Evaluating the measures taken to contain a Candida auris outbreak in a tertiary care hospital in South India: an outbreak investigational study.
BACKGROUND
Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. The objective of this work is to describe a multidisciplinary approach towards the investigation and containment of a Candida auris outbreak and the preventive measures adopted in a resource limited setting.


METHODS
This outbreak investigational study was conducted at a 1300-bedded tertiary care academic hospital in South India. The study included 15 adult inpatients with laboratory confirmed Candida auris isolates. The outbreak cluster was identified in adult patients admitted from September 2017 to 2019. The system response consisted of a critical alert system for laboratory confirmed Candida auris infection and multidisciplinary 'Candida auris care team' for patient management. The team implemented stringent Infection Prevention and Control (IPC) measures including patient cohorting, standardized therapy and decolonization, staff training, prospective surveillance and introduction of Candida auris specific care bundle.


RESULTS
Two outbreak clusters were identified; first cluster occurring between October and November 2017 and the second cluster in May 2018. The cohorts consisted of 7 and 8 Candida auris positive patients in the first and second waves of the outbreak respectively with a total survival rate of 93% (14/15). Deployment of containment measures led to gradual decline in the incidence of adult Candida auris positive cases and prevented further cluster formation.


CONCLUSIONS
The sustained implementation of guideline and evidence-based IPC measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Low- and Middle-income country.
['Sathyapalan|Dipu Thareparambil|DT|', 'Antony|Remya|R|', 'Nampoothiri|Vrinda|V|', 'Kumar|Anil|A|', 'Shashindran|Nandita|N|', 'James|Jini|J|', 'Thomas|Jisha|J|', 'Prasanna|Preetha|P|', 'Sudhir|Akkulath Sangita|AS|', 'Philip|Jeslyn Mary|JM|', 'Edathadathil|Fabia|F|', 'Prabhu|Binny|B|', 'Singh|Sanjeev|S|', 'Moni|Merlin|M|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000935:Antifungal Agents D058365:Candidiasis, Invasive D004196:Disease Outbreaks D006801:Humans D015994:Incidence D007194:India D017053:Infection Control D007362:Intensive Care Units D008297:Male D008875:Middle Aged D009026:Mortality D011446:Prospective Studies D062606:Tertiary Care Centers D016896:Treatment Outcome
Containment Candida auris Outbreak Multidisciplinary Implementation Infection prevention and control Bundle Hand hygiene Index case Low-and middle- income country