Candida auris Outbreak Control in Critical Care Units in a Tertiary-Care Hospital in Nairobi, Kenya

Abstract

Background:Candida auris is an emerging pathogen associated with nosocomial outbreaks. During January to May 2019, 11 invasive cases of C. auris were identified in the intensive care unit (ICU) and high-dependency unit (HDU) at a hospital in Nairobi, Kenya. We report on the interventions implemented to control the outbreak. Methods: Intensified infection prevention and control (IPC) interventions were implemented. All patients infected or colonized with C. auris were placed in single-patient rooms with strict contact precautions. Cleaning of the patient care environment was enhanced by instituting a 3-step procedure of cleaning with soap and water, disinfecting with 0.5% chlorine, and rinsing with water. Glo-Germ gel was used to evaluate the cleaning processes, and percentage of missed surfaces was calculated. Hand hygiene training and compliance observations were conducted to enforce adherence to hand hygiene. The IPC team provided training and observational feedback of IPC to staff, patients, and their families. The IPC interventions were guided by screening activities. To monitor ongoing transmission, a biweekly point-prevalence survey (PPS) was performed to screen all previously negative ICU and HDU patients for C. auris. Furthermore, admission and contact screening were added to guide patient placement. Screening was conducted by collecting a composite swab from the bilateral axilla and groin. Samples were incubated in salt dulcitol broth for 5 days at 40°C then subcultured onto Sabouraud dextrose agar. Colony identification was performed using a Vitek 2 system (bioMérieux). Results: In total, 177 patients were placed in single-patient rooms under contact precautions during May–August 2019. We conducted 123 environmental cleaning observations, and the percentage of missed surfaces decreased from 71% (10 of 14) in June to 7% (1 of 16) in August. Hand hygiene compliance among ICU and HDU staff was 79% (204 of 257) in May, 71% (159 of 223) in June, 73% (170 of 233) in July, and 81% (534 of 657) in August. In total, 283 screening swabs from 234 patients were processed during May–August 2019. Overall, 18 of 88 PPS swabs (20%), 13 of 180 admission screening swabs (7%), and 0 of 15 contact screening swabs (0%) were positive for C. auris. The PPS results showed a rapid decrease in colonization: 6 of 14 (43%) in May, 12 of 54 (22%) in June, 9 of 98 (9%) in July, and 1 of 70 (2%) in August. No new C. auris infections were identified from June to October 2019. Conclusions: The control of C. auris in a hospital outbreak requires multimodal interventions, including enhanced IPC interventions, PPS, admission and contact screening for colonization, rigorous monitoring, and team effort.

Funding: None

Disclosures: None