______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
Healthcare Consideration Cases of Candida auris ( C. auris ) increased dramatically from 2020 to 2021 in states across the U.S. C. auris is a type of yeast that can cause severe illness and spreads easily among patients in healthcare facilities. It is often resistant to common antifungal treatments, though most C. auris infections are treatable with a class of antifungal medicines called echinocandins. C. auris can cause infections in different parts of the body such as in the bloodstream, open wounds, and ears. The symptoms depend on the location and severity of C. auris infection and may be similar to symptoms of an infection caused by bacteria. There is not a common set of symptoms specific for C. auris infections. There are two methods to diagnose. 1. Colonization screening: A healthcare provider swabs the patient’s skin by rubbing a swab near the armpits and groin and sends the swab to a laboratory for testing. 2. Clinical specimen testing: If a patient is showing symptoms of an infection of unknown cause, a healthcare provider may collect a clinical sample, like blood or urine. They usually test for many types of infections, including those caused by bacteria. The results may show that the patient has C. auris . If a patient is colonized or infected, healthcare providers take special steps to prevent the spread of C. auris , including placing the patient in a room separated from those at risk, cleaning the rooms with special disinfectant products, and using PPE and EBP following facility procedures to deliver care. Source: [10]
2. Exogenous: Infection from a germ that recently spread from another person or from a shared contaminated surface When a healthcare facility identifies certain multidrug-resis- tant pathogens within their facility, the CDC recommends colonization screening using laboratory testing to identify patients who are colonized with resistant pathogens. Coloniza- tion screening identifies unrecognized carriers so that infection control measures can be targeted to prevent the spread of antimicrobial resistance. Traditional therapeutic strategies or medical interventions to decolonize people include: • Topical treatments, such as antiseptic agents like chlorhexidine gluconate for bathing • Antibiotic prophylaxis, such as using antibiotics like neomycin or aminoglycosides • Nasal ointment for the nose, using mupirocin, or povidone-iodine • These decolonization strategies help avoid the loss of beneficial germs and disrupting microbiomes by: • Limiting application to a certain body site/individual microbiome (e.g., in the gut or the nasopharynx, the top part of throat) or targeting specific pathogens • Decreasing the use of antibiotics and antifungals needed to treat infections, which can help slow antimi- crobial resistance • Implementing across larger populations of patients at increased risk for infection or only the subset who are colonized
• Newer, less frequently used strategies include micro- biome therapeutic strategies to reduce the number of pathogens colonizing a person, such as fecal microbiota transplantation for recurrent C. difficile infection. Susceptible Host: Transmission Risks and Factors Influencing Exposures Infection transmission is the result of a complex interrela- tionship between a potential host and an infectious agent that includes many factors. Most of the factors that influence infection and the severity of disease are related to the host. Some hosts are more resistant to infection with strong immune systems and natural barriers, including healthy intact skin and mucous membranes. Lifestyle and personal habits can influ- ence resistance or susceptibility to infection also. Some individuals are prone to becoming transiently or perma- nently colonized but remain asymptomatic. Still others progress from colonization to symptomatic disease either immediately following exposure or after a period of asymptomatic coloni- zation [9]. Other factors influence differences in transmission risks, including environmental factors, types of infectious agents, infection type, prevalence of indwelling devices, intensity of care, length of stay, and frequency of interaction between patients/residents with each other and with healthcare per- sonnel. Understanding these additional factors can assist the healthcare interprofessional team make decisions about early screening, identification, precautions, and workplace practice to prevent and control HAI.
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