- Candidozyma auris is an emerging, multidrug-resistant yeast that can cause severe, life-threatening infections, particularly in patients who already have serious medical conditions.
- In a prospective cohort study of over 1,000 interactions between healthcare personnel and 109 patients who had current or prior history of C. auris, transfer to gloves and/or gowns occurred in 29%.
- This transfer rate topped the 16% rate observed for methicillin-resistant Staphylococcus aureus and the 10% rate for carbapenem-resistant Enterobacterales in similar studies.
Transfer of Candidozyma auris from hospitalized patients to the gloves and gowns of healthcare personnel (HCP) occurred frequently, with extensive colonization at multiple patient body sites and shedding onto environmental surfaces contributing to transmission, a prospective cohort study showed.
In over 1,000 HCP interactions with 109 patients who had current or prior history of C. auris, transfer to gloves and/or gowns occurred in 29%, reported Lyndsay O'Hara, PhD, MPH, of the University of California Irvine, and colleagues in Open Forum Infectious Diseases.
This transfer rate topped the 16% rate observed for methicillin-resistant Staphylococcus aureus and the 10% rate for carbapenem-resistant Enterobacterales in similar studies.
Transfer was higher when HCP touched the patient (OR 3.32, 95% CI 2.3-4.9) compared with touching only an environmental surface, and patients who were colonized at five body sites were 15 times more likely to transfer C. auris to HCP gloves and/or gowns versus those colonized at only one site (OR 15.1, 95% CI 7.5-30.5).
The finding that C. auris is frequently passed to HCP gloves and gowns during routine patient care "reinforces the critical need for meticulous compliance with gloves and gowns and hand hygiene to avoid self-contamination and possible onward transmission of C. auris," O'Hara told MedPage Today.
Also known as Candida auris, C. auris is an emerging, multidrug-resistant yeast that can cause severe, life-threatening infections, particularly in patients who already have serious medical conditions. The first U.S. case was reported in 2016; by 2024, the annual tally had climbed to 6,304 cases, according to the CDC.
In addition to illnesses and deaths, C. auris also imposes significant operational and resource strains on healthcare facilities, O'Hara said, given the need for strict patient isolation protocols and specialized environmental cleaning protocols to control it.
Determining the most effective C. auris prevention measures "is a work in progress," she noted. Current measures include contact precautions such as glove and gown use, as well as chlorhexidine gluconate (CHG) baths for patients -- though the best approaches to CHG for decolonization aren't clear. "It is absolutely critical that increased funding be provided to agencies like the CDC and NIH to develop better measures to prevent transmission," O'Hara added.
What's also unclear is the relationship between C. auris transfer from patients to protective gear and consequent infections. "Transmission rates to gloves and gowns seen in the study are higher than subsequent transmission rates to patients and subsequent infection rates among patients," O'Hara cautioned.
O'Hara and team conducted their observational cohort study between July 2022 and May 2024 at nine U.S. acute care hospitals. They collected samples from C. auris patients' bilateral axillae, groin/inguinal creases, finger webs, anterior nares, and stool, as well as environmental surfaces from hospital rooms. They also observed 10 routine patient-HCP interactions in those hospital rooms.
C. auris transfer rates to gloves or gowns were similar in the intensive care unit (ICU; 30%) and non-ICU settings (29%).
Transfer was highest among nursing assistants/patient care technicians (OR 5.2, 95% CI 2.4-11.6), occupational/physical therapists (OR 4.8, 95% CI 1.4-16.7), and respiratory therapists (OR 4.7, 95% CI 1.9-11.7).
Vital sign monitors, supply carts, and ventilators all had a C. auris transfer rate to HCP gloves or gowns of 42%, while handling rectal tubes (55%) and providing wound care (53%) were the patient care activities with the highest transfer rates.
Most C. auris patients (84%) had the pathogen at multiple body sites, with one-third colonized at five body sites. The most frequently colonized body parts were fingers and perirectal areas (77% for each). Samples most likely to be contaminated were stool samples (75%), groin samples (73%), axilla samples (66%), and nares samples (61%).
The environmental surfaces most likely to be contaminated by C. auris were hospital room floors (45%), followed by call buttons and bed rails, both at 30%.
The frequent contamination of items touched by HCP "reinforces that importance of auditing hand hygiene and appropriate use of gowns and gloves with continual feedback to HCP," O'Hara and colleagues noted. "It also highlights the insufficiency of once daily cleaning/disinfection for this high-shed pathogen."
Observations were conducted only during weekdays, which was a study limitation. In addition, culturing of only part of the surface of gloves and gowns was done, which could lead to contamination underestimates. The study didn't assess whether high C. auris transfer rates to gloves or gowns led to subsequent patient transmission.
Disclosures
The study was supported by the CDC.
O'Hara and colleagues reported no disclosures.
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