What is a busy nursing home administrator or director of nursing to make of a deadly, drug-resistant fungus outbreak that has now spread to a dozen states?
Our coverage of the Candida auris generated lots of interest last week, and seemed to warrant another close look. This emerging fungus poses a global threat and can be particularly dangerous for sick older patients who have had an invasive medical procedure, according to the Centers for Disease Control and Prevention.
So far, there have been 587 reported cases of C. auris, with New York, Illinois and New Jersey the hardest hit, in that order. The fungus is not believed to be widespread in SNFs, but the American Health Care Association is paying close attention and providing guidance to its members about the spread of the infection, said David Gifford, M.D., the group’s senior VP of quality and regulatory affairs. He added that it is crucial that nursing facilities know how to identify, treat and control C. auris.
I recently spent a few minutes with Snigdha Vallabhaneni, M.D., a medical epidemiologist with the CDC, who works on its Antimicrobial Resistance Team as part of the Prevention and Response Branch. Her first bit of advice for skilled care providers is to treat this just the same as any other outbreak of infectious disease. It “really could affect any facility,” but especially those high-acuity nursing homes that treat patients, for instance, with ventilators or tracheostomies. However, it has hit some of the low-acuity places, too, she added. Yeast in the urine is one telltale sign of possible C. auris in a patient, she noted, while having traveled abroad is also a risk factor.
“The best way to prepare for this is to really examine the culture around infection control in the nursing home and be prepared for C. auris, just as you would be prepared for any other organism,” Vallabhaneni told McKnight’s. “That can range anywhere from C. diff, which nursing homes are really familiar with, to something like Ebola, which is probably a very unlikely scenario.”
Bolstering infection control, of course, is crucial and that starts with instituting a proper hand hygiene culture, washing up and using alcohol-based hand rub for every entry and exit, and for every patient-care activity. It also means having appropriate personal protective equipment. Nursing home operators also must make sure that they’re “paying a lot of attention” to environmental disinfection.
“In all of our assessments of nursing homes, hand hygiene and environmental disinfection are two places where there could be a lot of improvements. That means making sure that the rooms are cleaned on a regular basis, and that they’re using the disinfectants that work,” Vallabhaneni told me.
As further proof of that notion, a Centers for Medicare & Medicaid Services official noted last year, and even last week again at the annual AANAC/AADNS conference, that infection prevention continues to be a big challenge for the field. It was the No. 1 deficiency cited in SNF surveys last year, as it was the previous year. Adding further fuel to the fire, a recent study found that privacy curtains in skilled nursing facilities are a breeding ground for drug-resistant bacteria.
Providers in the hardest hit states mentioned previously should be on highest alert. Other states on the list — such as Texas, California and Massachusetts — have seen only a single-digit number of reports so far, according to the CDC.
While C. auris is potentially deadly, it’s been difficult for the centers to pinpoint an accurate count of deaths attributable to the disease. Many patients who have contracted it were already gravely ill and it can be hard to determine the underlying cause of mortality. About half of the nearly 600 reported cases were bloodstream infections, and about 40% of those with such a variety of C. auris die during hospitalization, Vallabhaneni said. “We’re seeing a very high death rate, but it just may not necessarily be from this specific infection,” she said.
The bottom line out of all of this is that nursing home leaders should take this outbreak as an opportunity to freshen up their infection control efforts. The CDC has plenty of tools to aid in the effort, including a nursing home infection preventionist training course, and more guidance on the topic here. Their Candida auris website also has plenty of goodies.
The CDC expert said that a “culture shift” really needs to occur in SNFs, so that infection control is addressed in the same widespread fashion as fall prevention.
“We want an infection control revolution in nursing homes, where this issue is taken very seriously,” Vallabhaneni said.
“The main message,” she emphasized, “is that any nursing home should be ready for this.”
Follow Staff Writer Marty Stempniak @MStempniak.