Development and implementation of an electronic admission-screening tool for Candidozyma auris (formerly Candida auris) at a large healthcare system in Miami, FL, USA

Abstract

Objectives: Candidozyma auris (formerly Candida auris) is an urgent public health threat pathogen worldwide. This article describes using and implementing an electronic questionnaire to screen all patients for risk factors associated with C. auris upon admission to all facilities within a large healthcare system in Miami, FL, USA. Methods: A screening questionnaire was implemented within the electronic medical record (EMR) applied at the point-of-entry to all inpatient admissions. The tool asked about risk factors for C. auris colonization and included: previous history of C. auris; overnight hospital stay outside the USA in the last 12 months; tracheostomy or mechanical ventilation present on admission; transfer from a healthcare facility with high risk for C. auris; or history of carbapenemase-producing organisms. Questionnaire responses triggered C. auris colonization testing using polymerase chain reaction (PCR) and initiation of contact precautions for those with identified risk(s). Results: Over a 12-month period, the questionnaire was applied to 83,046 admissions. Of those, 4401 (5.3%) had at least one risk factor for C. auris colonization. Of those tested, 166 (6.1%) were PCR positive. The overall prevalence rate was 0.20%. The question with the highest percent positivity was ‘arriving from another healthcare facility’ (4.5%), and ‘previous history of multi-drug-resistant organism infection or colonization’ was the factor with the highest percent positivity on PCR (16%). Conclusion: Screening questionnaires incorporated in the EMR are effective means to detect patients at risk for C. auris colonization, thus facilitating the early implementation of infection prevention and control measures aimed at avoiding the horizontal spread of highly transmissible organisms in healthcare facilities.