P-1143. Implementing Admission Screening for Candida auris and Carbapanemase-Producing Organisms (CPOs) in a Low-Prevalence State

TL;DR

Oregon implemented admission screening for Candida auris and CPOs to detect cases in low-prevalence areas, facing challenges like resource allocation and data sharing.

Contribution

The paper presents Oregon's implementation strategy and outcomes for admission screening of C. auris and CPOs in a low-prevalence setting.

Findings

As of May 2025, 16 hospitals and one facility implemented routine screening for C. auris and CPOs.

Between May 2023 and March 2025, 807 swabs were collected, with only five positive results.

Screening increased over time but faced challenges like training and data sharing with non-public health labs.

Abstract

In response to CDC guidance recommending admission screening for Candida auris and carbapenemase-producing organisms (CPOs), the Oregon Health Authority (OHA) launched a statewide effort to encourage and support healthcare facilities in implementing screening protocols. Oregon remains a low-prevalence state for these organisms.Figure 1:Screen shot from Oregon’s interim admission screening guidanceWeblink: https://rebrand.ly/AdmissionScreeningFigure 2:Timeline of C. auris and CPO admission screening implementation in Oregon

Screen shot from Oregon’s interim admission screening guidance

Weblink: https://rebrand.ly/AdmissionScreening

Timeline of C. auris and CPO admission screening implementation in Oregon

Starting in 2022, OHA began outreach to all high acuity Oregon healthcare facilities: 63 acute care hospitals (ACHs), one long-term acute care hospital (LTACH), and one ventilator-capable skilled nursing facility (vSNF). Twenty-nine facilities were prioritized based on regional epidemiology and facility interest. Outreach included emails (14), response consultations (6), presentations (4), and a statewide webinar (1). Ten volunteer facilities helped develop Oregon-specific screening guidance, published April 2024 (figure 1). This guidance was shared during subsequent OHA-led infection prevention trainings and assessments.Figure 3:Percent of target healthcare facilities currently implementing routine admission screening (n=17) or actively working towards implementation (n=5) by geographic regionFigure 4:Monthly number of C. auris and CPO swabs collected over time**OHA relies on healthcare facility partners to voluntarily report the number of swabs collected and tested at labs other than OSPHL and ARLN. Positive results require mandatory reporting.

Percent of target healthcare facilities currently implementing routine admission screening (n=17) or actively working towards implementation (n=5) by geographic region

Monthly number of C. auris and CPO swabs collected over time*

*OHA relies on healthcare facility partners to voluntarily report the number of swabs collected and tested at labs other than OSPHL and ARLN. Positive results require mandatory reporting.

An implementation timeline is shown in figure 2. As of 05/01/2025, 16 ACHs across six healthcare systems and one vSNF implemented routine admission screening; five additional ACHs are working toward it; and all other facilities are supported on an ad-hoc basis. At least one facility in each Oregon region is participating (figure 3). Screening criteria vary by facility or system. Facilities use a combination of labs to support testing including Oregon State Public Health Lab (7), Antibiotic Resistance Laboratory Network (5), private reference labs (4), and in-house clinical labs (1). When non-public health labs are used for screening, OHA relies on voluntary reporting of swab counts. Between 05/01/2023 and 03/31/2025, facilities collected 807 swabs; one of 543 C. auris swabs and four of 264 CPO swabs tested positive. Statewide screening has increased over time (figure 4).

Admission screening for C. auris and CPOs can identify cases that would otherwise remain undetected in low-prevalence regions. Challenges include resource allocation, training clinical and laboratory staff, turnaround time, and data sharing when non-public health labs are used. Oregon’s experience can guide other low-prevalence jurisdictions initiating admission screening.

Christopher D. Pfeiffer, MD, MHS, Department of Defense/MedPace: Grant/Research Support

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