AHCA: Guidance on Emerging Infection Candida Auris

Lisa Volk and Nancy Leveille in Clinical & Quality

Some of you may have heard about Candida auris in recent media stories based on a Sunday New York Times article here. C. auris is an emerging yeast that can be misidentified as other organisms, is multidrug-resistant, and can spread in health care settings. It is important to know how to identify, treat, and control the spread of this organism. The resources on the Centers for Disease Control and Prevention website meant for laboratorians, clinicians, infection control practitioners, and public health professionals are very helpful and we encourage you to review them.

"Health care facilities or laboratories that suspect they have a patient with C. auris infection should contact state or local public health authorities and CDC (candidaauris@cdc.gov) immediately for guidance."

Best Practices 

Facilities admitting individuals with C. auris should place them in a private room (or cohort with other residents with C. auris) and institute standard contact precautions. The infection control practices for these individuals are no different than for residents with Clostridioides difficile (also known as C. diff). All nursing centers should monitor and ensure adherence to the infection prevention practices needed to prevent the spread of C. auris and other resistant organisms, including hand hygiene, use of personal protective equipment as part of standard and transmission-based precautions, and thorough cleaning and disinfection of shared equipment.

Individuals at higher risk for developing infections from C. auris are those who require complex medical care and include those needing ventilator-support and tracheostomies, along with management of indwelling medical devices such as central lines. Facilities caring for these types of residents should work with local health departments and local hospitals to be aware of C. auris in the community. 

Screenings

While the CDC provides information on who, when and how to screen residents for C. auris, screenings by facilities should also be guided by the local health department. The CDC does NOT recommend routine screening for all residents. The agency recommends screening:

  • Residents who had an overnight stay in a health care facility outside the United States in the previous one year prior to admission to the nursing center, or;
  • Residents who have had contact with another resident in the facility with C. auris, or;
  • Patients in a hospital with C. auris.

Facilities may want to reach out to their hospital(s) to see if C. auris infections are in their areas, particularly if in New York, New Jersey or Chicago. The screening of residents should be guided by the local public health department.

Environmental Cleaning 

Environmental cleaning is also extremely important to prevent the infection from spreading. We strongly recommend that members review CDC guidance on cleaning. Meticulous cleaning and disinfection of both patient rooms and mobile equipment is necessary to reduce the risk of transmission. Quaternary ammonium compounds (QACs) that are routinely used for disinfection MAY NOT be effective against C. auris.

At this time, the CDC recommends using an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against C. diff  spores (see EPA List K cleaning agents). It is important to follow all manufacturers' directions for use of the surface disinfectant, including applying the product on the correct contact time. The CDC does not recommend environmental sampling for C. auris either before or after cleaning, but good practice is to ensure thorough cleaning with EPA List K agents.

Updates

As AHCA learns more, they will keep us informed, however, they strongly recommend your infection preventionist visit the CDC website on C. auris here.

NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20