Candida auris in Healthcare Facilities
Candida auris is an emerging fungus that presents a serious global health threat. The U.S. Centers for Disease Control and Prevention (CDC) is concerned about C. auris for several reasons:
- It causes serious infections: C. auris can cause bloodstream and other types of invasive infections, particularly in patients in hospitals and nursing homes who have multiple medical problems. More than 1 in 3 patients die within a month of C. auris infection.
- It is often multidrug-resistant: Antifungal medications commonly used to treat Candida infections often don’t work for C. auris. Some C. auris isolates are resistant to all three major classes of antifungal medications.
- It’s becoming more common: Although C. auris was just recognized in 2009, it has emerged quickly. Since then, it has been reported from over 20 countries, including the United States.
- It’s difficult to identify: C. auriscan be misidentified as other types of yeast unless specialized laboratory methods are used. Unrecognized C. auris can spread to other patients in a facility, causing an outbreak. Identifying C. auris is critical to knowing what steps to take to control it in a healthcare setting.
- It can spread in healthcare facilities: Just like other multidrug-resistant organisms such as CRE and MRSA, C. auriscan be transmitted in healthcare settings and cause outbreaks. It can colonize patients for many months, persist in the environment, and withstand many routinely used disinfectants in healthcare facilities.
The October 2018 issue of Emerging Infectious Diseases (EID), the CDC's monthly peer-reviewed public health journal, authors affiliated with the New York State Department of Public Health describe an outbreak of C. auris infections in healthcare facilities in New York City. Of the 51 clinical case-patients identified in the study, 45% died within 90 days and isolates were resistant to fluconazole for 98%. Eleven percent (11%) of screening. According to the abstract, C. auris transmission is ongoing in healthcare facilities, most often in patients with extensive healthcare exposures.
How to Prepare Your Facility for C. auris:
- Work with your laboratory to ensure the yeast identification method used in your facility can identify C. auris. If it cannot, know when to suspect C. auris and send suspected isolates to your state or local public health department for further identification.
- Begin surveillance. Establish a protocol with your laboratory so that your department is promptly informed when C. auris is suspected.
- If your laboratory is not equipped to identify C. auris, begin surveillance for organisms that commonly represent a C. auris misidentification. See common misidentifications by yeast identification method.
- Know which patients are at higher risk for C. auris. These include:
- Patients who have received healthcare in post-acute care facilities (e.g., nursing homes), especially those with ventilator units.
- Patients with a recent history of receiving healthcare outside the United States in a country with known C. auris transmission
(see a map of countries). These patients have a higher risk of C. auris infection or asymptomatic colonization.
- Have a response plan. Discuss recommendations for infection prevention and control of C. auris with healthcare staff, including environmental services.
If C. auris is found in your facility, the following actions should be taken:
- Check the CDC website for the most up-to-date guidance on identifying and managing C. auris.
- Report possible or confirmed C. auris immediately to your public health department.
- Ensure adherence to CDC recommendations for infection control, including:
- Place patients infected or colonized with C. auris in a single room on contact precautions
- Assess and enhance gown and glove use
- Reinforce hand hygiene
- Coordinate with environmental services to ensure the patient care environment is cleaned with a disinfectant that is effective against C. auris (i.e., those effective against Clostridium difficile) by searching “List K”. Work with the environmental services team to monitor the cleaning process.
- After consulting with public health personnel, screen contacts of case-patients to identify patients with C. auriscolonization. Use the same infection control measures for patients found to be colonized.
- When a patient is being transferred from your facility (e.g., to a nursing home or other hospital), clearly communicate the patient’s C. auris status to receiving healthcare providers.
Included with today’s notice is an example policy reflecting the CDC’s interim guidance for the identification and treatment of C. auris.
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