ISR 60 - Curbing the Incidence of Candida Auris in the Burn Intensive Care Unit - How Not to Get Burned Twice

Background: Identifying routes of transmission among patients during a Candida auris (C. auris) healthcare-associated outbreak can be challenging, particularly among patients in the Burn Intensive Care Unit (BICU). Between January-November 2022 seven patients in a New York City Hospital were colonized or infected with C. auris, two of whom occupied the same room 14 days apart. This study aims to evaluate the effectiveness of a C. auris prevention protocol (CAPP) to quell further transmission of C. auris.

Methods: A quasi-experimental study of patients with C. auris positive cultures over an eleven-month period was conducted. The pre-intervention period was from January-July and the post-intervention period was August-November 2022. The intervention consisted of a CAPP that included five elements: monitoring of hand hygiene, enhanced contact precautions, dedicated staff and equipment, routine terminal cleaning of patient rooms and equipment with bleach, and hospital-wide communication.
Evaluation strategies used a benchmark approach to appraise adherence with interventions and patient outcomes. Cleaning compliance was tracked and trended with quantification of adenosine triphosphate (ATP) bioluminescence, qualitative analysis of fluorescent markers, and supported with direct observation of cleaning methods of C.auris patient rooms.

Results: Prior to the implementation of the CAPP, a total of 7 patients were noted to be colonized or infected with C. auris. Of the 7 patients 2 resulted positive for C. auris in the same BICU room 14 days apart. After introducing the CAPP bundle, there were no new hospital-onset C. auris cases in the BICU.

Conclusions: A hospital-wide approach between multiple departments is critical for the success of C. auris transmission in a BICU. A multi-faceted approach to monitoring compliance with the CAPP bundle can help reduce the transmission of C. auris. This approach can decrease the burden on the healthcare system and improve patient outcomes.