Management of a Candida Auris Patient Across Two Healthcare Systems

BACKGROUND: Containing Candida auris (C. auris) has proven to be especially challenging during the COVID-19 pandemic given the enormous constraints on Infection Prevention (IP) departments. Knowledge of the organism, appropriate identification methods, and infection prevention strategies are key to reducing the risk of transmission. Many IP departments have been unable to develop or maintain comprehensive admission screening protocols and have limited best practices available for managing C. auris patients in the acute care setting. We describe the first case of C. auris in the acute care setting in the state of Minnesota and outline the infection prevention strategies used by the two systems that provided care to this patient. METHODS: Upon receipt of a preliminary positive C. auris result at Hospital One, the patient was placed into contact precautions. All patients that were identified as exposed were screened. A comprehensive infection prevention strategy was implemented in collaboration with the state health department and Hospital Two. The plan included transmission-based precautions, hand hygiene compliance, environmental cleaning and disinfection, and staff and patient education. RESULTS: A total of 48 patients were screened for C. auris at Hospital One and no additional positive results were identified. The patient was transferred to Hospital Two for progressive care needs and required an extensive hospital stay post-surgery. No additional screening was recommended by the state health department. Practical prevention strategies for high level disinfection and sterilization, environmental cleaning, patient transport and ambulation, and procedural protocols were developed. No additional C. auris colonization nor clinical isolates have been identified to date. CONCLUSIONS: This case highlighted the importance of inter-facility communication and the need for an established screening protocol for C. auris to identify cases in a timely manner. The robust infection prevention strategies implemented by the two systems resulted in no known transmission to other patients or staff.