A deadly fungus invading US health facilities has exposed the broader problem of patient safety being jeopardised by underfunded and understaffed infection-prevention efforts – with, on any given day, one in 31 hospital patients and one in 43 nursing home residents acquiring an infection while seeking medical care.
The US Centres for Disease Control and Prevention (CDC) considers Candida auris, the fungus spreading primarily in long-term acute-care hospitals and skilled-nursing facilities, a serious global public health threat because it it hard to detect and resists some antifungal drugs and disinfectants.
MedicalBrief notes that cases of Candida auris infection have been flagged by doctors at the Rahima Moosa Mother and Child Hospital following a damning report on the conditions at the facility (See Focus).
Healthcare settings are ripe for infection transmission because patients are on invasive devices and susceptible to infections healthy people don’t get, reports The Washington Post.
Other pathogens – from methicillin-resistant Staphylococcus aureus to E. coli bacteria that cause urinary tract infections – are more rampant.
“Infection control within healthcare is extremely neglected,” said Saskia Popescu, an assistant professor at George Mason University and an expert in infection prevention. “We expect hospitals to continuously respond to growing and emerging infectious-disease threats but don’t give them the resources to do so.”
Candida auris – what you need to know
In 2021, the CDC recorded more than 27 000 infections from intravenous lines, more than 24 000 from catheters and more than 50 000 from ventilators across thousands of acute-care hospitals. Another 4 000 infections were identified at long-term care hospitals.
Exposure is inevitable. Invasive devices break the skin, a natural barrier against pathogens, and open a path for bacteria and fungi to enter the body. And patients at long-term facilities are often elderly, severely ill or immunocompromised.
But the risk can be mitigated with infection-prevention protocols like regular surveillance, isolation of infected patients, protective equipment, proper hand hygiene and deep cleaning.
The pandemic upended those efforts as hospitals battled with a deluge of Covid patients, often amid staff and supply shortages in the early months. Ventilator use soared, and CDC scientists found that infections from invasive devices surged alongside Covid hospital admissions in the winter and summer of 2021.
The pandemic also disrupted the nation’s progress against antimicrobial-resistant pathogens, with Candida auris being just one of eight showing alarming increases from 2019 to 2020. The CDC said more than 29 400 people died of such infections in the first year of the pandemic, with nearly 40% being infected in hospitals.
Some experts say the coronavirus exacerbated problems that predated the pandemic.
The health system faces financial challenges and staffing shortages that make infection control more difficult, said Akin Demehin, senior director of policy at the American Hospital Association. “That is why we continue to advocate for needed financial support to hospitals, and for supportive workforce resources and policies.”
Hospital accreditation organisations and government regulators require infection-prevention specialists at acute-care hospitals, but do not set standards for staffing or funding. And the rules are looser in other healthcare settings.
“That’s what’s scary about Candida auris – we know most infections happen in long-term care and nursing homes, and the infrastructure in infection prevention in those settings is not that strong,” said Patricia Jackson, president of the Association for Professionals in Infection Control and Epidemiology.
Facilities with full-time infection-prevention staff have more capacity to screen patients for risk factors and to isolate those who are contagious. But there can be basic gaps – such as staff and visitors failing to properly wash their hands.
Miscommunication can also contribute to the spread of infections.
The American Health Care Association, which represents nursing homes, said the fungus is primarily spreading into their facilities from patients discharged from acute- and long-term care hospitals. “It is critical that hospitals follow enhanced barrier precautions and inform nursing homes of colonisation so, together, we can mitigate the spread,” said David Gifford, the association’s chief medical officer.
LA health official Zachary Rubin said some facilities forget to screen patients or communicate their results before transferring them, despite their legal requirements. He also suspects that some facilities are deliberately withholding this information to avoid the hassles of isolating and caring for a patient carrying a deadly fungus.
He said only 5% to 10% of patients with Candida auris on their bodies develop deadly infections. Most strains in the US are still treatable by some drugs.
Experts note that most infections acquired at health facilities are not catastrophic – that it’s a risk that comes with seeking medical care.
“Hospitals are not the safest places to be. The safest place is to be home,” said John Votto, a former president of the National Association of Long Term Hospitals. “What we do in every hospital is try to prevent. You can’t prevent 100 percent. There’s no way.”
In November last year, MedicalBrief reported that the WHO had released the first ever fungal priority pathogens list to help guide research, development and public health action. The agency said that “the rise of serious fungal infections can no longer be ignored”.
Fungal infections are estimated to affect more than 1bn people each year, of which more than 150m cases are severe and life-threatening, especially to immune-compromised people, said the agency at the time.
See more from MedicalBrief archives:
NICD study shows high levels of candida auris infections in private hospitals
Fast and deadly spread of C.auris hits SA also
UFS welcomes WHO’s recognition of fungal infections threat