Healthcare personnel’s (HCP) practice of wearing multiple layers of gowns and gloves to treat COVID-19 patients contributed to an outbreak of Candida auris bloodstream infections at a Florida hospital, the Centers for Disease Control and Prevention (CDC) reported.1

In July 2020, three C. auris bloodstream infections and one urinary tract infection were reported in four patients who received care in the same dedicated COVID-19 unit of acute care “Hospital A.” The HCP in the unit wore double gloves and gowns, likely contaminating themselves, patients, and the environment as they donned and removed layers.

“A second, disposable isolation gown and pair of gloves were donned before entering individual patient rooms, then doffed and discarded upon exit,” the CDC noted. “Alcohol-based hand sanitizer was used on gloved hands after doffing outer gloves. HCP removed all PPE and performed hand hygiene before exiting the unit.”

A multidrug-resistant yeast that can cause invasive infections, C. auris has been described as spreading more like bacteria and is notoriously difficult to remove from the environment. Accordingly, before the pandemic, the hospital screened on admission for C. auris, admitting colonized patients to a dedicated ward.

“Hospital A’s COVID-19 unit spanned five wings on four floors, with 12 to 20 private, intensive care-capable rooms per wing,” the CDC stated. “Only patients with positive test results for SARS-CoV-2 … at the time of admission were admitted to this unit. After patient discharge, room turnover procedures included thorough cleaning of all surfaces and floor and ultraviolet disinfection.”

Several Infection Points

Among 67 patients admitted to the COVID-19 unit and screened during point prevalence surveys, 35 were positive for C. auris. Of those, six produced clinical cultures that grew the fungus. In addition, computers and medical equipment were not always disinfected between uses, and medical supplies like oxygen tubing and gauze were stored in open bins in hallways.

“A combination of factors that included HCP using multiple gown and glove layers in the COVID-19 unit, extended use of the underlayer of PPE, lapses in cleaning and disinfection of shared medical equipment, and lapses in adherence to hand hygiene likely contributed to widespread C. auris transmission,” the CDC concluded. “After Hospital A removed supplies from hallways, enhanced cleaning and disinfection practices, and ceased base PPE layer practices, no further C. auris transmission was detected.”

REFERENCE

  1. Prestel C, Anderson E, Forsberg K, et al. Candida auris outbreak in a COVID-19 specialty care unit — Florida, July-August 2020. MMWR Morb Mortal Wkly Rep 2021;70:56-57.