Successful eradication of Candida auris in a tertiary care ICU following a nearly 30 month outbreak: a drastic “Unit reset” protocol
Daniel Leshin-Carmel, Vadim Berezovsky, Alla Hadad, Revital Arye Yaish, Evgeny Frodin, Yamit Nofit Vagima, Ilanit Edri, Hila Hameiri, Diana Roif-Kaminsky, Sussanna Mostovoy, Tal Bergman Levy, Hagay FrenkelAbstract
Background:
Candida auris is a globally emerging, multidrug-resistant pathogen characterized by extreme environmental persistence and resistance to standard hospital disinfectants. Our ICU faced an endemic outbreak that lasted for 30 months, which was resistant to standard infection prevention and control (IPC) bundles.
Objective:
To evaluate the efficacy of a radical, multi-sectoral “Unit Reset” protocol involving total operational decanting, mechanical disassembly, and inventory disposal after incremental IPC strategies were exhausted.
Methods:
We executed a 120-hour “Unit Reset” in February 2026. The intervention comprised: (1) transferring all patients to a temporary satellite site; (2) total disposal of all pharmaceutical and disposable inventories; (3) structural remediation; and (4) dual-team mechanical disinfection with 5,000 ppm hypochlorite supplemented by 18% automated hydrogen peroxide vapor (HPV).
Results:
Over the 30-month endemic period, C. auris acquisition rates escalated despite high compliance with standard IPC bundles. Environmental surveillance rounds identified persistent reservoirs on high-touch surfaces that the routine cleaning protocols missed. Following the 120-hour Unit Reset, the ICU was reopened to admissions. During the subsequent 16-week active surveillance window, zero new clinical acquisitions or screening-positive cases were detected, representing the first sustained interruption of transmission since August 2023.
Conclusions:
When C. auris achieves deep environmental sequestration within deteriorated medical infrastructure or complex equipment housings, incremental “enhanced cleaning” protocols may fail due to biofilm shielding. A radical, coordinated institutional reset can terminate entrenched nosocomial transmission when standard IPC bundles reach their limits.