Efficacy of standard precautions versus proactive containment for nosocomial Candida auris outbreaks: a systematic review and meta-analysis.

INTRODUCTION

The environmental resilience and exogenous transmission dynamics of Candida auris (C. auris) pose persistent challenges for nosocomial infection control, and current international guidelines rely heavily on episodic chemical disinfection. Therefore, this study aims to mathematically quantify the operational efficacy of these standard, guideline-based infection protocols compared against advanced, proactive containment strategies.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review and meta-analysis was conducted utilizing PubMed and Scopus for the period 2016-2025. We structurally compared the consensus mandates of 7 international public health guidelines with empirical data extracted from 23 clinical outbreak cohorts. Random-effects modelling utilizing the Mantel-Haenszel method was applied to estimate pooled failure proportions and comparative risk ratios (RR).

FINDINGS: Guideline-mandated standard contact precautions and episodic chemical disinfection, when utilized as isolated strategies, yielded a pooled operational failure and recontamination proportion of 0.708 (95% confidence interval [CI]: 0.559-0.830). Conversely, the implementation of proactive containment strategies was associated with a 79% reduction in transmission risk (RR, 0.21; 95% CI: 0.12-0.37; P < .001). The highest outbreak-termination efficacy was achieved through the targeted withdrawal of highly handled, reusable clinical fomites (RR, 0.08; 95% CI: 0.02-0.32), complemented by admission rapid molecular screening (RR, 0.19; 95% CI: 0.04-0.97).

CONCLUSION

Standard reactive chemical disinfection and contact precautions exhibit high operational failure rates in halting nosocomial transmission of C. auris. Optimizing infection prevention protocols requires a transition towards proactive interventions, specifically prioritizing diagnostic acceleration and the rigorous management of reusable clinical fomites.