Infection control guidance issued for emerging fungal threat

Public Health England (PHE) has issued updated guidance on tackling Candida auris for healthcare providers and healthcare professionals, as well as a separate document aimed at community care settings.

“The spread of this fungus shows the increasing threat from resistant organisms”

Neil Wigglesworth

C. auris first appeared in Japan in 2009 but has subsequently spread across the globe. By the end of July, over 200 patients had been detected with it in the UK in 20 NHS trusts and private providers.

In addition, over 35 other UK hospitals have received patients with a known C. auris infection, said PHE in its new guidance, which was published on 11 August.

C. auris is a pathogenic yeast species that had been reported to cause bloodstream infections, wound infections, and otitis. It has also been cultured from urine and the respiratory tract.

However, unlike other pathogenic yeast species, PHE highlighted that C. auris appears to have a “propensity for transmission between hospital patients”.

It is also commonly resistant to the first-line antifungal, fluconazole and can develop resistance to other classes of anti-fungal agents, warned PHE.

“It appears to be highly transmissible between patients and from contaminated environments”

PHE guidance

C. auris affects both paediatric and adult populations, and has predominantly been identified in critically unwell patients in high dependency settings, added the government arm’s-length body.

PHE stated: “There have been three large nosocomial intensive care unit outbreaks in England, which despite intensive infection prevention and control measures have been difficult to control.”

“It appears to be highly transmissible between patients and from contaminated environments, highlighting the importance of instituting effective infection prevention and control practices,” it said.

PHE advised that first-line therapy remained an echinocandin anti-fungal drug, “pending specific susceptibility testing which should be undertaken as soon as possible”.

All affected patients should be isolated in a single room with en-suite facilities, wherever possible, with clinicians strictly adhering to standard infection control precautions.

It recommended that strategies to prevent colonisation should include strict adherence to central and peripheral catheter care bundles, urinary catheter care bundle and care of the tracheostomy site; prompt removal of venous cannulas if there is any sign of infection; and skin decontamination with chlorhexidine washes in critically ill patients.

Once the patient had left the room or area, PHE said a “terminal clean” should be undertaken using a chlorine-based agent at 1,000ppm of available chlorine.

In addition, all trusts have been “encouraged” to develop a screening policy after local risk assessments are undertaken.

Meanwhile, the guidance for nursing homes and other community care settings stated that there was “no reason” to refuse admission or re-admission for patients colonised or infected with C. auris.

But it said staff should take “particular care” when undertaking dressings, and managing or changing urinary catheters and other devices.

A discharging wound should be secured with an impermeable dressing and any environmental contamination, from the wound or other body fluids, cleaned “immediately”.

Additionally, it was important that individuals and their families understand both their diagnosis and the importance of infection control measures such as hand washing, noted PHE.

Commenting on the new guidance, Dr Neil Wigglesworth, president of the Infection Prevention Society, said: “The spread of this fungus shows the increasing threat from resistant organisms.

“The outbreaks reinforce the importance of rigorous infection prevention and control practices to help prevent further occurrences,” he said.

“Early intervention through infection prevention will help ensure patient safety as well as protecting vital NHS resources,” said Dr Wiglesworth.

He added: “Hospital trusts in England should follow PHE’s guidance and ensure they have plans in place to identify and manage any cases of Candida auris. Similar plans should also be implemented in Scotland, Wales and Northern Ireland.”

• The role of vaccination in preventing antimicrobial resistance
• Prevention by breaking the chain of infection