Becker's Clinical Quality & Infection Control

15 QUALITY IMPROVEMENT & MEASUREMENT Physicians should 'think fungus' amid rising infections, CDC expert says By Ashleigh Hollowell F ungal infections have been on the rise since COVID-19's inception, but public health tracking tools, tests, and data systems in the U.S. are not quite where they need to be yet, Tom Chiller, MD, CDC's head of mycotic diseases, told Becker's. "We don't have good surveillance for fungal infections," Dr. Chiller said. "A lot of our information is piecemeal or is institutional. We don't have a national fungal surveillance system. So it's oen hard to say with definitive facts and data that things are increasing or decreasing, staying the same." While there may not yet be robust systems in place to determine all of the important public health indicators related to fungal infections, there are some tools that exist and which are being used to track specific emerging fungal infections — like Candida auris — which the CDC began tracking in 2018. is, along with other indicators including environmental factors like climate change, are signaling that the emergence of new, severe fungal-caused infections is expected to continue, he explained. Expect the unexpected As the planet warms, fungi may be able to emerge and thrive in environments they previously have not been able to. And with these conditions, fungal infections that are increasingly drug-resistant are also likely, Dr. Chiller explained. Fungal infections are opportunistic, since they are closely linked to the environment, some spores can be in the air in almost any place. Our immune systems are the defense we have currently when breathing anything in that could be a pathogen, but as other factors continue to promote the emergence of drug-resistant fungi, that could be concerning for public health officials, he said. "ere are certainly indications that there may be more of them and new ones coming as well, that may be more resistant, more thermo- tolerant, more able to survive in general," Dr. Chiller said. "We know that environmental changes are going to affect fungi and I think they could affect them. ey could cause certain fungi to outcompete others that weren't as thriving as well in a lower temperature but now are thriving better at a higher temperature. ose then fungi could outcompete those others. And it could be that those fungi then might be more pathogenic to humans or animals, or even plants." Since many crops are sprayed with protective pathogens that are fungi, this could lead to more risk. "Probably 80 percent of crop pathogens are fungi. at also creates a higher risk for us because one of our defenses that we probably developed over millions of years is the ability to have a high internal body temperature and most fungi grow at a much lower temperature than our body," Dr. Chiller said. "As temperatures increase in the environment and as they adapt to these higher temperatures, they will become closer and closer to being able to survive our temperatures and to then survive within humans. at's going to be challenging because that's going to potentially create more successful fungal pathogens." Dr. Chiller said there are between 3 million and 5 million species of fungi, but only about 120,000 that are actually identified. Only a fraction of them cause human diseases, but that number is rising. "e potential is unfortunately huge for there to be more pathogens because [right now] we're only aware of a sliver of the fungal species Nurses urge CDC to bolster infection control rules By Paige Twenter N urses are calling on the CDC to strengthen its infection control guidance for hospitals, which has not seen revisions for 16 years, because of concerns the agency might state surgical masks are equal to N95s in infection control measures. The CDC's Isolation Precautions guidance has not been updated since 2007, and the agency's Healthcare Infection Control Advisory Committee met Aug. 22 to discuss revisions. The proposed draft and meeting minutes are not publicly available, but National Nurses United says the committee's presentations indicate the agency is "headed in a problematic direction." The union said the proposed draft fails to recognize the aerosol transmission of SARS-CoV-2 and other respiratory pathogens, promotes surgical masks that do not offer protection against respiratory pathogens, and looks to weaken other infection control measures. The committee was poised to vote on the guidance Aug. 22 but delayed voting until its next meeting, which is scheduled for Nov. 2 and Nov. 3, according to its website. The National Nurses United said the committee did not address its concerns and cut off public comments after hearing from 14 people. "The draft updates are anti-science and put nurses, other healthcare workers and patients at risk by proposing that surgical masks are adequate protection against aerosol- transmitted diseases, among other alarming updates," the union's president, Zenei Triunfo-Cortez, RN, said in a statement. Some hospitals are bringing masks back months after the COVID-19 public health emergency — and its ties to the CDC's community transmission metric — ended. Most hospitals are responsible for their own mask rules, while the CDC recommends a "risk-based approach." n

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