KNOW Candida auris: Prevention of another outbreak through screening and early identification

Abstract

Background: Candida auris, within the last decade, has emerged as a multidrug resistant public health threat that can lead to hospital outbreaks. It is an invasive fungal yeast resistant to multiple antifungal agents. The mode of transmission is through contaminated hospital items (including clothes and furniture) and interventions by staff. Two Candida auris outbreaks occurred in Qatar. The first outbreak was in Al Wakra Hospital (AWH), which is a facility of Hamad Medical Corporation (HMC), the principal public healthcare provider in the State of Qatar. As concluded by Eyre DW, et al. (2018), a series of interventions and environmental screening program may reduce the Candida auris outbreak. A screening toolkit that includes a checklist based on an existing protocol and operationally defined criteria is a key preventive measure for Candida auris identification. We aim to attain 100% compliance with screening suspected patients and preventing further outbreaks. Methods: A screening protocol toolkit was created for eligible patients that allowed early identification and prompt intervention therefore enhancing the provision of high-quality, efficient, cost effective, and safe patient care. Furthermore, implementation of an Outbreak Prevention Bundle had been proven effective in preventing the spread and comprised: (1) prophylactic contact precautions, (2) blanket screening of at risk/exposed patients, (3) environmental sampling, and (4) hydrogen peroxide disinfection. Results/Findings/Recommendations: In 2020, continuous screening was maintained for patients fitting the HMC criteria. The protocol for the management of outbreaks was implemented. The number of COVID-19 positive cases peaked during July - August 2020 when COVID-19 patients were transferred to AWH . Overall, AWH reached 407 cumulative days without Candida auris outbreak . Conclusion: Candida auris outbreak is preventable through early identification via screening and implementation of an Outbreak Prevention Bundle. This method has led to no active outbreak in AWH since August 2019 until October 2020.

Molecular characterization of Candida auris outbreak isolates in Qatar from patients with COVID-19 reveals the emergence of isolates resistant to three classes of antifungal drugs

“…Of particular concern, a significant rise in C. auris infections was observed during the COVID-19 pandemics [ 8 , 9 , 10 ]. SARS-CoV-2 infection alters immune and metabolic responses in patients, which together produce an inflammatory environment that is highly permissive to fungal infections [ 10 ].…”