The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#115 Deadly Fungus Among Us
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The CDC is now monitoring a new concerning pathogen--the Candida Auris fungus. Candida Auris or C. Auris is concerning due to it's rapid transmission and the fact that it multi-drug resistant. This episode will raise your awareness of C. Aurus in dental settings and provide practical advice to be sure your current surface disinfectant will kill this deadly pathogen.
Resources:
- CDC Candida auris: https://bit.ly/3pTrDke
- CDC Outpatient Information: https://bit.ly/3O0zbcV
- CDC Healthcare Acquired Infections: https://bit.ly/43vmUTO
- Very Well Health - What is Candida Auris? https://bit.ly/3K617Lz
- Healthline - What is Candida Auris? https://bit.ly/3XURlS9
- NY Times - Deadly Fungus Spread Rapidly During the Pandemic https://nyti.ms/3Q6FApJ
Welcome.
SPEAKER_02I'm Leslie Cannum. I'm Mary Gavoni.
SPEAKER_01I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas podcast. My name is Olivia Juan, and I'll be your moderator today. This week's episode is about the deadly fungus among us. As the compliance divas, it is our purpose to keep audiences informed. And we're now talking about this deadly fungus, which has been recognized as an emerging disease. This was discussed at OSAP, and I've been reading numerous articles about it in the last few weeks. What's really scary about this fungus is we've seen a dramatic increase of cases. I read one article that indicated that one-third of those who have this fungus die. I read yet another article that said over half of them die. So we thought it would be interesting to talk about this fungus, which is called the Candida Oris. Let's talk with the divas about this fungus and learn more about it and how we can protect our patients or at least recognize it. Let's start with our diva Mary. Mary, why is this fungus a concern for us? What can you tell us about it?
SPEAKER_02Well, several of the things that you mentioned, one is that there's been a dramatic increase in cases, plus, it has a relatively high mortality rate. And the reason is that this particular fungus, which was discovered in Japan in 2009, is resistant to the typical antifungal treatments that are used to treat Canada infections. So if you've got vulnerable populations like patients in nursing homes or hospitals, because the patients are already there for other health conditions, and this fungus spreads and colonizes on surfaces, and other patients get infected that are susceptible, it's very difficult to treat these infections if they're resistant to the typical antimicrobial antifungal medications that are given. Then if a patient is vulnerable, they have the infection, they're not getting better, and they're not on the right medication, then they can become very, very sick and die from the infection. So since 2021, the reason that this has become a health alert or a health concern by the from the CDC is that there has been about a 200% increase in cases since 2019. So 500 or so cases were reported to the CDC, and it is a reportable disease. Um in 2019, 500 cases, and in 2021, 1,400 plus cases were reported. So it is dramatically increasing. It has high resistance, it's difficult to identify, so it's like the perfect storm of an infection spreading.
SPEAKER_01Good points, Mary. And I think that's why our podcast is so important to our audiences because we are truly trying to keep them informed about the latest issues going on. As the compliance divas, we are always trying to provide clarity and simplicity to compliance by navigating regulatory compliance to keep our listeners on course. And we really encourage them to subscribe to our channel because just like this issue of this deadly fungus, we need to stay on top. And you pointed out beautifully, Mary, that this Candida Ourus is very difficult to identify. It could be misidentified. You also pointed out that it has a high mortality rate. So this is not something that you pick up and it's easy to get rid of, particularly for elderly people. And the fact that it's drug resistant really makes it scary. And I know that Linda Harvey wanted to join us, but wasn't able to do so today. But she wanted to talk about why the fungus is such an alarming concern. And we do see it spreading in nursing homes and hospitals. And think about how vulnerable we are if we are in a hospital room and it had not been disinfected properly, or the disinfectant that was selected was not appropriate for Candida Ouris, and it's not going to effectively kill this fungus. It has been noted that it can be transmitted on the skin, but also clothing that's contaminated with this fungus. And so we want to really monitor these outbreaks in healthcare settings because that's where we see it spreading thousands and thousands of cases, and it can colonize patients for many months and persist in the environment. So that's why it's such a concern to promote early detection and have the correct infection control processes in place to limit the spread of Candida oris. So it is a deadly fungal deadly fungus. Leslie, what can you share with us? Really curious about what CDC is doing to protect and educate our population.
SPEAKER_00Well, Olivia, CDC's fungal experts had never received a report describing Candida infection resistant to all antifungal medications, let alone candida, that spreads so easily between patients. So after hearing the news that these infections were identified by international colleagues back in 2016, CDC sounded the alarm in the United States about C. aureus, a life-threatening candida species. And the disease detectives, as they call themselves, from CDC and state and local health departments investigated some of the first U.S. Candida RS cases, infections, and they learned about how the fungus spreads, as you mentioned, uh clothing and skin of people who may not be infected. They learned more about the uh different areas that it may spread in, and uh health departments and healthcare facilities uh wanted to know how they could contain it. So a key finding was that the Candida aureus spreads most easily in long-term healthcare facilities among patients with severe medical problems. CDC and partners developed new tests to rapidly identify it and continue to work with healthcare facilities to control its spread. Um, you know, it is a global threat as well, and investigators still don't know why all four strains of the Candida Oris emerged around the same time across the globe. The four strains have been found in the United States, and they're likely introduced, of course, through international travel and subsequent spread to U.S. facilities. Now, CDC also has a number of resources to assist clinicians in delivering safe care, which I'll get to in a few minutes.
SPEAKER_01Thank you, Leslie. This is really scary. I mean, could you imagine, especially for an elderly person, if they were to go into the hospital for, let's say, a hip replacement, and then they end up passing away due to this deadly fungus. So how do we even know that we have it? Mary, how would someone know that they've been exposed to this fungus?
SPEAKER_02Well, you wouldn't necessarily know that you were exposed to the fungus. That's the scary part, but you may start showing some signs or symptoms. Common symptoms of a Canada infection of this particular infection are um chills and fever that don't get better after being treated with a suspected um with antibiotics after a suspected bacterial infection. So that's the first issue is actually diagnosing what it is. So with fever and chills, most likely a physician would look at someone having a bacterial infection. They give them antibiotics, they don't get better, and then they start doing um lab testing. And that's the only way that this can be diagnosed is through a lab test. And exactly um how easily it's going to be diagnosed is a whole other issue. So you have to have very close um communication with the healthcare um provider to really, as Leslie mentioned before, playing disease detective to figure out what it is. So it's not getting better from antibiotics, the symptoms still persist, ear infections are very common, or perhaps a wound infection, and the most serious is a blood infection. If it becomes systemic in the blood, then it becomes very difficult to treat again because it is resistant to most of the medications that we're using to treat fungal infections.
SPEAKER_01So it's interesting, uh, Mary, this candida or candida, I've heard it pronounced both ways, it can actually enter the bloodstream and causes very, very serious infections, particularly among older patients. So that's uh a little bit scary for us to think about. And the symptoms that you described sounds like it be could be so many other things and make it easy to misdiagnose. So, Mary, what about the environmental disinfectants? What can you share to our look to our listeners about the disinfectants?
SPEAKER_02Olivia, this issue of what are effective surface disinfectants came up and was very confusing during COVID-19. Every dental practice wanted to be using a product that was effective against that emerging viral pathogen that COVID-19 was, but not all of the products that were currently being used or available actually could make that label kill claim. So hopefully, this will help stem any confusion that might come up with this particular pathogen. The CDC guidelines for infection control and dentistry from 2003 state that whenever there is possibility of blood present, which we assume there always is in a dental procedure, that a disinfectant with a tuberculosidal kill claim should be used. Those products are listed under the EPA list of disinfectants on the list B as in boy. Look up your product that you're using, make sure it's on that list, then go to the EPA list P as in Peter to see if that same product is listed there as designated effective against C. Oris. Most likely the product that you're already using with a tuberculosidal kill claim is going to be on that list. If your product does not have a tuberculosidal kill claim, then you need to investigate other products, but don't necessarily pick a product just from list P. Make sure that you select a product that is listed on list B. It needs to be tuberculosidal first and foremost, and then check to see if that same product is effective against C. oris.
SPEAKER_01So it's so important to make sure that the correct disinfectant is being selected. Good information and complex too, Mary. We really have to do our homework and look this information up. Leslie, what can you share with us about infection prevention guides?
SPEAKER_00Olivia, CDC has created an infection control program and guide for healthcare workers, very similar to what we have in dentistry, where there's a PDF that can be downloaded that helps you identify your administrative responsibilities and your clinical responsibilities. And they have a checklist, which again is very much like our CDC checklist for infection prevention and control in dental health care settings. And I was looking over that PDF where you can actually print out the whole thing or you can fill it in on your computer or on your mobile device. And it helps to guide the clinicians on what elements need to be assessed. So, for example, uh in one part of the program, the written planets asks you whether you have written infection prevention policies and procedures that are available, current, and based on evidence-based guidelines. You answer your assessment yes or no, and then maybe make notes about needs for improvement. The next question on elements to be assessed is infection prevention policies and procedures that are reassessed at least annually or according to state or federal requirements, and then updated if appropriate. And of course, answering yes or no. Most large healthcare facilities have this type of program in place. In order to run, they need to have some written plans, they need to have oversight. So likely that's going to be in place. But sometimes smaller practices, uh, private medical practices or smaller facilities may not have this type of uh program and infrastructure. They also indicate, just like in dentistry, at least one person should be trained in infection prevention who's employed by the facility and who's regularly available to manage the facility's infection control program. And uh one other part that's probably key is that the facility has systems for early detection and management of potentially infectious persons at initial points of patient encounter. And that would be particularly important with candida, even though it is difficult to detect. We've already learned through this podcast that it can be uh transmitted on skin and clothing and that someone doesn't actually have to have symptoms to be colonized with it. So CDC is doing a great job of providing healthcare providers with the information that they need. And it's important to recognize that in dental settings, we should be following our infection control recommendations from CDC as well. I know that the recommendations will be available on the show notes and on the compliance divas website to give people an opportunity to take a look at uh these uh valuable resources from CDC.
SPEAKER_01Yes, we'll have all that information for our listeners. So just as a recap, and thank you, Leslie, for that information. Uh, Candida Oris is a novel and major fungal pathogen that has triggered multiple outbreaks in nursing homes and hospitals. It is very difficult to treat because it's multidrug resistant, and that the disinfectants uh could be ineffective. So we have to make sure we're using the correct disinfectant, as Mary pointed out, and it's transmitted on the patient's skin and could be spread to other people, and it has a very high mortality rate. So it is recognized as a very serious threat. You know, as the compliance divas, we work very hard at bringing clarity and simplicity to compliance by navigating regulatory to compliance to keep you on course. We hope you've enjoyed this episode on Deadly Fungus Among Us. Please submit your questions to support at the compliancedeevas.com. Thank you for tuning in.