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Cloth Lanyards as a Source of Intermittent Transmission of Candida auris on an ICU
Charlotte A Patterson1, Duncan Wyncoll2, Amita Patel1
1Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Objectives:
Candida auris has been implicated in ICU outbreaks worldwide and is notable for being difficult to identify and treat, its resilience in the environment, and significant patient mortality associated with invasive disease. Here, we describe a small C. auris outbreak and how it was terminated.
Design:
Single-center, observational.
Setting:
Two general adult ICUs at an urban U.K. teaching hospital.
Patients:
All patients positive for C. auris during the 5-month outbreak were included (n = 7).
Interventions:
Stepwise implementation of enhanced infection prevention and control precautions was introduced including twice-weekly screening, contact tracing, isolation precautions, and environmental decontamination. A detailed environmental screen was performed to identify potential reservoirs. This included the patient bed space and clinical equipment and a frequently handled cloth lanyard attached to a key used to access controlled drugs. Personal possessions such as mobile phones, lanyards, and identification badges were also screened.
Measurements And Main Results:
The index case and six linked acquisitions were identified. Four of six (67%) patients were identified after discharge of all known previous C. auris cases from ICU, highlighting potential for an environmental reservoir. Environmental screening identified C. auris from a patient bed space following deep cleaning, prompting review and enhancement of cleaning procedures. The controlled drug cloth lanyard was positive for C. auris, which prompted removal and culture of all staff lanyards. C. auris was identified on 1/100 staff lanyards (1%). No mobile phones or identification badges were positive for C. auris. The outbreak terminated following withdrawal of lanyards from ICU.
Conclusions:
This outbreak further implicates environmental reservoirs as sustaining C. auris ICU outbreaks. Identification of C. auris on cloth lanyards highlights the need to identify commonly handled moveable objects during an outbreak. We suggest that ICUs with a C. auris outbreak should investigate similar infrequently cleaned items as potential reservoirs and review their policies on lanyard use.
Insights
A Candida auris outbreak in intensive care units (ICUs) was terminated by enhanced infection control measures. Environmental screening identified contaminated lanyards as a key reservoir, leading to their removal and outbreak cessation.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Candida auris is a multidrug-resistant yeast causing outbreaks in healthcare settings, particularly intensive care units (ICUs).
- Its environmental resilience and difficulty in identification and treatment contribute to significant patient mortality.
- Previous outbreaks have been linked to inadequate infection control and environmental contamination.
Purpose of the Study:
- To describe a small outbreak of Candida auris in two adult ICUs.
- To investigate the source and transmission dynamics of the outbreak.
- To detail the interventions implemented to terminate the outbreak and prevent recurrence.
Main Methods:
- An observational study was conducted over five months in two adult ICUs.
- Enhanced infection prevention and control measures were implemented, including increased screening, isolation, and environmental decontamination.
- Environmental screening targeted patient areas, equipment, and frequently handled personal items, including staff lanyards.
Main Results:
- Seven cases of Candida auris infection were identified during the outbreak.
- Environmental screening detected Candida auris in a patient bed space post-cleaning and on one staff lanyard.
- The outbreak was terminated following the removal of all lanyards from the ICUs.
Conclusions:
- Environmental reservoirs, including frequently handled items like lanyards, can sustain Candida auris outbreaks in ICUs.
- Enhanced environmental cleaning and targeted screening of movable objects are crucial for outbreak control.
- Reviewing policies on items like lanyards may be necessary in ICUs experiencing Candida auris outbreaks.
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