Episode Transcript
Infection Control Explained (ICE) Podcast 5
This Podcast is brought to you by the GOSH Learning Academy.
[00:00:06] Kate H: Welcome back to the ICE Podcast. ICE stands for Infection Control explained. I'm Kate Harkus, I'm the lead practice educator for Infection Prevention Control. And today we're gonna be talking a little bit about Candida Auris, and we've got Barbara Breckle joining us today, and she's from our Infection prevention and control team at GOSH, and will be speaking as our expert.
Welcome Barbara.
[00:00:32] Barbara: Hello.
[00:00:33] Kate H: Hello. So let's just talk a little bit about, first of all, what Canida Auris is. Is there gonna be a lot of people listening that maybe have never even heard of it? Could you explain.
[00:00:44] Barbara: Yes. I'm happy to explain that So,Candida Auris was actually recently renamed as Candozyma Auris, but we'll just call it C. Auris for now.
And this is a yeast type of fungus that can colonise or infect individuals.
What is really important is not to confuse it with candida albicans, which is different kind of fungus. It's very common. And this is a fungus that causes thrush so it, it can cause thrush like orally or in other places of the body.
And in contrary to, to C. Aurisit's very common and it's easily treatable.
[00:01:22] Kate H: Okay,
[00:01:22] Barbara: so C. Auris was first identified in 2009 in Japan, so quite recent. Since then, it has been reported in hospitals worldwide, and it has also caused outbreaks in several countries.
The concern with C. Auris is that it is that it's not only colonises people, meaning it's the organism can live on the body without causing symptoms or infection, but it also has the capability of causing severe disease if it enters the body, for example, through a wound.
[00:01:56] Kate H: Okay
[00:01:57] Barbara: An additional complication is that C. Auris is resistant to most of the drugs that will be commonly used to treat fungal infections. This means that C. Auris may not respond to treatment and therefore making it difficult to treat infections.
[00:02:14] Kate H: Okay.
[00:02:15] Barbara: Invasive C. Auris infection is a life-threatening disease, which with high mortality and detecting, preventing and controlling C. Auris infections are therefore of the utmost importance for all infection prevention and control teams.
[00:02:30] Kate H: Okay. So it sounds like a pretty big deal, and obviously one of the reasons why we've got this as a subject on our podcast series. So thinking about a patient in hospital, then how are we testing our patients?
[00:02:44] Barbara: So, C. Auris testing is done by taking some skin swabs, also swabs from the nose and the throat.
And also a stool sample. So at Great Ormond Street Hospital, we have a C. Auris screening program in place. And that's mainly for international patient transfers, and this is due to the increased prevalence and ongoing transmission of C. Auris in some countries. But we also screen patients that were transferred from affected units in the uk.
[00:03:15] Kate H: Okay. And I guess, do you think that other centers are doing a similar thing or is it, does it, do you think it differs from hospital to hospital?
[00:03:23] Barbara: No, other centers there is national guidance, so therefore we all guided by national guidance and other NHS hospitals will do the same.
[00:03:33] Kate H: Got you. So now I've screened my patient.
And maybe the result has come back as positive. So what sort of, what does that mean for us?
[00:03:44] Barbara: It is important to know that if a patient is colonised with C. Auris this will help the medical team to choose the most effective antifungal drugs. Should a patient develop signs of a yeast infection.
So the fact that a patient screened positive, so some of the swabs came back positive. That doesn't necessarily mean at the time that this patient also has an infection. So it may just be sitting there on the skin. But obviously with a lot of patients that are admitted to hospitals, they may have wounds, they may have other indwelling devices like catheters cannulas, etc.
So these are all sort of entry points. Where an organism could enter the body and then cause infections. It also means that the patient will then be put in isolation precautions to limit the risk of transmission to other patients or the environment.
[00:04:38] Kate H: Okay. Yeah, I understand. And for that patient then if they've got the positive result, and we have talked about that sort of difference between colonisation and infection and then what does it really mean for that child then if they have a positive result?
[00:04:51] Barbara: So if a child that tests positive for C.Auris the child will be asked in contact isolation precautions in a single room.
We will also put an alert on the child's computer record to indicate that they require a single room when they're coming to Great Ormond Street Hospital. This may impact on the timing of appointments or investigations, but the child will not be canceled just because of this alert.
[00:05:17] Kate H: And we've mentioned the term contact precautions, and we've touched upon that in our other podcast, but can we talk a little bit more about what that means?
[00:05:24] Barbara: Happy to explain that. So contact precautions are a type of isolation precautions that we use for infections that are transmitted through contact.
Like it is the case with C. Auris. So C. Auris can spread by direct contact with another person, usually by hands. But it can also be passed on indirectly from one person to another via contaminated equipment, contaminated toys, or the environment.
So we will make sure that everyone cleans their hands before and after after leaving the patient's room because C. Auris can survive on equipment and surfaces for several weeks.
We also have a special cleaning regimen in place, and we will make sure that everything that is taken out of the room is cleaned and disinfected. We also use additional precautions such as wearing gloves and gowns.
[00:06:17] Kate H: Get you. If I'm a parent of a child that maybe tests positive and I've got all this sort of special precautions in hospital and staff wearing different PPE, is there anything that I need to do as a parent that sort of differs?
[00:06:32] Barbara: The only advice that we give to parents, clean your hands when you go into the room of your child and clean your hands when you come out of the room.
And also, if anything, any items are taken out of the room, like sometimes meal trays or things like that. They should be wiped down with the sanitizing wipes before taken out of the room.
If they're going to any communal areas on the wards.
[00:06:53] Kate H: I get you. So thinking about them, I've got my inpatient, they've tested positive, we've now got them in their isolation precautions. And then how do we manage that patient when they're visiting different places in the hospital? So popping to an outpatient department, for example, for a test or something.
[00:07:10] Barbara: Yeah. So when visiting different places in the hospital, patients that are nursed in contact precautions will be seen in a separate room. And this includes patients that are coming to Great Ormond Street Hospitals for outpatient appointments.
[00:07:24] Kate H: Got you. And can we talk a little bit about what's available to patients who are unable to attend those like weekend clubs in public areas of the hospital and the things that, would enhance their stay?
[00:07:38] Barbara: Yeah, so children that are under in contact precautions for C. Auris can't can't attend places like the hospital school, unfortunately, where they would've contact with other children and potentially could spread C.Auris. However, our excellent hospital school teachers will arrange individual visits then for the patients that can't come to hospital school.
[00:07:58] Kate H: That's good to know.
[00:07:59] Barbara: And they will also supply them with any materials that might need for their studies.
[00:08:04] Kate H: Okay, that's really useful. And then thinking about that alert then that we put on the patient's chart, will that patient then, have that alert on their chart throughout their whole time coming in and out of hospital or how does that work?
[00:08:18] Barbara: Yes, so patients are alerted for C. Auris will remain alerted throughout their treatment. This is because it can sometimes be difficult to detect C. Auris in samples and patients could still carry it even though they no longer have symptoms.
[00:08:32] Kate H: Okay. I think we've covered, a vast amount of information there for, both staff and if there's any patients or parents listening to this.
So just thinking about those top three key messages that are our take home messages, what would you say that they were?
[00:08:52] Barbara: So first of all, as I said before, don't confuse it for candida albicans. It's a different kind of yeast of fungus, but it's less, much less common than candida albicans.
Remember, candida albicans is the fungus that causes thrush. Whilst can can Candida Auris causes severe invasive disease. So we screen patients that are at risk, as I said, international transfers or transfer from other affected units in the uk. And then it's important to isolate the patients to prevent any cross infections to other patients.
[00:09:31] Kate H: Wow. Thank you very much. Hopefully that's been useful to all of our listeners and thank you Barbara, for your time and join us again for another ICE podcast.
[00:09:42] SA: Thank you for listening to this episode. If you want to find out more about the work of the GOSH Learning Academy, you can find us on social media on Twitter, Instagram, and LinkedIn.
You can also visit our website at www. gosh. nhs. uk and search Learning Academy. We have lots of exciting new podcasts coming soon, so make sure you're subscribed wherever you get your podcasts. We hope you enjoy this episode and we'll see you next time. Goodbye.
