LB1. Regional Assessment and Containment of Candida auris Transmission in Post-Acute Care Settings—Orange County, California, 2019
Authors: Karmarkar Ellora , Karmarkar Ellora , O’Donnell Kathleen , Prestel Christopher , Forsberg Kaitlin , Forsberg Kaitlin , Schan Douglas K , Chow Nancy A , McDermott Darby S , Rossow John A , Toda Mitsuru , Toda Mitsuru , Glowicz Janet , Brooks Richard , Brooks Richard , Bagheri Hosniyeh , Nelson Teresa , Gualandi Nicole , Khwaja Zenith , Horwich-Scholefield Sam , Jacobs Joshua , Cheung Michele , Mikhail Lydia , Walters Maroya S , Walters Maroya S , Jacobs-Slifka Kara , Stone Nimalie D , Stone Nimalie D , Gade Lalitha , Berkow Elizabeth L , Berkow Elizabeth L , Jackson Brendan R , Jackson Brendan R , Vallabhaneni Snigdha , Vallabhaneni Snigdha , Zahn Matt , Epson Erin , Epson Erin 
Published: October 2019

Abstract

Background
Patients in long-term acute care hospitals (LTACHs) and skilled nursing facilities with ventilator units (VSNFs) are at high risk for Candida auris colonization; among patients colonized with this emerging pathogen, 5%–10% develop invasive disease with >45% mortality. In September 2018, a California LTACH-affiliated laboratory began enhanced C. auris surveillance by classifying species of Candida isolated from routine urine specimens. In February 2019, the first known Southern California case was detected in an Orange County (OC) LTACH; the patient had not traveled outside the region, indicating local acquisition. We performed point prevalence surveys (PPS) and infection prevention (IP) assessments at all OC LTACHs and VSNF subacute units to identify patients colonized with C. auris and control transmission.

Methods
During March–August 2019, we conducted PPS at facilities by collecting composite axilla and groin swabs for C. auris polymerase chain reaction testing and reflex culture from all patients who assented. Facilities with ≥1 C. auris-colonized patient repeated a PPS every 2 weeks to assess for new transmission. Isolate relatedness was assessed by whole-genome sequencing (WGS). We evaluated hand hygiene (HH) adherence, access to alcohol-based hand rubs (ABHR), and cleaning of high-touch surfaces to guide IP recommendations.

Results
The first PPS at all OC LTACHs (n = 3) and adult VSNFs (n = 14) identified 45 C. auris-colonized patients in 3 (100%) LTACHs and 6 (43%) VSNFs; after repeated PPS, the total count reached 124. Most patients (70%) were at 2 facilities (Table 1). Three of 124 patients developed candidemia. To date, isolates from 48 patients have completed WGS; all were highly related (<11 single-nucleotide polymorphisms) in the African clade. Of 9 facilities with C. auris, 5 had HH adherence < 50%, 3 had limited ABHR, and at 2, <60% of assessed high-touch surfaces were clean. We recommended regular HH and cleaning audits, and increased ABHR.

Conclusion
Our investigation, prompted by enhanced surveillance, identified C. auris at 9 OC facilities. WGS indicated a single introduction and local transmission. Early detection, followed by rapid county-wide investigation and IP support, enabled containment efforts for C. auris in OC.

Disclosures
All authors: No reported disclosures.