Candida auris – spreading through UK hospitals
Candida auris is a multi-drug resistant yeast that was first discovered in the ear of a Japanese patient in 2009. The yeast can enter the bloodstream via catheters, lines or other tubes entering the body and spread through the body causing serious invasive infections.
This month (August) Public Health England issued updated guidance on the management of Candida auris within healthcare and community settings such as care facilities. As part of the update, PHE issued data analysing the prevalence of Candida auris within UK hospitals. As of July 2017, 20 separate Trusts and independent hospitals had detected in excess of 200 patients colonised or infected with Candida auris. Over 35 other hospitals have reported incidents of patients known to be colonised with Candida auris being transferred to them. There have been three large nosocomial outbreaks of Candida auris in the UK, with the largest occurring at the Royal Brompton in London where 50 patients were involved, with 22 developing infection and 9 with Candidemia (Candida within the blood). All three outbreaks occurred within the hospitals ICUs.
Although Candida auris is associated with high mortality, particularly in immunocompromised patients, thankfully in the UK to date, there have been no known cases of fatality related to Candida auris. However, its growing resistance to the major classes of antifungals – azoles, echinocandins and polyenes – make this microorganism a serious global health threat.
Worryingly, Candida auris is able to survive and persist on hospital surfaces, and whilst the exact mechanism of patient transmission as yet to be identified, environmental transmission is likely to play a major role. Environmental sampling conducted during the Royal Brompton outbreak showed the presence and persistence of Candida auris around the patient bed space area.
The PHE guidance document recommends that patients colonised or infected with Candida auris are isolated in a single room. The lack of availability of single rooms within UK hospitals could make compliance with the PHE guidance challenging. The Bioquell Pod allows a hospital to convert multi-bed wards quickly into single-occupancy isolation units. The Bioquell Pod contains HEPA filtration and specialist lighting providing patient comfort, whilst isolating any potential contamination. The Bioquell Pod is designed to be rapidly bio-decontaminated using Bioquell Hydrogen Peroxide Vapour, providing an aseptic environment and assurance that the risk of nosocomial infection to the next patient receiving treatment within the room has been mitigated. Bioquell Hydrogen Peroxide Vapour systems were deployed during the Candida auris outbreak at the Royal Brompton to curtail the outbreak, find out more here.