Managing Candida auris outbreak in residential care homes for the elderly: key takeaways from an outbreak in Hong Kong

Background C andida auris , a critical priority pathogen by the World Health Organization, is linked to hospital outbreaks and high mortality rates, particularly among vulnerable populations. Controlling outbreaks in residential care homes for the elderly (RCHEs) is challenging. On 7 th March 2024, the Centre for Health Protection of the Department of Health, Hong Kong Special Administrative Region, was notified of an RCHE resident who tested positive for C. auris upon hospital admission, raising concerns about potential transmission within the facility, which experienced a C. auris outbreak two years prior. Methods A multi-disciplinary response team conducted epidemiological investigations and implemented control measures to contain the outbreak. Contact tracing identified six additional colonized residents, apart from the index case and five residents who had persistent colonization from the previous outbreak. Infection control recommendations included proper placement of affected residents and frequent environmental disinfection, along with decolonization therapy arranged for all affected residents. Results The present outbreak involved seven residents, all with medical conditions that affect their ability to maintain personal hygiene. None developed clinical infections. Five residents were cleared with C. auris six months after completing decolonization therapy, while two passed away due to unrelated conditions. Discussion and Conclusion Current knowledge regarding clearance criteria, effective decolonization regime, and the role of air dispersal in transmission is limited, meriting further research. Effective communication among health authorities, hospitals, and RCHE staff is vital for prompt outbreak response, while continuous support enhances compliance and builds rapport with RCHEs, ensuring better outbreak management outcomes.