Background: Previous studies demonstrated that the addition of anterior nares to axilla/groin skin testing substantially improved the detection of Candidozyma auris colonization (Proctor et al., Nature Medicine, 2021; Sansom et al., CID, 2024), but these observations were limited by small sample sizes and reflected mostly nursing home residents. We aimed to assess the benefit of adding nares testing to axilla/groin testing among hospitalized patients participating in C. auris point prevalence surveys (PPSs). Methods We conducted a prospective observational study at three long-term acute care hospitals (LTACHs) in the Chicago region, one of which also included distinct inpatient rehabilitation floors. Facilities participated in quarterly public health-led C. auris PPSs from May 2024 to October 2025. Patients underwent swab sampling at two sites: composite bilateral axillae/groin (swab 1) and bilateral anterior nares (swab 2). Samples were processed at a central laboratory for C. auris detection by PCR using a validated assay with enzymatic preprocessing and automated DNA extraction. Primary analyses were restricted to patients with results available from both sampling sites; a positive C. auris test from either body site was considered the reference standard. Analyses were performed using R v4.5.2 (www.r-project.org) and Stata/SE v18.0 (Stata Corp., College Station, TX). Results Across 18 PPSs, 769 of 867 (89%) eligible patients participated. The overall C. auris prevalence was 46% (317/685) among LTACH patients and 15% (13/84) among rehabilitation patients. Among all patients who tested positive for C. auris, 64% were in Contact Precautions for any reason at time of PPS and 34% were previously known to be C. auris colonized. After excluding 16 patients who were missing a body site specimen, 753 patients were eligible for analysis (670 LTACH, 83 rehabilitation). Among 320 patients with C. auris detected at any body site, 301 were detected by axilla/groin screening (94% sensitivity; 95% confidence interval 91% to 96%) and 234 (73%) tested positive at the anterior nares for C. auris. Inclusion of nares swabbing identified 19 additional patients who would have been missed by axilla/groin screening alone, corresponding to an incremental increase of 6%. Conclusion Among LTACH and rehabilitation patients, C. auris colonization was common and PPSs identified a substantial number of patients not previously known to be colonized. The incremental benefit of adding nares screening was modest compared to axilla/groin screening alone. Testing more body sites can identify more C. auris colonized patients, but facilities should balance benefit versus cost of expanded screening approaches.

We evaluated Clostridioides difficile admission screening in a cancer unit. Admission screening was associated with a non-significant decrease in hospital-onset C. difficile infection (CDI) incidence and a significant decrease in community-onset CDI incidence, which may reflect, in part, the artifactual impact of screening on subsequent provider testing behavior.

Background: Gaps in knowledge and compliance regarding control of Candida auris contribute to ongoing spread in healthcare facilities, but few studies have evaluated barriers to effective prevention measures. Methods: We assessed the knowledge, attitudes, beliefs, and practices for control of C. auris among frontline healthcare workers at 2 long-term acute care hospitals (LTACH) with high admission prevalence of C. auris in the Chicago, Illinois region. Surveys included 92 questions including the following subjects: participant demographics; awareness of multidrug-resistant organisms [MDRO]; attitudes and beliefs regarding C. auris; motivation for using and compliance with personal protective equipment [PPE]; knowledge of C. auris prevention measures; perceived barriers and facilitators of C. auris prevention; sources of education and training; and preferred learning styles. Responses were measured on a 5-point Likert scale. Anonymous online surveys were administered during the one-month study period Recruitment efforts included posters, fliers, email, and in-person rounds with the LTACH infection preventionist. Participants were eligible to win a gift card upon survey completion. Only complete surveys were analyzed. Results: Fifty-three surveys were completed (estimated 12% response rate across all facility staff) with respondents identifying as 92% female, 43% nurses, and 60% with >10 years of experience in their current role. Participants were familiar with commonly identified MDROs (i.e., Clostridoides difficile [98%], methicillin-resistant Staphylococcus aureus [88%]) but were less aware of extended-spectrum β-lactam-resistant (68%) and carbapenem-resistant pathogens (56-79%) (Figure 1). Participants felt that their actions helped prevent C. auris spread (85%) but were less confident when asked whether C. auris is a problem at their own hospital (53%). Participants were able to successfully identify most prevention strategies for C. auris (≥72% correct for all measures). The highest ranked barriers to C. auris prevention were understaffing (63%) and inadequate training (51%) (Figure 2). Information regarding C. auris was most commonly obtained through training provided within their hospital (62%) and from coworkers (45%). Participants responded that they prefer to learn about infection prevention through in-person teaching by experts at their facility (83%) or from another institution (79%), although self-learning styles were also popular (67-73%) (Figure 3). Conclusion: We identified perceived barriers to effective C. auris prevention among frontline healthcare workers in 2 LTACHs. While staff members successfully identified most prevention strategies for C. auris, they may benefit from enhanced education and training programs that support multiple learning styles.

Background: Clostridioides difficile infection (CDI) disproportionately impacts hematology-oncology patients. In June 2022, our hospital implemented screening of asymptomatic patients admitted to the hematology-oncology unit to reduce CDI rates by early identification and isolation of C. difficile carriers. We evaluated the impact of admission screening on rates of CDI and compared incidence of diarrhea and subsequent symptomatic testing stratified by asymptomatic admission testing result. Method: During the intervention period (July 2022 – July 2024), asymptomatic patients admitted to the hematology-oncology unit were tested for C. difficile (perirectal swab, Cepheid GeneXpert®, Sunnyvale, CA). Guidelines for C. difficile symptomatic testing (unformed stool, Cepheid GeneXpert®) and treatment did not change between the baseline (May 2020 – May 2022) and intervention periods. Monthly CDI rates were calculated using CDC definitions based on clinical symptoms and positive C. difficile testing (community onset [CO] if positive in the first three hospital days, hospital-onset [HO] if day 4 or later). We performed an interrupted time-series analysis adjusted for repeated measures to compare CO-CDI and HO-CDI rates per 10,000 patient-days between baseline and intervention periods. The risk of developing diarrhea through hospital day 14 or being tested for symptomatic CDI during the intervention’s first year (July 2022 – June 2023) was analyzed using a cohort of asymptomatic C. difficile carriers and non-carriers in a 1:2 ratio, matched on hospital length of stay and date of admission. Result: The incidence rate ratio was 0.45 (P=0.10) for HO-CDI (Figure 1) and 0.15 (P=0.049) for CO-CDI (Figure 2) after screening implementation. During the first year of the intervention, 25 individuals were identified as asymptomatic C. difficile carriers by positive admission screen and were matched to a cohort of 50 asymptomatic non-carriers. There were no significant differences in development of diarrhea during hospital days 1-3 or days 4-14 between carriers and non-carriers (Table). None of the carriers received symptomatic C. difficile testing during hospitalization, compared to 20% of matched non-carriers (P=0.03). Conclusion: There was no significant change in HO-CDI rates and a statistically significant reduction in CO-CDI rates after implementation of C. difficile admission screening. Patients identified as carriers at time of admission were less likely to be tested for CDI during hospitalization than non-carriers, despite similar rates of diarrhea. Admission screening for C. difficile may reduce CDI rates through a variety of mechanisms; changes in provider testing behavior for patients previously screened for C. difficile may play a role.