Prevention and control of Candida Auris spread in hospitals

Candida auris is a fungus first identified in 2009 in an elderly patient in Japan, specifically in her ear (hence the name "auris," which means "ear" in Latin).

What alarmed the international public was an article published in April 2019 in The New York Times, with a rather disturbing headline: A Mysterious Infection, Spanning the Globe in a Climate of Secrecy, The Rise of Candida auris embodies a serious and growing threat to public health: drug-resistant germs.

Journalists Matt Richtel and Andrew Jacobs reported on an elderly patient admitted to Mount Sinai Hospital in Brooklyn for abdominal surgery. The presence of Candida auris was detected in the patient's blood culture. The patient died after 90 days.

Environmental sampling showed that the entire room where the patient had been housed was contaminated with the same fungus. To eliminate surface contamination, in addition to cleaning, it was necessary to remove and replace part of the ceiling and floor tiles. Hospital representatives stated that all surfaces in the room were contaminated: walls, bed, doors, curtains, telephones, sink, whiteboard, IV poles, and ceiling.

By 2018, Candida auris had spread throughout the world; cases were reported in South Korea, India, Pakistan, Bangladesh, Israel, Kuwait, Oman, Malaysia, China, the United Arab Emirates, Saudi Arabia, Iran, Singapore, Thailand, South Africa, Kenya, and Spain.

Why is a Candida auris infection so dangerous?

Approximately 90% of Candida auris cases reported globally are resistant to at least one of the 3 classes of currently available antifungals, especially azoles. Unlike other Candida species, Candida auris can cause hospital outbreaks that are difficult to control.

This is because the fungus is particularly persistent in the environment and capable of colonizing surfaces, it can form biofilms, is resistant to some disinfectants commonly used to sanitize hospital environments, and is therefore difficult to eradicate.

Candida auris is a particularly infectious pathogen; the skin and other areas of the body can be colonized even in the absence of clinical manifestations, which causes the fungus to spread into the environment and be transmitted to other people.

Patients can remain colonized for months or years.

The fatality rate is high (ranging from approximately 30% to 70%), while the attributable mortality rate is difficult to calculate because affected patients often have comorbidities; the infection often affects patients who have already been hospitalized, can develop weeks after discharge, and death can occur within months.

Unawareness of this species in healthcare facilities can lead to a delayed diagnosis, ineffective treatment, and a high risk of death for an infected patient, as well as the spread of Candida auris into the environment and the infection of other people.

Prevention and control of the spread of Candida auris

After an invasive infection, the patient remains colonized for long periods of time, possibly years. Given the difficulty of treatment, it is necessary, both during the infectious period and the colonization phase, to comply with measures to prevent transmission and to standardize epidemiological surveillance systems, such as:

• Placing infected or colonized patients in individual rooms; if this is not possible, they can be grouped in a single room (cohort isolation) or, in the same room, maintain a distance of at least 1 meter between patients with and without Candida auris, also using privacy curtains to avoid any contact between patients.
• Rigorous hand hygiene with soap and water and, if unavailable, with an alcohol-based hand sanitizer, before and after contact with the person infected with C. auris or their personal items or objects in their room, or in accordance with the five moments of hand hygiene.
• Application of contact precautions (disposable gown and gloves).
• Proper handling of invasive medical devices and removing them when no longer needed.
• Removing personal protective equipment when leaving the patient's room and performing proper hand hygiene. KLINTENSIV® – Hand disinfectant gel
• Cleaning and disinfecting any equipment used by multiple patients and, when possible, using personal devices (e.g., thermometers).
• Frequent cleaning and disinfection of room surfaces using professional solutions effective against Candida auris. KLINOSEPT® P&P – Rapid surface disinfectant Alternatively, chlorine-based disinfectants can be used. To reduce surface damage from bleach, excess bleach solution can be removed with 70% ethanol. It is important to note that common disinfectants (e.g., cationic surfactants and quaternary ammonium compounds), products active against Candida albicans, or generic fungicides may not be effective against Candida auris.
• Proper handling of laundry, avoiding contact with contaminated surfaces.

Guidelines for preventing infection after patient discharge

After discharge, to minimize the risk of infecting a colonized or infected person, family members and/or close contacts must follow these guidelines:

• Assigning a dedicated room for the person infected with Candida auris.
• Cleaning and disinfecting all surfaces, as well as equipment or items shared with other people, daily and after use, with disinfectant solutions.
• Rigorous hand hygiene and frequent use of disinfectants. ALCHOSEPT® – Hand and skin disinfectant