cleaning and disinfection of equipment, the cleaning of the environment, and then when you identify people with these organisms, using personal protective equipment appropriately and not in a way that's going to lead to more transmission," said Dr. Shenoy, an infectious diseases physician at Massachusetts General Hospital and the medical director of infection control at Mass General Brigham, both based in Boston. 

Failures in fundamental practices are because "there's more work and fewer people to do that work," Dr. Shenoy said. 

Saskia Popescu, PhD, an assistant professor at Fairfax, Va.-based George Mason University and an expert in infection prevention, echoed that statement and said "infection control within healthcare is extremely neglected" because of a lack of resources.

The usual turnover of an operating room will not work against Candida auris, according to Michael Mansour, MD, PhD, a faculty member at Massachusetts General Hospital. 

"It sticks to surfaces really really well, so [...] traditional cleansers that many hospitals use are insufficient; they don't sterilize Candida auris stuck to the bedrails or the side tables," said Dr. Mansour, who is also associate professor of medicine at Boston-based Harvard Medical School. 

Minor changes and investments to bettering compliance to infection control measures can be a large help to preventing C. auris outbreaks, Dr. Mansour and Dr. Shenoy said. 

2. Making a screening plan

Dr. Shenoy said the one thing missing from the national conversation around C. auris and its threat in hospitals is an unclear screening strategy. 

The CDC's map of C. auris shows pockets of infection, so a national screening policy does not make sense, she said. It will be up to each healthcare facility on whether to screen everyone or do targeted screening after identifying a colonized case. 

"Once you've identified a clinical case, that's really the tip of the iceberg and you really need to make sure there's been no spread," Dr. Shenoy said. "Many people with Candida auris can be colonized and not show any symptoms, and if those people are not isolated, they can be a reservoir to transfer those pathogens to other individuals, who can be colonized or actually have an infection from it."

The CDC recommends screening close healthcare contacts after discovering C. auris and screening those who stayed overnight in a healthcare facility outside the U.S. in the last year. It also said more extensive screening, such as a point prevalence survey, might be needed. 

Test turnaround time can also vary, she added, so healthcare sites should plan for surveillance strategies as they wait for those results. 

During the height of the COVID-19 pandemic, the number of C. auris cases tripled, according to a CDC study published March 21. With this worsening risk, Dr. Mansour said C-suite leaders at hospitals and healthcare sites need to acknowledge the threat and proactively plan for what to do when C. auris is detected.

3. Equipping labs

There are also difficulties in identifying C. auris, according to Sarah Turbett, MD, associate lab director for the clinical microbiology laboratories and an infectious disease physician at Massachusetts General Hospital. 

Platforms that test Candida species pull from a database of the biochemical properties of common organisms, but some of these devices could be misidentifying C. auris

"When you have an emerging pathogen, you don't know the biochemical profile," Dr. Turbett said. "When that's not built into that system, it can be much tricker. It turns out that some of these more traditional systems or platforms actually can misidentify Candida auris because it's trying to match it to what it thinks it is based on its reference database."

For facilities that do not have labs or the right equipment to test for C. auris, preemptively developing a relationship with a state lab is imperative, Dr. Turbett said. The CDC also offers free testing with its AR Lab Network. 

Depending on the database, she recommended maldi-tof, a mass spec for organism identification, and full genome sequencing, which is usually used in reference labs. 

Dr. Turbett said an FDA-approved assay is coming down the pipeline, and Dr. Mansour said he is hopeful for technology currently being researched that wipes C. auris off the skin. 

"That's the stuff to look forward to; we need to do something today," Dr. Mansour said, such as "having more active surveillance [and] having a plan in place."

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