HospitalInspections.org

Based on interview and record review the hospital failed to ensure the Dallas County Health and Human services (DCHHS) were allowed follow-up onsite visits to provide consultation to address gaps in infection control assessments for the hospital's Candida Auris (C. auris) outbreak. The C. auris outbreak had occurred in 2023, and cases had increased in 2024. This failure could affect 40 of 40 current in-patients.

Findings included:

In the morning of 7/02/2024 the surveyor conducted an on-site complaint investigation for TX00507232 regarding allegations of concerns of infection control issues related to patients infected or colonized with Candida Auris. The DCHHS had requested to schedule an on-site visit with the hospital on serveral occassions. The hospital failed to schedule an onsite visit following their requests.

During an interview on 07/02/24 at 10:15 AM Personnel #1 confirmed the hospital followed CDC (Centers for Disease Control and Prevention) guidelines. Personnel #1 confirmed the hospital currently had patients who had been identified with Candida Auris.

During an interview on 7/02/24 at 12:45 PM Personnel #2 confirmed no dates had been scheduled with DCHHS for a follow-up on-site visit.

The hospital's daily audit for 7/02/24 reflected the current total of C. auris patients was 14 of 40 patients. There were three HAI (hospital acquired infections), and 11 POA (present on admission) infections. Personnel #1 confirmed the findings.

Documentation provided by DCHHS reflected that on 4/13/24, 5/16/24, 5/17/24, 5/30/24, and 6/07/24, DCHHS had made requests for a follow-up on-site visit. No follow-up on-site visits had been scheduled with DCHHS.

The following information was provided by DCHHS reflecting the number of C. auris cases at the hospital in 2023 and 2024.
In 2023 between January and December, there was a total of 39 cases of C. auris. In 2024 between January and May, there was a total of 60 cases of C. auris.

The hospital's policy CORE: Management of an Outbreak and/or Epidemic dated 6/2022 reflected, "PURPOSE
This policy establishes guidelines to assure the safety of patients, visitors and staff in the event that an outbreak is suspected or confirmed. When an outbreak is suspected or confirmed, the Infection Preventionist (IP) shall be notified immediately.
POLICY
The policy of Kindred Hospital is to ensure the following: 1. The IP will consult with the Infectious Disease physician and/or the Infection Prevention and Control Committee Chairperson, the CCO, and the CEO/Administrator.
2. Investigations may require consultation with outside experts such as the Local or State Department of Health, or other local or state-specific agencies..."

https://www.cdc.gov/candida-auris/prevention/index.html. Date: 04/24/24"...Spread in healthcare facilities
C. auris spreads easily in healthcare facilities. It can cause life-threatening infections in some patients. Other patients can carry it on their skin or other body sites without having any signs of infection. This is called colonization..."

Interim Guidance for a Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs). December 2022. https://www.cdc.gov/healthcare-associated-infections/media/pdfs/Health-Response-Contain-MDRO-H.pdf
Tier 2 Organisms
" ...1. MDROs that are primarily associated with healthcare settings and are not commonly identified in the region. Generally, these have either not been previously identified in the region or have been limited to sporadic cases or small outbreaks
(i.e., correspond to "not detected" or "limited to moderate spread" epidemiologic stages). However, these MDROs might be found more commonly in other areas of the United States or even in other regions or patient sharing networks within the same jurisdiction. In most of the U.S., carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Acinetobacter spp. with OXA-48 or metallo-lactamase carbapenemases (e.g., New Delhi Metallo--lactamase (NDM), Verona-integron-mediated carbapenemase (VIM), and Imipenemase (IMP)), carbapenemase-producing Pseudomonas spp., and Candida auris meet the Tier 2 criteria. In many areas of the United States, carbapenem-resistant Enterobacterales producing Klebsiella pneumoniae carbapenemase (KPC-CRE) and C. auris also meet the Tier 2 criteria because they are not commonly identified.
2. Organisms for which no current treatment options exist (pan-not susceptible) and that have the potential to spread more widely within a region (e.g., have plasmid-mediated resistance mechanisms), even if more susceptible isolates of the same organism and mechanism are more commonly identified (i.e., Tier 3 or endemic) ...
The objective of Tier 2 investigations is to identify the extent of spread and implement measures to prevent further...
Health departments and healthcare facilities should ensure implementation of appropriate infection control measures (e.g., Contact Precautions), which may vary depending on the healthcare setting, and adequate supplies to implement these measures ... Prioritize the facility for a rapid infection control assessment to identify and address any potential gaps in IPC ... Health departments or other experts should conduct on-site IPC assessments at all healthcare facilities ... Conduct IPC assessments on-site whenever possible ..."