Mitigating Candida auris at a Busy Community Hospital: A Quasi-Experimental Near Real-Time Approach

Abstract Background Candida auris, an emerging multidrug-resistant pathogen associated with increased mortality, can disseminate on hospital surfaces and resist disinfection. Transmission dynamics remain poorly understood at community hospitals. Immediately following identification of a C. auris infection in an unsuspected patient admitted to a semi-private room 6 days previously, we sought to limit and determine the extent of C. auris contamination at Rochester General (RG), a 528-bed hospital in New York, using available resources. Methods The index and roommate were placed on enhanced contact precautions and moved to private rooms. Their former room was terminally cleaned with peracetic acid/hydrogen peroxide (PAHP) and UV light. Ten high-touch environmental surfaces in the new rooms of the index and roommate, the nursing stations, and throughout the ward were sampled immediately before and after, and between daily cleaning. The nares, axillae, and groin of the index, the roommate, and all concurrent ward patients were also sampled. All patients on the involved ward were sequentially moved from their initial rooms into vacated rooms that were terminally cleaned with PAHP and UV light. Prior to the index event, RG laboratory began sending all possible C. auris isolates to the state public health laboratory for confirmation, and using PAHP for all cleaning. RG also leverages preexisting agreements with other referral laboratories to support outbreak investigations. Hand-hygiene compliance averaged 80–90% on the ward. Hospital leaders, laboratory, nursing, environmental services, and local public health personnel regularly participate in infection prevention efforts. Results C. auris was isolated from 3 of 132 surface samples on the eighth, nineth, and 15th day of ward occupancy, and 0 of 48 patient samples from 18 co-located patients. The index remained colonized until death on hospital Day 21. No surfaces were C. auris-positive 1 month later. Conclusion Compared with prior reports, dissemination at RG was limited. This, the first such quantitative assessment, illustrates how community hospitals can enhance surveillance and patient safety when formal agreements, vigilance, and multi-disciplinary and interagency teamwork exist before outbreaks occur. Disclosures All authors: No reported disclosures.

Download Full-text

1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1443 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S576-S577

Author(s):

Brittany O’Brien ◽

Sudha Chaturvedi ◽

Vishnu Chaturvedi

Keyword(s):

New York ◽

Diagnostic System ◽

Multidrug Resistant ◽

Drug Combinations ◽

Antifungal Drugs ◽

Drug Resistant ◽

Candida Auris ◽

Current Case ◽

Healthcare Facilities ◽

Broth Microdilution Method

Abstract Background Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs. Methods BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC). Results We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates. Conclusion We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia. Disclosures All authors: No reported disclosures.

Download Full-text

Alcohol Consumption by Older New York City Residents: The Need for New Policies to Address Misuse

Alcohol and Alcoholism ◽

10.1093/alcalc/agaa022 ◽

2020 ◽

Vol 55 (4) ◽

pp. 448-454

Author(s):

Daniel Weisz ◽

Michael Kelley Gusmano

Keyword(s):

Public Health ◽

New York ◽

New York City ◽

Alcohol Consumption ◽

Alcohol Use ◽

York City ◽

Alcohol Misuse ◽

Cross Sectional ◽

Local Public Health ◽

New Public Health

Abstract Aims The aim of this study is to assess risk factors for alcohol misuse among older New York City residents and examine the effect of local public health efforts to address alcohol misuse. Methods The Community Health Survey, a cross-sectional telephone survey of 8500 randomly selected adult New Yorkers, records the frequency of alcohol use. We examine these results among 65 and older subjects by sociodemographic status using logistic regression modeling and compare trends in smoking and alcohol consumption between 2002 and 2016. Results Those with unhealthy drinking habits, combining binge drinking and excessive consumption, constituted 5.7% of 65 plus population and were more likely to be White, US born, healthy, better educated and wealthier. The percentage of older smokers in New York City has decreased while unhealthy drinking is nearly flat since 2002. Conclusions Our findings reinforce the importance of screening geriatric populations for alcohol use disorders and support the development of new public health efforts to address alcohol misuse if the city is to achieve results similar to those obtained in decreasing tobacco consumption.

Download Full-text

1146. Effectiveness of Ultraviolet Irradiation on Candida auris: A Laboratory Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.979 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S345-S345

Author(s):

Gennifer Garmon ◽

Dhammika Navarathna ◽

John Coppin ◽

Marjory Williams ◽

Chetan Jinadatha

Keyword(s):

Stainless Steel ◽

Prolonged Exposure ◽

Uv Light ◽

Multidrug Resistant ◽

Published Data ◽

Log10 Reduction ◽

Healthcare Associated Infection ◽

Candida Auris ◽

Light Emitting Devices ◽

Log Reduction

Abstract Background Candida auris is a multidrug-resistant yeast which persists on healthcare surfaces for prolonged periods of time and is an emerging pathogen in hospitals. It has been linked to healthcare-associated infection (HAI) through surface transmission. Mobile ultraviolet (UV) light emitting devices from mercury sources have been shown to be effective in reducing C. auris bioburden but require prolonged exposure. In this study, we demonstrate the efficacy of an UV emitting device used in our hospital for terminal disinfection on C. auris. Methods Two C. auris strains (AR-381-CAU-01 and CAU-02) isolates obtained from Centers for Disease Prevention and Control (CDC) were used along with a Candida albicans (C. albicans) strain. An organism load of 10 μL containing 106 colony forming unit (CFU) was spread on a 20-mm diameter stainless steel coupon and exposed to the UV source from a pulsed xenon device at 5 feet distance and 4 feet height for 5, 10, and 30 minutes. Killing efficacy in terms of log reduction was calculated in comparison to untreated control coupons. Results Mean CFU log10 reduction for C. albicans, CAU-01, and CAU-02 was 0.547, 1.051, and 0.952 at 5 minutes; 1.412, 1.975, and 1.879 at 10 minutes; and 2.639, 3.971, and 4.145 at 30 minutes, respectively. Figure 1 describes the mean log10 reduction as well as the minimum and maximum log reduction by isolates. Conclusion Our study demonstrates the UV from a pulsed xenon device is effective in reducing the C. auris on stainless steel coupons. Similar to previously published data on reduction of C. auris by other UV sources, extended exposure is required to achieve a higher log reduction of C. auris. We did not have any C. auris clinical infections to assess efficacy of UV on HAI reduction. Disclosures C. Jinadatha, Xenex Healthcare Service: Grant Investigator, Research grant.

Download Full-text

2267. Epidemiology of Candida auris Candidemia in a Teaching Hospital in North of Oman: One-Year Survival

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1945 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S776-S776

Author(s):

Arash Eatemadi ◽

Aiman Al Wahibi ◽

Hilal Al shibli ◽

Ali Al reesi

Keyword(s):

Public Health ◽

Teaching Hospital ◽

Multidrug Resistant ◽

Hospital Environment ◽

Fungal Treatment ◽

Candida Auris ◽

Coagulase Negative Staphylococci ◽

Central Public Health ◽

Antibiotic Susceptibility Test ◽

Recent Emergence

Abstract Background Recent emergence of Candida auris as a multidrug resistant fungal pathogen, is a serious concerns for public health. However, there is a paucity of reported cases from Oman. Literature search resulted in finding only 7 cases from Oman, reporting C. auris infections in the articles first published in 2017. However, the rate of isolatin is increasing. Methods In this study, we included the results of all positive blood cultures of C. auris in Suhar teaching hospital from May 2018 (date of first detection) till end of April 2019. Further confirmation of the species was performed by MALDI-TOF and antibiotic susceptibility test (AST) by Vitek 2 in central public health laboratory (CPHL) of Oman. Results We detected 13 patients (9 females, 4 males). The mean age was 58.61% years (28–76 years). All candidemic patients had serious underlying conditions, including prolonged hospital stay or extensive and prolonged antimicrobial exposure or medical comorbidities (8 of 13). The time from hospital admission to onset of C. auris candidemia was 8–49 days, with a median of approximately 27 days. The most common isolated co- pathogen from blood culture was K. pneumonia (without regard to Coagulase-negative staphylococci). As average, every patient received 4.8 kind of different antibiotics in mean 88 doses before candidemia developed and piperacillin–tazobactam was the most common used antibiotics. AST was done just for 5 patients and revealed high-level resistance to fluconazole and Amphotricin B while, Echinocandins (anidulafungin, caspofungin) were fully sensitive and voricunazole had intermediate sensitivity. Mean duration of anti-fungal treatment was 12.5 days (5 – 26 days). 8 patients treated by Echinocandins (4/8 died), 4 by Fluconazole (3/4 died) and one without treatment discharged. 30-day all-cause mortality was 61.5%. Conclusion In Oman, C. auris has been reported from many hospitals. Resistance to several antifungal agents and persistence in the hospital environment make this organism a potential menace for the treating physician and the infection control personnel. In our hospital, every candidemic patient should be treated with Echinocandins and assumed to be resistant to Fluconazole until proven otherwise according to results of AST. Disclosures All authors: No reported disclosures.

Download Full-text

Hand Hygiene, Cohorting, or Antibiotic Restriction to Control Outbreaks of Multidrug-Resistant Enterobacteriaceae

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.284 ◽

2015 ◽

Vol 37 (3) ◽

pp. 272-280 ◽

Cited By ~ 27

Author(s):

Camille Pelat ◽

Lidia Kardaś-Słoma ◽

Gabriel Birgand ◽

Etienne Ruppé ◽

Michaël Schwarzinger ◽

...

Keyword(s):

Hand Hygiene ◽

Multidrug Resistant ◽

Transmission Model ◽

Patient Contact ◽

Hand Hygiene Improvement ◽

Single Carrier ◽

Before And After ◽

Hygiene Compliance ◽

Using Data ◽

Improvement Intervention

BACKGROUNDThe best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.OBJECTIVEWe developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.METHODSWe modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.RESULTSImproving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.CONCLUSIONOur results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.Infect. Control Hosp. Epidemiol. 2016;37(3):272–280

Download Full-text

Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/591940 ◽

2008 ◽

Vol 29 (11) ◽

pp. 1035-1041 ◽

Cited By ~ 160

Author(s):

Philip C. Carling ◽

Michael M. Parry ◽

Mark E. Rupp ◽

John L. Po ◽

Brian Dick ◽

...

Keyword(s):

Acute Care ◽

Performance Feedback ◽

Hospital Setting ◽

Acute Care Hospitals ◽

The United States ◽

Multidrug Resistant ◽

Environmental Services ◽

Environmental Surfaces ◽

Before And After ◽

Quasi Experimental

Objective.The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.Design.Prospective quasi-experimental, before-after, study.Setting.Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.Methods.We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.Results.Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).Conclusions.Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.

Download Full-text

Health Promotion at the Ballpark

Health Promotion Practice ◽

10.1177/1524839916663684 ◽

2016 ◽

Vol 18 (2) ◽

pp. 229-237 ◽

Cited By ~ 2

Author(s):

Bonni C. Hodges

Keyword(s):

Public Health ◽

New York ◽

Health Promotion ◽

Information Dissemination ◽

Cognitive Theory ◽

Environmental Changes ◽

Health Priorities ◽

Local Health ◽

Local Public Health ◽

Collegiate Baseball

The arrival of a new summer collegiate baseball league franchise to a small central New York city was seen as an opportunity for health promotion. The initiative was set up to explore two overarching questions: (1) Are summer collegiate baseball events acceptable to local public health organizations as viable places for health promotion activities addressing local health issues? (2) Are summer collegiate baseball organizations amenable to health promotion activities built in to their fan and/or player experiences? Planning and implementation were guided by precede–proceed, social cognitive theory, social marketing, and diffusion of innovations constructs. Environmental changes were implemented to support healthy eating and nontobacco use by players and fans; four health awareness nights were implemented at home games corresponding to local public health priorities and included public service announcements, between inning quizzes, information dissemination at concession and team market locations, and special guests. Sales and fan feedback support mostly healthy concession offerings and a tobacco-free ballpark; postseason evaluations from team staff and public health partners support continuing the trials of this sports event as a venue for health promotion.

Download Full-text

A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission

PLoS ONE ◽

10.1371/journal.pone.0250455 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250455

Author(s):

Raeseok Lee ◽

Su-Mi Choi ◽

Sung Jin Jo ◽

Songyi Han ◽

Yun Jeong Park ◽

...

Keyword(s):

Experimental Study ◽

Education And Training ◽

Multidrug Resistant ◽

Blood Agar Plate ◽

Resistant Bacteria ◽

Contamination Rate ◽

Nosocomial Pathogens ◽

Before And After ◽

Quasi Experimental ◽

And Training

Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and effectiveness of disinfection training to reduce. This study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in disinfection of stethoscopes among healthcare workers (HCWs) before and after education and training. We performed a prospective pre and post quasi-experimental study. A total of 100 HCWs (55 doctors and 45 nurses) were recruited. HCWs were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis was performed to determine the relatedness of carbapenem-resistant Enterobacteriaceae. Most of the stethoscopes were contaminated with microorganisms before and after the intervention (97.9% and 91.5%, respectively). The contamination rate of stethoscopes with nosocomial pathogens before and after education was 20.8% and 19.2%, respectively. Stethoscope disinfection habits improved (55.1% vs 31.0%; p<0.001), and the overall bacterial loads of contamination were reduced (median colony-forming units, 15 vs 10; p = 0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae isolates from a stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used. Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and might act as a vehicle of MDR bacteria. Continuous, consistent education and training should be provided to HCWs using multifaceted approach to reduce the nosocomial transmission via stethoscopes.

Download Full-text

Impact of Replacing Powdered Gloves With Powder-free Gloves on Hand-hygiene Compliance Among Healthcare Workers of an Intensive Care Unit: a Quasi-experimental Study

10.21203/rs.3.rs-81396/v1 ◽

2020 ◽

Author(s):

Mayra Gonçalves Menegueti ◽

Fernando Bellissimo-Rodrigues ◽

Marcia A. Ciol ◽

Maria Auxiliadora-Martins ◽

Anibal Basile-Filho ◽

...

Keyword(s):

Intensive Care Unit ◽

Experimental Study ◽

Hand Hygiene ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Latex Gloves ◽

Before And After ◽

Quasi Experimental ◽

Hygiene Compliance ◽

Powdered Latex Gloves

Abstract Background/Objective. After wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU). Methods. A quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization (WHO) Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual’s percentage of compliance using the t test for paired data before and after the intervention.Results. Overall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% Confidence Interval [CI]: 51-59%) using powdered latex gloves and 60% (95% CI: 57-63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI: 2.5-7.6%, p<0.001).Conclusion. Our data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.

Download Full-text

In Vitro Evaluation of Antifungal Drug Combinations against Multidrug-Resistant Candida auris Isolates from New York Outbreak

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02195-19 ◽

2020 ◽

Vol 64 (4) ◽

Cited By ~ 6

Author(s):

Brittany O’Brien ◽

Sudha Chaturvedi ◽

Vishnu Chaturvedi

Keyword(s):

New York ◽

Drug Combination ◽

Multidrug Resistant ◽

Drug Combinations ◽

Health Care Facilities ◽

Antifungal Drugs ◽

Candida Auris ◽

Pathogenic Yeast ◽

Content Type

ABSTRACT Since 2016, New York hospitals and health care facilities have faced an unprecedented outbreak of the pathogenic yeast Candida auris. We tested over 1,000 C. auris isolates from affected facilities and found high resistance to fluconazole (MIC > 256 mg/liter) and variable resistance to other antifungal drugs. Therefore, we tested if two-drug combinations are effective in vitro against multidrug-resistant C. auris. Broth microdilution antifungal combination plates were custom manufactured by TREK Diagnostic System. We used 100% inhibition endpoints for the drug combination as reported earlier for the intra- and interlaboratory agreements against Candida species. The results were derived from 12,960 readings, for 15 C. auris isolates tested against 864 two-drug antifungal combinations for nine antifungal drugs. Flucytosine (5FC) at 1.0 mg/liter potentiated the most combinations. For nine C. auris isolates resistant to amphotericin B (AMB; MIC ≥ 2.0 mg/liter), AMB-5FC (0.25/1.0 mg/liter) yielded 100% inhibition. Six C. auris isolates resistant to three echinocandins (anidulafungin [AFG], MIC ≥ 4.0 mg/liter; caspofungin [CAS], MIC ≥ 2.0 mg/liter; and micafungin [MFG], MIC ≥ 4.0 mg/liter) were 100% inhibited by AFG-5FC and CAS-5FC (0.0078/1 mg/liter) and MFG-5FC (0.12/1 mg/liter). None of the combinations were effective for C. auris 18-1 and 18-13 (fluconazole [FLC] > 256 mg/liter, 5FC > 32 mg/liter) except MFG-5FC (0.1/0.06 mg/liter). Thirteen isolates with a high voriconazole (VRC) MIC (>2 mg/liter) were 100% inhibited by the VRC-5FC (0.015/1 mg/liter). The simplified two-drug combination susceptibility test format would permit laboratories to provide clinicians and public health experts with additional data to manage multidrug-resistant C. auris.

Download Full-text