ITS 74 - Impact of Nonadherence to Candida Auris Screening Protocols

Background: Identifying risk factors for Candida auris (C. auris) on admission to a healthcare facility offers an opportunity to actively screen patients for carriage of this highly resistant fungus and mitigate exposure by applying infection prevention measures immediately. Our facility performs admission screening of patients >18 years of age with a history of being in a tertiary care facility within the past 6 months. Deleterious effects were identified from sub-standard adherence with C. auris admission nurse protocols, including resource intensive ring surveillance and identification of secondary transmissions.

Methods: Review of our C. auris screening program from February 2022 to November 2022 included review of patient eligibility for surveillance, collection of specimens for laboratory testing and appropriate use of isolation precautions. Reasons for nonadherence to the screening protocols were assessed as an opportunity for nursing interventions. Newly identified cases prompted ring surveillance on the inpatient unit.

Results: Preliminary data identified nurse admission screening compliance of 45% and 73% compliance with lab ordering and specimen collection of eligible patients. Between February and November 2022, 159 C. auris ring surveillance tests were performed as part of nosocomial case investigations and 6 transmissions were identified. Barriers from nursing included physician dominated ordering protocols and overall nonadherence to completion of the admissions navigator. Updated verbiage to clarify nursing protocol order, re-socialization of C. auris prevention foundations and the screening protocol gateways were escalated.

Conclusions: Opportunities exist to invest in nursing educational resources and expand research for proactive prevention of C. auris transmission in healthcare facilities. Health leaders, providers and Infection Preventionists can improve the understanding of the deleterious effects of non-adherence to C. auris screening of high-risk patients on admission, particularly resource intensive ring surveillance and secondary transmission. Constant monitoring and feedback of an ongoing surveillance program is imperative to assess success and potential barriers.