Candida auris is the fungal pathogen that provokes a wide range of invasive infections that typically develop within healthcare facilities. It was first described in Japan in 2009 and there were multiple cases of outbreaks in five continents (Schelenz et al., 2016). For example, in the period from March 2012 and July 2013, there were 18 cases of infection reported in the United States (Calvo et al., 2016). Already in 2015, the first case of Candida auris was identified in a hospital in the United Kingdom (Schelenz et al., 2016). Thus, outbreaks of Candida auris is a burden of healthcare facilities worldwide. The major concerns of healthcare professionals are the multidrug resistance of this pathogen and the fact that it is difficult to identify due to its similarity to other Candida types (Centers for Disease Control and Prevention, 2017).
Candida auris affects patients regardless of gender or age. Still, patients who were using broad-spectrum antibiotics or antifungal drugs have certain comorbid conditions such as diabetes, or those who had recent surgeries are at a higher risk of being infected. A specific patient population with increased risk of developing Candida auris includes patients of nursing homes and those receiving long-term care due to the fact that they have breathing or feeding tubes or central venous catheters. In case a patient with Candida auris is revealed in a long-term care facility, it is necessary develop an intervention to manage the case and avoid the spread of infection. This paper reviews the findings of current scholarly literature about Candida auris, presents the case of its outbreak, and provides a technologically-based solution for the case.
Literature Review
Candida auris is “an emerging multidrug-resistant pathogen that can be difficult to identify using traditional biochemical methods” (Sears & Schwarts, 2017, p. 95). Due to problems with identification, Candida auris can spread quickly in conditions of a healthcare facility. It is clinically proved that this pathogen causes such diseases as “fungemia, ventriculitis, osteomyelitis, malignant otitis(including otomastoiditis), complicated intra-abdominal infections, pericarditis, complicated pleural effusions, and vulvovaginitis” (Sears & Schwarts, 2017, p. 96). Preventive strategies include control of the removed catheters and tubes, and particular attention to patients receiving anti-fungal therapy or experienced recent surgeries. To prevent the spread of infection, it is recommended to apply Standard Precautions as well as Contact Precautions (Sears & Schwarts, 2017). Spivak and Hanson (2017) also claim that the key problem in identifying and treating Candida auris is its multi-drug resistance and frequent misidentification. Moreover, the researchers admit that the pathogen can be transmitted between and within healthcare facilities due to virulence factors that empower skin colonization of Candida auris. Chowdhary, Sharma, and Meis (2017) discover Candida auris as a rapidly developing reason for hospital-acquired multidrug-resistant fungal infections in the global context. They treat this pathogen as a threat to society and a challenge for healthcare providers.
Some researchers acknowledge that Candida auris is an international problem. Thus, Clancy and Nguyen (2017) refer to the Centers for Disease Control and Prevention (CDC) calling for US healthcare facilities “to be on the lookout for Candida auris in patients” to identify it timely and prevent the transmission to other patients or outside a healthcare facility (p. 141). The authors claim that starting from identification of Candida auris in Japan in 2009, there were cases of this infection reported from South Korea, India, South Africa, and Venezuela. Clancy and Nguyen (2017) analyze laboratory testing of Candida auris and reasons for its possible misidentification. The researchers conclude that a high concern regarding Candida auris among public health agencies can be explained by the possible combination of biologic and epidemiologic factors that can lead to a more global emergence of this infection. The problem of identification of Candida auris is reflected in the study by Mizusawa et al. (2016). The researchers mention that one of the barriers for American laboratories in identifying this pathogen is the lack of experience since Candida auris is not widely spread in the United States. Still, the CDC is involved in the study of Candida auris and provided a panel of the pathogen to empower its identification and assist clinical microbiology laboratories.
Case Description
The case under consideration occurs in a long-term care setting. These facilities as well as hospitals are considered to be particularly dangerous for developing Candida auris because patients placed there are usually in frail health (Marselas, 2018). Sometimes, outbreaks of Candida auris are conditioned by multi-use patient equipment such as thermometers, for example. The patient is a 76-year-old woman with the history of type-1 diabetes is referred to a long-term care facility being partially disabled after a stroke. She has an intravenous catheter currently. Previously, in the acute care unit of the hospital where she received treatment after a stroke, she had a breathing tube and urinary catheter for 12 days. Moreover, she experienced parenteral nutrition in the acute care unit. After a week of stay in the long-term care facility, the patient experienced deterioration of general condition. Considering the complex of risk factors, Candida auris was suspected. Both blood and urine laboratory tests proved the presence of infection. The patient was isolated to prevent the spread of the infection, and the staff of the facility was informed to take precautions measures. Infection control precautions are necessary for the whole period of the patient being infected and can be removed after the tests show no signs of the pathogen.
Technology as a Solution to the Patient Situation
Health Information Technologies are useful tools that can assist the resolution of patient cases. In conditions of the long-term care facility, Electronic Health Record (EHR) can be beneficial. While EHR is widely implemented in different clinical settings, long-term care frequently does not apply this technology, partially due to the lack of funding. Nevertheless, the experience of EHR use in long-term care proves to be beneficial for patients (Kruse et al., 2017). The advantages revealed by the study include the improvement of clinical documentation management, which, in its turn, has a positive impact on clinical decision-making.
Technology Application to the Case
In the context of the case under analysis, EHR can become a powerful tool both for managing the patient’s condition and prevention of the infection spread. Thus, immediately after Candida auris is identified, this information needs to be recorded to EHR, which is available for all healthcare professionals involved in the treatment of the patient. This intervention has certain benefits. First of all, healthcare professionals are informed about the case of infection and can take safety measures. Moreover, professional not directly involved in the process of care for the patient will avoid the unnecessary unprotected contacts. Another benefit of EHR is treatment planning, which is particularly important for the patient. Her initial condition was critical and made worse by type 1 diabetes. Therefore, the woman still needs medications to manage diabetes, to continue rehabilitation after the stroke, and new treatment for the emerged infection.
Considering the fact that nurses work shifts in the majority of healthcare facilities including those of long-term care, confusion and misinterpretation is possible. Thus, to prevent medical errors, empower the decision-making of the facility staff, and provide the appropriate treatment for the patient, EHR should be applied. Due to the fact that EHR contains data about all patient interventions, it provides an opportunity to identify the source of infection and eliminate it. It is preferable that EHR of the long-term care facility is synchronized with that of the acute care unit of the hospital where the patient was treated before being administered to long-term care because there is a possibility that the woman was infected earlier. Therefore, safety measures can be necessary in the hospital as well to prevent the spread of the infection. Also, it is necessary to screen the individuals who contacted the infected patient both in the long-term care facility and the hospital unit to reveal potentially infected people and begin treatment. Finally, it is necessary to limit the visits of the family members to avoid the spread of infection outside the facility.
Summary of the Case and Solution Integration
On the whole, the case under discussion is a typical example of nosocomial infection. The patient has some risk factors that increased the probability of developing Candida auris in long-term care. The suggested solution, which is to apply EHR as a tool to manage the patient’s condition and prevent the further spread of infection, is expected to be effective. It empowers safety measures that can be taken by the staff of the facility and thus contributes to infection prevention. Despite comorbid conditions such as diabetes, the patient is expected to recover from the infection. The fact that it was timely diagnosed and that the patient was not prescribed any broad-spectrum antibiotics or anti-fungal medications increases the probability of favorable outcome. Also, timely preventive measures planned and executed due to the use of EHR in the long-term care facility are likely to not allow spreading of infection within or outside the facility.
Conclusion
Summarizing, it should be said that nosocomial infections are a burden of contemporary healthcare. These conditions are not always timely revealed due to other comorbid conditions that a patient has. At present, Candida auris is a pathogen that develops inside healthcare facilities and is difficult to diagnose because of its similarity to other Candida types. Long-term care patients are frequently at risk of developing this infection due to the use of catheters and tubes in the process of care. Still, Electronic Health Record is a technology that empowers timely diagnosing, treatment organization, and planning of safety measures to prevent the spread of infection. Moreover, EHRs prove to be efficient for long-term care and thus can be recommended for implementation. As for the analyzed case, EHR provides an opportunity to inform healthcare professionals involved in the process of care about the case of infection thus preventing further spread of pathogen within a healthcare facility.
References
Calvo, B., Melo, A. S., Perozo-Mena, A., Hernandez, M., Francisco, E. S., Hagen, F., … Colombo, A. L. (2016). First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. Journal of Infection, 73(4), 369-374. Web.
Centers for Disease Control and Prevention. (2017). General information about Candida auris. (2017). Web.
Chowdhary, A., Sharma, C., & Meis, J. (2017). Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. PLOS Pathogens, 13(5), e1006290. Web.
Clancy, C., & Nguyen, M. (2017). Emergence of Candida auris: An international call to arms. Clinical Infectious Diseases, 64(2), 141-143. Web.
Kruse, C., Mileski, M., Vijaykumar, A., Viswanathan, S., Suskandla, U., & Chidambaram, Y. (2017). Impact of Electronic Health Records on long-term care facilities: Systematic review. JMIR Medical Informatics, 5(3), e35. Web.
Marseals, K. (2018). CDC monitoring new superbug with certain hot spots.McKnights’s Long-Term Care News. Web.
Mizusawa, M., Miller, H., Green, R., Lee, R., Durante, M., Perkins, R., … Zhang, S. X. (2016). Can multidrug-resistant Candida auris be reliably identified in clinical microbiology laboratories? Journal of Clinical Microbiology, 55(2), 638-640.Web.
Schelenz, S., Hagen, F., Rhodes, J. L., Abdolrasouli, A., Chowdhary, A., Hall, A., … Fisher, M. C. (2016). First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrobial Resistance & Infection Control, 5(1). Web.
Sears, D., & Schwartz, B. (2017). Candida auris: An emerging multidrug-resistant pathogen. International Journal of Infectious Diseases, 63, 95-98. Web.
Spivak, E., & Hanson, K. (2017). Candida auris: An emerging fungal pathogen. Journal of Clinical Microbiology, 56(2), e01588-17. Web.
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Appendix
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