CDC partners with a private hospital in Nairobi to contain Candida auris

In May 2019, the Kenya Ministry of Health requested help from CDC to investigate a potential case of Candida auris infection at a private hospital in Nairobi. This investigation led to a successful collaboration between the hospital’s staff and CDC to identify and contain the spread of this emerging pathogen.

C auris is a serious global public health threat because it can spread from person to person in healthcare settings, living on surfaces for several weeks. One in three patients with an invasive C. auris infection can die from it, and the fungus is often resistant to the drugs used to treat it.

CDC epidemiologists with Dr. Loice Achieng (third from left, infectious disease physician at a private Nairobi hospital) and Evelyn Wesangula (far right, Kenya Ministry of Health).

“The hospital wanted to do everything possible to stop the transmission of C. auris, so they really welcomed support. It was great that we worked in collaboration with everyone involved,” said CDC epidemiologist Mitsuru Toda, PhD, of CDC’s Mycotic Diseases Branch (MDB).

Building laboratory and hospital capacity

To better identify and contain C. auris in the facility, the hospital’s laboratory, epidemiology, clinical, and infection control teams worked with CDC scientists from MDB, the International Infection Control Program of the Division of Healthcare Quality Promotion, and the Division of Global Health Protection to build capacity by:

• Training staff on proper laboratory techniques, including screening patients who might at risk for or sick with C. auris, or have the fungus on their skin
• Reviewing patient charts to learn more about suspected cases and risk factors
• Reviewing and improving practices for cleaning healthcare facilities to prevent the spread of C. auris
• Developing strict isolation and infection control policies for patients with C. auris

Hospital staff soon detected multiple cases of C. auris infection in the facility, potentially caused by the transfer of patients between facilities.

Patient chart reviews helped identify patients with C. auris.

Stopping the spread of C. auris

As a result of this collaboration amongst the hospital staff, CDC, and the Kenya Ministry of Health, C. auris has not spread outside the hospital. As of November 2019, the hospital has not seen a new case of the pathogen inside the hospital either.

This collaboration empowered hospital staff to better identify and contain the spread of C. auris in their facility.

“This is an example of what’s supposed to happen when it comes to containing C. auris – our plan worked!” said Elizabeth Berkow, PhD, MDB laboratory team lead at CDC. “The Nairobi team was very organized and mobilized quickly, so when we got there, we were able to accomplish a lot. They were very eager, willing, and communicative partners who were great to work with,” she said.

CDC epidemiologist Ulzii-Orshikh Luvsansharav, MD, PhD, agreed that this close working relationship was key to successfully controlling C. auris.  “The collaboration among the laboratory, clinical, epidemiology, and infection control teams made all the difference in containing the outbreak.  All four groups were needed for a successful outcome.”

The Nairobi hospital team was also pleased with the collaboration with CDC. The success of this effort began with the hospital identifying the problem and identifying gaps in their capacity to control the spread of C. auris.  “We are grateful to the CDC teams for the very quick response, and willingness to help and work alongside the hospital teams to put in place all the measures that were needed to control the outbreak,” said Loice Achieng, MD, an infectious disease doctor at the hospital.

Ways to prevent C. auris

Some ways healthcare facilities can work to reduce the spread of C. auris between patients include:

• Quickly and accurately identifying C. auris in facilities
• Carefully following proper infection control practices
• Looking at common risk factors among patients with C. auris
• Streamlining communication between facilities, especially when transferring patients with C. auris from one facility to another

Healthcare facilities should also properly and consistently follow recommended practices for:

• Hand hygiene
• Personal protective equipment use
• Cleaning and disinfecting medical equipment and the healthcare environment
• Using antimicrobial medications correctly

US healthcare facilities or laboratories that suspect they have a patient with C. auris infection should contact state or local public health authorities and CDC (candidaauris@cdc.gov) immediately for guidance.