Rapid Environmental Contamination With <i>Candida auris</i> and Multidrug-Resistant Bacterial Pathogens Near Colonized Patients
Sarah E. Sansom, Gabrielle Gussin, Michael Schoeny, Raveena Singh, Hira Adil, Pamela Bell, Ellen C Benson, Cassiana E. Bittencourt, Stéphanie Black, Maria del Mar Villanueva Guzman, Mary Carl Froilan, Christine Fukuda, Karina Barsegyan, Ellen Gough, Meghan Lyman, Jinal Makhija, Stefania Marron, Lydia Mikhail, Judith Noble-Wang, Massimo Pacilli, Robert Pedroza, Raheeb Saavedra, D. Joseph Sexton, Julie A Shimabukuro, Lahari Thotapalli, Matthew Zahn, Susan S. Huang, Mary K. Hayden
Abstract
BACKGROUND: Environmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations. METHODS: We conducted a prospective multicenter study of environmental contamination associated with C. auris colonization at 6 ventilator-capable skilled nursing facilities and 1 acute care hospital in Illinois and California. Known C. auris carriers were sampled at 5 body sites followed by sampling of nearby room surfaces before disinfection and at 0, 4, 8, and 12 hours after disinfection. Samples were cultured for C. auris and bacterial multidrug-resistant organisms (MDROs). Odds of surface contamination after disinfection were analyzed using multilevel generalized estimating equations. RESULTS: Among 41 known C. auris carriers, colonization was detected most frequently on palms/fingertips (76%) and nares (71%). C. auris contamination was detected on 32.2% (66/205) of room surfaces before disinfection and 20.5% (39/190) of room surfaces by 4 hours after disinfection. A higher number of C. auris-colonized body sites was associated with higher odds of environmental contamination at every time point following disinfection, adjusting for facility of residence. In the rooms of 38 (93%) C. auris carriers co-colonized with a bacterial MDRO, 2%-24% of surfaces were additionally contaminated with the same MDRO by 4 hours after disinfection. CONCLUSIONS: C. auris can contaminate the healthcare environment rapidly after disinfection, highlighting the challenges associated with environmental disinfection. Future research should investigate long-acting disinfectants, antimicrobial surfaces, and more effective patient skin antisepsis to reduce the environmental reservoir of C. auris and bacterial MDROs in healthcare settings.