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Background:Candida auris is an emerging nosocomial fungal pathogen causing invasive illness and outbreaks worldwide. A major issue regarding C. auris is that it can be misidentified unless appropriate technology is used. We conducted a survey of available methods for identification of C. auris in 21 hospital laboratories in India regarding their protocols for prevention of C. auris infection. Methods: The survey was an adaptation of a similar survey conducted for the Connecticut Laboratory Response Network in 2017. We mailed the survey to 30 microbiologists and ID physicians, and 21 of them from 12 states responded. All respondents were from private acute-care and teaching hospitals. The responses were analyzed and compared to the Connecticut study. Results: Of 21 hospitals, 19 (90.5%) can identify C. auris in house. Also, 18 (85.7%) have identified C. auris in the past 18 months. Species level identification was done only for blood cultures in all hospitals. Only 5 (26%) laboratories speciated Candida spp isolated from other sites such as respiratory and urinary specimens. Automated systems were used like Vitek 2 in 16 (84.2%), Phoenix BD in 2(10.5%) and Microscan in 1(5.26%) laboratory. MALDI-TOF MS and PCR for identification were used in 2 laboratories. Antifungal susceptibility testing is done in-house in 19 (90.5%) laboratories. Only 10 (52.6%) responding hospitals from India had infection prevention protocols for C. auris, and 9 (47.4%) of them isolated patients. The major challenges for infection prevention with C. auris are absence of screening in high-risk patients (66.7%), misidentification by automated systems (84.2%), and inability to speciate from nonsterile sites underestimates the prevalence (100%). Conclusions: There is an urgent need to enhance the capacity of hospital laboratories to detect C. auris early, and to implement infection prevention measures. In both studies early detection is the key and as suggested by the US authors, challenges can be overcome through collaboration between hospitals and referral laboratories when resources are limited. This optimizes laboratory capacity and prevents global spread through colonized patients. The limitation of this study is that data from public hospitals are unknown and larger studies are needed.
Objectives: In April 2006, Connecticut conducted an exercise that tested its ability to receive and dispense antibiotics from the Strategic National Stockpile. In conjunction with the exercise, a competency-based assessment was performed to determine the training needs of point of dispensing (POD) workers.
Methods: POD core competencies were developed by adapting existing preparedness materials. They were used to assess the training needs of more than 250 people who staffed a POD during the exercise. The assessment measured their confidence in their ability to perform 17 competency-based tasks.
Results: The vast majority needed training on 5 or fewer tasks, suggesting that they were fairly well trained. Pharmacists were particularly likely to need training on at least 5 tasks. Given their role in a POD operation, they should be a focus of further training. Almost one third of participants needed additional training on at least 1 of the 3 basic POD Incident Command System tasks. Additional training is also needed on competencies concerning POD safety and security, liability protections, and family preparedness. POD workers who are concerned about these matters may be less willing or able to staff a POD. People who participated in training both before and on the day of the exercise were best prepared to staff the POD, indicating that both types of training have value.
Conclusions: When compared with the competencies, POD workers possessed many of the necessary skills to staff a POD; however, training with emphasis on areas of weakness revealed by the assessment could improve willingness to report for duty and performance.
(Disaster Med Public Health Preparedness. 2010;4:306-311)
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