scholarly journals Case Study - Candida auris in Skilled Nursing Facility

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 614-614
Author(s):  
Nancy Vo ◽  
John Chen ◽  
Sayaka Tokumitsu ◽  
Armen Melik-Abramians
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Skilled Nursing Facility ◽  
Resistant Organism ◽  
Team Approach ◽  
Contact Precaution ◽  
Candida Auris ◽  
Nursing Facility ◽  
Positive Skin ◽  
Skilled Nursing

Abstract Candida Auris (C. auris), is a multidrug-resistant organism, first described in Japan 2009, and now a serious, emerging global health threat1. C. auris pathogen can potentiate morbidity and mortality, i.e. lifelong contact precaution isolation, intravenous antifungal treatment, hospitalization and mortality rate of 30-60%1. Los Angeles County (LAC) developed 15 new cases in May 2020, and 73 cases in July 2020, amidst COVID-19 pandemic2. A 88 year old Black female had a positive skin test for C. auris by LAC Department of Public Health (DPH) during skilled nursing facility (SNF) admission for hip fracture in September 2020. Patient’s risk factors for C. auris included: age, kidney transplantation (1998) immunosuppression on tacrolimus, fungal infection on fluconazole, drug-drug interaction between tacrolimus-fluconazole including nephrotoxicity and neurotoxicity, malnutrition, bedbound, Stage 4 sacrococcyx pressure ulcer, osteomyelitis on broad-spectrum antibiotics, chronic indwelling catheter, and healthcare setting. Our multimorbid and frail patient remained asymptomatic with C. auris under an interdisciplinary team approach, including geriatricians, infectious disease, pharmacists, SNF team and local DPH. Our patient’s psychosocial isolation and family distress with local DPH guidelines for COVID-19 SNF visitation restrictions were compounded by multifaceted coordination of patient-centered care between SNF team and specialists via telehealth. Further research in the prevention, detection, and management of C. auris is warranted to protect our vulnerable SNF residents. 1. Centers for Disease Control and Prevention. (2020). Tracking Candida auris. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html 2. Los Angeles County Health Alert Network. (2020). CDPH Health Advisory: Resurgence of Candida auris in Healthcare Facilities in the Setting of COVID-19. http://publichealth.lacounty.gov/eprp/lahan/alerts/CAHANCauris082020.pdf

scholarly journals COVID-19 Outbreak Among Vaccinated Staff and Residents at a Skilled Nursing Facility in Los Angeles County

2021 ◽  
pp. 1-5
Author(s):  
Prabhu Gounder ◽  
Mona Saint ◽  
Cesar Larios ◽  
Nicole Fountas ◽  
Patrick Tran ◽  
...  
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

scholarly journals 897. Prevalence of Candida auris at Body Sites, Characterization of Skin Microbiota, and Relation of Chlorhexidine Gluconate (CHG) Skin Concentration to C. auris Detection Among Patients at a High-Prevalence Ventilator-Capable Skilled Nursing Facility (vSNF) with Established CHG Bathing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S25-S26 ◽  
Author(s):  
Mary K Hayden ◽  
Thelma E Dangana ◽  
Rachel D Yelin ◽  
Michael Schoeny ◽  
Pamela B Bell ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Skin Microbiome ◽  
Body Site ◽  
Candida Auris ◽  
Candida Spp ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Mechanically Ventilated ◽  
High Prevalence ◽  
High Concentrations

Abstract Background vSNF patients are at high risk of colonization and infection with C. auris. CHG bathing has been used as an intervention to reduce nosocomial transmission of multi-drug-resistant organisms, but its effect on C. auris is unclear. Methods We studied a 70-bed ventilator ward in a 300-bed vSNF in Chicago, IL with a high prevalence of C. auris and established CHG bathing. Swab samples were collected from patients for culture, microbiome analysis, and CHG skin concentration testing (Table 1). Results We collected 2,467 samples (950 culture, 950 microbiome, 567 CHG) from 57 patients during 2 surveys conducted January–March 2019. Forty-six (81%) patients had C. auris cultured from ≥1 body site. Mean (±SD) age was 59 (±14) years, 40% were women, 70% were African American, mean (±SD) Charlson score was 3 (±2). Patients colonized with C. auris were more likely to be mechanically ventilated (50% vs. 0%, P < 0.001), have a gastrostomy tube (78% vs. 27%, P < 0.001) or have urinary catheter (72% vs. 23%, P = 0.01) than noncolonized patients. Frequency of C. auris isolation varied among 10 body sites tested (P < 0.001); colonization of anterior nares (41%) and hands (40%) was detected most often (Figure 1). By ITS1 analysis, all isolates were members of the C. auris South American clade. Skin microbiome sequencing confirmed culture Results. While Malassezia is the dominant genera observed in healthy volunteers and patients in this vSNF, C. auris was observed to dominate the fungal community of multiple skin sites, including nares, hands, inguinal, toe web (Figure 2). Other Candida spp. were also identified on the skin of patients in the current study, but at lower relative abundance. CHG was detected on skin of 52 (91%) patients (median CHG concentration 19.5 µg/mL; IQR 4.9–78.1 µg/mL). In a mixed-effects model controlling for body site and multiple measurements per patient, odds of C. auris detection by culture were less at CHG concentrations ≥625 µg/mL than at lower concentrations (Figure 3; OR 0.25, 95% CI: 0.10–0.66; P = 0.005). Conclusion Frequent C. auris colonization of vSNF patients’ anterior nares and hands suggests that nasal decolonization and patient hand hygiene are potential options to reduce C. auris transmission. High concentrations of CHG may be needed to suppress C. auris on skin. Disclosures All Authors: No reported Disclosures.

scholarly journals Risk Factors for Colistin Resistance among Gram-Negative Rods andKlebsiella pneumoniaeIsolates

2018 ◽  
Vol 56 (9) ◽  
Author(s):  
Stefan E. Richter ◽  
Loren Miller ◽  
Daniel Z. Uslan ◽  
Douglas Bell ◽  
Karol Watson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skilled Nursing Facility ◽  
Resistant Organism ◽  
Neurologic Disease ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Gram Negative ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Prior Infection

ABSTRACTInfections due to colistin-resistant (Colr) Gram-negative rods (GNRs) and colistin-resistantKlebsiella pneumoniaeisolates in particular result in high associated mortality and poor treatment options. To determine the risk factors for recovery on culture of ColrGNRs and ColrK. pneumoniae, analyses were chosen to aid decisions at two separate time points: the first when only Gram stain results are available without any bacterial species information (corresponding to the ColrGNR model) and the second when organism identification is performed but prior to reporting of antimicrobial susceptibility testing results (corresponding to the ColrK. pneumoniaemodel). Cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. After excluding bacteria that were intrinsically resistant to colistin, a total of 28,512 GNR isolates (4,557K. pneumoniaeisolates) were analyzed, 128 of which were Colr(i.e., MIC > 2 μg/ml), including 68 of which that were ColrK. pneumoniae. In multivariate analysis, risk factors for ColrGNRs were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, prior infection with a carbapenem-resistant organism, and receipt of ventilatory support (c-statistic = 0.81). Risk factors for ColrK. pneumoniaespecifically were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, receipt of an anti-methicillin-resistantStaphylococcus aureusantimicrobial in the last 90 days, and prior infection with a carbapenem-resistant organism (c-statistic = 0.89). A scoring system derived from these models can be applied by providers to guide empirical antimicrobial therapy in patients with infections with suspected ColrGNR and ColrK. pneumoniaeisolates.

scholarly journals Regional Emergence of Candida auris in Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility

2020 ◽  
Vol 71 (11) ◽  
pp. e718-e725 ◽  
Author(s):  
Massimo Pacilli ◽  
Janna L Kerins ◽  
Whitney J Clegg ◽  
Kelly A Walblay ◽  
Hira Adil ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Lessons Learned ◽  
Candida Auris ◽  
Public Health Response ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
High Acuity

Abstract Background Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). Methods We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016–December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. Results During August 2016–December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23–71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. Conclusions High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.

scholarly journals Antimicrobial-Resistant Organism Outbreak in a Skilled Nursing Facility in Pennsylvania, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s122-s122
Author(s):  
Julie Paoline ◽  
Michel Masters ◽  
Feba Cheriyan ◽  
Cara Bicking Kinsey
Keyword(s):  
Public Health ◽  
Hand Hygiene ◽  
Infection Control ◽  
Skilled Nursing Facility ◽  
Direct Care ◽  
Infection Prevention And Control ◽  
Resistant Organism ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Cord Injury

Background: In April 2019, the Montgomery County Office of Public Health (MCOPH) was notified by the Pennsylvania Department of Health (PADOH) of a tier 2 carbapenemase mechanism in a resident of a Pennsylvania skilled nursing facility that was detected through targeted surveillance. Production of the New Delhi metallo-β-lactamase (NDM) carbapenemase was detected using polymerase chain reaction (PCR). The initial follow-up revealed that the patient resided at a 148-bed skilled nursing facility that specializes in spinal cord injury, neurological diseases, ventilator dependence, and pulmonary diseases. MCOPH and PADOH initiated an investigation to identify additional cases and prevent transmission. Methods: Over a series of 9 point-prevalence surveys, we collected 518 specimens for colonization screening. Screening was conducted on the wing of the index case and was later expanded to include the entire unit (n = 90), after evidence of transmission was noted. Perirectal swabs were submitted to the regional antibiotic resistance laboratory for testing using the Cepheid GeneXpert Carba-R assay. Together with screening, MCOPH and PADOH conducted a series of on-site visits involving the completion of the CDC infection control assessment and response (ICAR) tool and direct care observations, including 409 hand hygiene observations. Results: In addition to NDM, Klebsiella pneumoniae carbapenemase (KPC) and Verona integron-encoded metallo-β-lactamase (VIM) were also detected. ICAR results and direct care observations revealed numerous deficiencies in the domains of hand hygiene, personal protective equipment, and environmental cleaning. In addition to 2 cases of carbapenemase-producing organisms (CPO) being detected through clinical specimens, an additional 27 CPO cases were identified through screening coordinated by public health. This large, multimechanism outbreak is attributed to a combination of intrafacility transmission and imported cases. Based on these findings, recommendations for infection prevention and control were provided on site and in writing. Our continued work with this facility lead to improvements in infection control, including a HH success rate improvement of 53%. Conclusions: Novel or targeted multidrug-resistant organisms are effectively contained when healthcare facilities and state and local public health work together to reduce transmission to baseline and to improve infection control practices.Funding: NoneDisclosures: None

scholarly journals Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility

2021 ◽  
Author(s):  
Diana M. Proctor ◽  
Thelma Dangana ◽  
D. Joseph Sexton ◽  
Christine Fukuda ◽  
Rachel D. Yelin ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Candida Auris ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Epidemiologic Investigation ◽  
Skin Colonization

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Sign in / Sign up

Export Citation Format

Share Document