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Japanese fungus: nurse staffing levels in spotlight

Infection prevention experts say there is ‘no evidence’ low nurse numbers played a part in the rise in cases of a potentially deadly fungus appearing on hospital wards.
Ward cleaning

The issue of nursing staffing numbers is in the spotlight after more than 200 people have been contaminated or infected with a potentially deadly strain of drug-resistant fungus during outbreaks at UK hospitals

As of the beginning of July, some 20 separate NHS Trusts and independent hospitals detected Candida auris (C. auris) in patients, with three hospitals tackling 'large' outbreaks, according to Public Health England (PHE).

First discovered in Japan, the family of yeasts can live on the skin and inside the body, causing complications in people with weakened immune systems.

Infections are usually minor, while serious infections are rare.

Public Health England (PHE) said doctors at one hospital were still dealing with an outbreak of the fungus, which is resistant to a commonly

The issue of nursing staffing numbers is in the spotlight after more than 200 people have been contaminated or infected with a potentially deadly strain of drug-resistant fungus during outbreaks at UK hospitals


Three hospitals are dealing with 'large' outbreaks of Candida auris, Public Health England said
Picture: Science Photo Library

As of the beginning of July, some 20 separate NHS Trusts and independent hospitals detected Candida auris (C. auris) in patients, with three hospitals tackling 'large' outbreaks, according to Public Health England (PHE).

First discovered in Japan, the family of yeasts can live on the skin and inside the body, causing complications in people with weakened immune systems.

Infections are usually minor, while serious infections are rare.

Public Health England (PHE) said doctors at one hospital were still dealing with an outbreak of the fungus, which is resistant to a commonly prescribed fungicidal drug.

New guidance

Staff have been issued with new guidance on detecting and dealing with the fungus, including the 'intensive' disinfection of wards amid concern over the 'increasing experience of the complexities' infections are posing.

Meanwhile a biosafety unit at Porton Down in Wiltshire has been testing fungicidal activity of a variety of disinfectants and antiseptics.

The Times reported that King's College Hospital NHS Foundation Trust in London, which had dealt with an outbreak between October 2016 and April this year, had reported in minutes of a board of directors meeting in February that the spread of the pathogen at its organisation was 'affected by low nursing levels'.

‘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,' the papers stated.

A trust spokesperson told Nursing Standard that nursing levels were not a contributing factor during the outbreak

'The C. auris outbreak commenced in October 2016 and was declared over in April 2017,' the spokesperson said.

'During the outbreak, 31 patients were colonised, six of whom had C. auris in their blood cultures. No deaths have been attributed to C. auris.

'Furthermore, we can confirm that nursing levels were not a contributing fator during the outbreak as we had appropriate nurse staffing in all affected areas.'

Effects

RCN professional lead for infection prevention and control Rose Gallagher told Nursing Standard while there is no specific evidence that low nursing levels cause outbreaks, staffing levels can effect how they are dealt with.

‘When identified (outbreaks) require extra support staff to clean equipment and ensure best practice,' she added.

‘The environment where infections are housed also plays a big role in how they are spread - that’s why investment in adequate staff to permit thorough cleaning and infection prevention control practices are essential in preventing other patients from being infected.’

A 2012 US study examined the link between nurse staffing, burnout and health care-associated infection. It concluded that reducing burnout in registered nurses was a 'promising strategy' to help control infections in acute care facilities.

'No evidence'

Infection Prevention Society president Neil Wigglesworth told Nursing Standard that there was 'currently no high quality evidence' that low staffing levels impacts directly on infection levels.

‘However, there is no getting away from the fact that nurses have a massive responsibility for ensuring the measures which are in place are effective,' he added.

‘That includes observing basic hand hygiene, use of personal protective equipment, and making sure all equipment is properly cleaned before and after use.

‘While Candida is a fungus not a bacteria, the rise of multidrug-resistant gram negative  infections is worrying to everyone, not just those in healthcare.

‘No-one can let their guard down in the fight against infections, there is always a new challenge emerging.’

Further information


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