Patients colonized or infected with
) continue to be identified in Orange County.
Point prevalence surveys, with testing of all residents of a facility, have been completed in all long term acute care hospitals (LTACs) and skilled nursing facilities that provide ventilator (vSNFs) in Orange County. Multiple LTACs and vSNFs were found to have patients who are
colonized. Over 100 colonized patients have been identified thus far. Several facilities had no colonized patients identified, and some facilities who initially had colonized patients identified no longer have evidence of ongoing
In communities experiencing
outbreaks, colonization and disease rates have consistently been highest in residents of LTACs and vSNFs. However,
transmission has likely occurred in a variety of healthcare settings during this event. Appropriate infection control measures should be taken by healthcare providers in all settings.
OCHCA is working with all facilities where
-colonized patients have been identified to assure that receiving facilities are informed of the situation when patients are transferred.
Updated recommendations for healthcare facilities receiving patients from LTACs and vSNFs with potential ongoing spread of
- Hospitals should institute empiric Standard and Contact Precautions.
- Skilled nursing facilities should institute either empiric Contact Precautions or Enhanced Standard Precautions, depending on the clinical status of the patient and the C. auris epidemiology of the facility.
- Admission screening for C. auris should be performed by receiving facilities for all patients who may be admitted for a prolonged period (one week or longer) from facilities with potential ongoing C. auris spread.
- Admission screening for C. auris should include a composite swab of the axilla and groin.
- Screening of nares for colonization has been found to add little sensitivity to axilla and groin swabbing and is no longer recommended.
- Patients who have been previously screened at a facility with C. auris-colonized patients should still have admission screening performed at the accepting facility.
- Culture testing for C. auris colonization is available through the Centers for Disease Control and Prevention (CDC) and takes 7-21 days to result.
- Receiving facilities should contact OCHCA at 714-834-8180 to arrange for receipt of screening swabs and to coordinate their transfer to a public health laboratory for testing.
- Facility-to-facility communication is critical when transferring a patient who is suspected or confirmed to be colonized or infected with C. auris. Any receiving facility should be made aware of the patient’s status.
- Hospitals that frequently share patients with Orange County LTACs and/or with vSNFs where C. auris-colonized patients have been identified are currently recommended to perform species identification of all clinical Candida isolates, regardless of specimen source. OCHCA has contacted the affected facilities regarding this recommendation. Enhanced Candida speciation will help assure identification of C. auris. No additional surveillance or infection control measures are recommended for these hospitals at this point.