Quality & Patient Safety

Keeping fungi at bay

Patient Safety Monitor, May 17, 2017

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In March, The Washington Post ran an alarming story about a new strain of Candida auris (C. auris) fungus in U.S. hospitals. At presstime, there were more than 50 C. auris cases in the U.S., mostly clustered in the Northeast.
This particular fungus raises several concerns. First, some of its strains are resistant to all three classes of antifungal drugs. Its spores are extremely durable and can survive on skin and surfaces (such as doorknobs and bedrails) for weeks. Finally, unlike other yeast infections, C. auris can cause severe bloodstream infections. About 60% of patients who contract this fungus have died, though researchers note the sample size for this observation is small, and several of the patients already had serious medical issues.

While fungal infections like C. auris may attract headlines, there are also plenty of other fungi that can pose risks to patients. In fact, there are about 1.5 million species of fungi in the world, though only 300 of them are known to be health risks. Fungal infection can cause a gamut of effects, from mild (runny nose) to severe (death). So what do you need to know about infection control (IC) for fungi?

Rachel Marrs, MSN, RN, CIC, DNP, infection prevention and control program manager at University of Chicago Medicine (UCM), says fungal IC relies on many of the best practices used to combat bacteria and viruses: proper PPE, environmental cleaning, and hand hygiene. However, the main difference lies in how a particular fungus is transmitted—through touch or through the air.

“If you’re focusing on a fungus like C. auris—which spreads through touch—you’re going to focus more on the handwashing and contact precautions like wearing gowns and gloves, and also environmental disinfection,” she says. “Whereas if it’s something like Aspergillus, [it’s airborne].  People commonly breathe in Aspergillus spores as they can be in the environment routinely. You’re going to focus more on air quality, having a HEPA filter in the building, and having construction barriers in place.”

Overall, healthcare organizations do a pretty good job preventing fungi from propagating in their facilities, Marrs says. However, every year there’s at least one news story about a hospital fungal outbreak.

“A lot of them [outbreaks] are around projects or in hospitals where they’re doing construction or renovation and they weren’t able to control the dust from that project and it got into the rest of the healthcare facility,” she says. “There’s also outbreaks linked to carpets, linens, and things like that. But I would say that construction is the biggest one.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

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