Controlling a possible outbreak of Candida auris infection: lessons learnt from multiple interventions

Abstract

The frequently used disinfectants in our hospital and current hand hygiene practices were efficient against C. auris if proper contact time and procedures were followed. Evaluation of possible persistence of C. auris on dry fabrics showed that they can persist for up to seven days.

An outbreak due to Candida auris with prolonged colonisation and candidaemia in a tertiary care European hospital

“…The explanation for this was most likely the use of surface cationic‐active products, as it was not known until very recently that these products, as well as quaternary ammonium disinfectants, cannot effectively remove C. auris from surfaces. At present, it has been recommended to use disinfectants with sporicidal activity or hydrogen peroxide‐based products to clean surfaces in rooms of patients infected or colonised with C. auris due to its high efficiency in removing this species from inert surfaces . Furthermore, the capacity of C. auris to survive and persist for several days in clinical environments is well known and facilitates a potential route for dissemination of this emerging and multidrug‐resistant pathogen…”

“…This feature could be due to the use of cationic surface‐active products like quaternary ammonium, disinfectants that until very recently its efficacy against this species was unknown. Currently, the activity of sporicidal disinfectants and hydrogen peroxide‐based disinfectants against C. auris has been demonstrated . Likewise, many colonised biomedical devices could be also implicated in cross‐infection, maintenance of reservoirs and therefore persistence of an outbreak …”

“…Although there are no established breakpoints for C. auris , studies have demonstrated elevated resistance to azoles with minimum inhibitory concentration (MIC) 256 μg/mL and ≥2 μg/mL to fluconazole and voriconazole, respectively, and variable susceptibility to other azoles, amphotericin B and echinocandins . Finally, delay in species identification, presence of comorbidity and clinical severity of infected patients (critical care patients) and antifungal resistance lead to high mortality rates and presence of frequent complications (septic metastasis and recurrent/persistent candidaemia) . Therefore, C. auris infections are a worrisome healthcare problem and a daily challenge for the clinician dealing with infected or colonised patients.…”

Diagnosis, management and prevention of Candida auris in hospitals: position statement of the Australasian Society for Infectious Diseases

“…auris may persist on moist or dry surfaces for 7 days and sampling of environmental surfaces during an outbreak also identified C . auris on beds and equipment for up to seven days . In another study, C .…”

“…auris colonises skin of both symptomatic and asymptomatic patients . Of various body sites, axillary and inguinal swabs are most frequently positive . Therefore, composite swabs of the axilla and groin should be obtained as a minimum.…”