How one medical center fought off an emerging infectious disease threat
WHEN A PATIENT arrived at OU Medical Center in Oklahoma City in April 2017 with a fungal infection, it took a rapid response to prevent a potentially severe outbreak of an emerging global multidrug-resistant infectious disease.
The patient was infected with Candida auris, a type of yeast that’s appeared in more than 600 patients in 12 states as of March 2019, according to the Centers for Disease Control and Prevention.
Unlike typical fungal infections, C. auris acts more like an antimicrobial-resistant bacterial infection that can spread quickly to other patients or healthcare personnel. The infection can enter the bloodstream and an invasive infection causes death in more than 1 in 3 patients.
“We, as healthcare professionals, are not used to being worried about a fungus spreading,” said Dr. Tom Chiller, chief of the mycotic diseases branch at the CDC’s division of foodborne, waterborne and environmental diseases. “We don’t typically worry about a patient with Candida in their bloodstream spreading that infection potentially to other patients in that hospital.”
The unusual nature of C. auris can lead to unintentional infections if it is diagnosed as a typical fungus, making rapid identification an essential component of the response.
For many hospitals, the process of identifying a potentially infectious organism can take several days as samples are sent to the local or state health department laboratory and then sent to a CDC lab for confirmation.
But OU Medical Center was able to identify the fungus within 24 hours of admitting the patient by having lab technology on-site. “That was the first step to our success,” said Dr. Linda Salinas, epidemiologist and chief quality officer at OU Medical Center. The hospital used matrix-assisted laser desorption ionization imaging, which is an ionization technique that creates ions from large molecules to analyze biomolecules.
Salinas said the patient was quickly isolated upon arrival at the hospital because that person had other drug-resistant infections that were found prior to confirmation of C. auris.
The hospital’s infection-control team implemented disinfection protocols similar to those used for patients with Clostridium difficile, a common bacterial infection that causes nearly half a million illnesses a year. Bleach was applied to all surfaces of the patient’s room twice daily. Members of the CDC’s infectious disease response team were on-site within a few days to educate clinicians on proper handling of devices and protective gear to reduce the risk of spreading the infection beyond the patient’s room. Patient bed linen was separated from the rest of the hospital’s laundry and cleaned on its own to reduce contamination.
Aside from physicians, the care team consisted of one nurse per shift, which Salinas said reduced the likelihood of infection among care personnel.
Even though the safety-net hospital routinely reinforces proper hand hygiene techniques, the threat of C. auris offered an added level of alert to make sure such practices were stringently followed.
“These are protocols that have been a part of our infection-control plan for many years,” Salinas said.
Such practices resulted in the C. auris being contained to the one patient, who was treated and discharged within a week.
OU Medical is one of only a few facilities that have been able to successfully contain the spread of C. auris. More than a hundred cases have occurred in New Jersey and Illinois, while New York has had more than 300 reported cases since the fungus was first introduced to the U.S. in 2013.
Salinas acknowledged that OU Medical Center’s ability to identify C. auris in its own lab helped cut a step from the process and was a key factor in responding quickly. But she said hospitals without such resources could minimize their risk by strictly adhering to their infection-control processes each time they encounter similar threats.
“It’s important to follow your structure and process and limit your variation,” Salinas said. ●