South Carolina VA Facility Battles Candida auris...and Wins

Two patients were found with C auris in the CVAHCS beginning in October 2020, and a recent study describes how the facility handled the situation.

Candida auris is an emerging pathogen that poses major infection prevention challenges because the organism can cause severe illness and can remain on various surfaces for an unknown length of time. Because the health care environment has a vulnerable population, the challenges presented by C auris are intensified. A recent study published in the American Journal of Infection Control, titled “Novel Case of Candida auris in the Veterans Health Administration and in the state of South Carolina,” describes the battle Columbia Veterans Administration Health Care System (CVAHCS) had with this pathogen beginning in October 2020 during the COVID-19 pandemic.

After 1 patient, Patient A, was identified with C auris at the CVAHCS, “Since Patient A was admitted, infection prevention (IP) immediately contacted nursing to place the patient in a private room with dedicated equipment and to follow contact precautions to include strict hand hygiene, and the use of gowns and gloves,” the investigators noted in the study. “IP staff reviewed the literature to determine other necessary interventions such as cleaning requirements and the benefit of ultraviolet C (UVC) light disinfection.” Ultimately, IP and the Infectious Disease Chief recommended the environmental staff clean and disinfect the environments where the patient was cared for using bleach 1:10 solution followed by UVC light disinfection.

The facility’s C auris screening results were received, and another new case was identified. Patient B was immediately placed on contact precautions with a private room. Investigators determined that Patients A and B had shared a semi-private room for one day.

Because of the newly identified C. auris transmission, “a meeting was held with nursing, environmental management services, laboratory, radiology, cardiology, hemodialysis, and medical staff to discuss all infection control aspects of managing the C auris event including hand hygiene, isolation, cleaning, disinfection, and staffing,” the investigators wrote in the study. “Infectious Diseases recommended 1:1 nurse staffing for Patient B. Infection Control implemented enhanced monitoring and observation of hand hygiene and isolation compliance during both patients stays. Also, heightened communications regarding the pathogen during patient transfers within and outside the facility were emphasized.”

The investigators noted that for staff’s safety concerns, “S.C. Department of Health and Environmental Control and Center for Disease Control noted that testing of staff and the environment is not recommended since C auris does not pose a risk to immunocompetent individuals.”

Because this pathogen presented during the COVID-19 pandemic at the CVAHCS, the facility faced even greater challenges for the IP staff monitoring and reporting requirements for COVID-19 to the state health department. The nurses and IPs also faced contact tracing demands as well as performing C auris surveillance swabs. Then staffing difficulties were aggravated when 1:1 staffing recommendations were implemented to prevent transmission of C auris. Laboratories also had difficulties as well; Staff had to process C auris specimens along with the ongoing COVID-19 testing.

Investigators praise the CVAHCS staff. The staff “successfully managed these competing priorities to reduce the risk of transmitting a virulent and resistant organism throughout a vulnerable population of hospitalized patients."

Fortunately, the investigators note that "to date, no further transmission has been identified of C auris at the CVAHCS. The support of experts at the CDC, SCDHEC, VHA, and the active involvement of key stakeholders at the CVAHCS medical center was essential to guiding actions and averting further transmission.”