Superbug Outbreak Tied to Improper Sanitation and PPE Practices

Although COVID-19 appears to have taken over the focus of hospital workers caring for patients and cleaning their rooms, antibiotic-resistant superbugs remain a threat, especially when contracted by those also exposed to the SARS-CoV-2 virus.

A new study by the U.S. Centers for Disease Control and Prevention (CDC) looked at how COVID-19 patients at a Florida hospital became infected with Candida auris, or C. auris.

C. auris is one of the five superbugs on the CDC urgent threat list. It is a species of fungus—a multidrug-resistant yeast—which was first identified in 2009 and can cause invasive bloodstream, wound, and ear infections. It can also be found in urine and respiratory samples.

In January 2020, the CDC reported the largest U.S. concentrations of the fungus was in New York. By October 31, C. auris had been documented in more than 30 countries with more than 1,500 U.S. cases reported to the CDC, NDTV reports. It is associated with up to 40% of hospital mortality cases and has been found on surfaces and equipment inside health care facilities.

Before the COVID-19 pandemic, the Florida hospital was conducting admission screenings for C. auris and infected patients were housed in a separate ward. Despite these precautions, the C. auris outbreak began in July 2020 and was reported to the Florida Department of Health. Four COVID-19 patients were infected with the fungus—three through bloodstream infections and one from a urinary tract infection.

In August, the hospital identified 35 more patients with the fungus. Eight of these patients died within 30 days of screening, but it has not been clear whether the fungus contributed to their death.

The Florida Department of Health and CDC performed a joint investigation focused on infection prevention and control measures at the hospital. They included observation of health care personnel, use of personal protective equipment (PPE), disinfection of shared medical equipment, hand hygiene, and supply storage.

The investigation discovered numerous weaknesses including:

• Mobile computers and medical equipment were not always disinfected between uses
• Medical supplies were stored in open bins in hallways
• Health care personnel were observed missing opportunities to perform hand hygiene
• Health care staff wearing multiple layers of PPE were found to heighten the risk of microbe transmission
• Staff practice of reusing PPE also was found to increase microbe transmission.

The study found when the hospital removed supplies from hallways, enhanced cleaning and disinfection practices, and ceased base layer and reuse PPE practices, no further C. auris transmission was detected on subsequent surveys.