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Trust distances itself from staffing link to fungus outbreak

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A major London hospital trust has sought to distance itself from suggestions that a lack of nursing staff was implicit in an outbreak of the so-called “Japanese fungus” infection Candida auris.

The emerging fungal pathogen has come to notice this month following the publication of NHS guidance sparked by an increasing number of cases in the UK that have affected 55 hospitals so far.

Newspaper headlines in The Times and the Daily Mail today linked an outbreak of the fungus at King’s College Hospital NHS Foundation Trust with “low nursing levels”.

The articles referred to board papers that described an outbreak of C. auris at the trust, involving 31 patients, which were published in February and March this year.

Minutes of the February 2017 meeting stated: “While the trust is implementing infection prevention and control protocols, it was noted that the spread of the pathogen is affected by low nursing levels.”

“We can confirm that nursing levels were not a contributing factor during the outbreak of Candida auris at the trust”

Trust statement

However, the trust has now insisted that the reference to low nursing levels in the board papers was a “general statement and not a reflection of staffing levels at King’s at the time of the outbreak”.

In a statement, a spokeswoman for King’s said: “The Candida auris outbreak commenced in October 2016 and was declared over in April 2017. During the outbreak, 31 patients were colonised, six of whom had candida auris in their blood cultures.

“No deaths have been attributed to candida auris,” she said. “Furthermore, we can confirm that nursing levels were not a contributing factor during the outbreak of Candida auris at the trust, as we had appropriate nurse staffing in all affected areas.”

Asking by Nursing Times to further clarify if the papers were referring to the national situation regarding the infection, the spokeswoman added: “It was a general observation not pertaining to any specific situation.”

According to board papers, the trust’s first case was admitted from the Royal Brompton in April 2016. But the patient was known to be positive on admission, and was isolated in a side room on the critical care unit and cardiac wards.

The documents added that further cases were subsequently identified in the period since July 2016, with an outbreak since “declared and actions taken to manage and control further transmission”.

Centers for Disease Control and Prevention

Infection control guidance issued for fungal pathogen

Source: Shawn Lockhart

A strain of Candida auris cultured in a petri dish

The “key areas” affected by the outbreak were the critical care units, liver and cardiac wards, but the most recent confirmed case was identified in a patient in the clinical decision unit, noted the trust.

A Candida auris Symposium was subsequently held on 6 December 2016, which was attended by over 100 staff and colleagues from other trusts, as well as Public Health England and NHS England.

“Outbreak meetings have continued to be held and actions taken to control the outbreak and prevent ongoing transmission,” said the board papers. “Good engagement from staff in affected areas have been observed.”

The papers also highlighted a number of “key challenges” that remained in February to managing the outbreak.

These included insufficient laboratory capacity to meet the demands of the increase in testing and an eight or nine day delay in obtaining external confirmation of cases.

The delay in confirmation meant presumptive cases were left in isolation for much longer and contacts screened unnecessarily, said the trust.

It added that insufficient side rooms, especially in critical care, to isolate presumptive cases remained “an issue”, as they had “been nursed on the main unit whilst awaiting confirmation”.

Meanwhile, the trust highlighted that patients at a higher risk of C. auris have also been found to be positive with other Candida pathogens following a negative result.

As reported by Nursing Times, updated guidance was published by Public Health England on 11 August on the management and prevention of C. auris.

C. auris first appeared in Japan in 2009 but has subsequently spread across the globe. By the end of July, over 200 patients had been detected with it in the UK in 20 NHS trusts and private providers.

In addition, over 35 other UK hospitals have received patients with a known C. auris infection, according to Public Health England.

C. auris is a pathogenic yeast species that had been reported to cause bloodstream infections, wound infections, and otitis. It has also been cultured from urine and the respiratory tract.

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