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healthcare-associated Infections (HAI) program

Candida auris ​​ (C. auris)

NEWLY UPDATED:

Candida auris and other novel multidrug-resistant organism prevention in long-term care facilities. December 10, 2020

 C. auris Quicksheet (PDF) for guidance on investigating C. auris cases and clusters.

Containment of Candida auris, other Multidrug-resistant Organisms (MDRO) and SARS-CoV-2. November 18, 2020

Containment of Candida auris and other Multidrug-resistant Organisms (MDRO) in the Context of COVID-19. September 1, 2020

ABOUT

Candida auris (C.auris) is an emerging multi-drug resistant yeast that can spread in healthcare settings via person-to-person transmission or contact with contaminated surfaces. C. auris causes serious, hard to treat infections in hospitalized patients. CDC provides the most recent case counts for each state on their Tracking Candida website.

INFECTION CONTROL AND PREVENTION

Public health departments and healthcare providers can work together to prevent the emergence and transmission of C. auris. Rigorous adherence to infection control practices can prevent the spread of C. auris.

 

​HEALTHCARE PROVIDERS

​PUBLIC HEALTH PARTNERS

​Laboratory Identification

  • ​Know the yeast identification method used by your laboratory and its limitations for C. auris identification

  • Some local public health laboratories offer testing for C. auris identification and confirmation. Contact your local health department for more information. 

  • ​Know local, state and regional laboratory resources for C. auris testing.  CDPH offers testing for C. auris identification and confirmation. Contact HAIProgram@cdph.ca.gov for more information.

​Surveillance

  • ​Perform species identification on all yeast from invasive sources
  • Ensure the laboratory notifies infection prevention immediately following a positive result for C. auris, even if preliminary. Early detection of C. auris is essential for containing its spread in healthcare facilities
  • Participate in the AR Lab Network Targeted Surveillance Program to access confirmatory identification and antifungal susceptibility testing for non-albicans Candida isolates at no cost. Contact HAIProgram@cdph.ca.gov for more information.
  • ​Know the local epidemiology and prevalence in your region.
  • Understand patient risk factors and high risk settings, such as indwelling medical devices in patients residing in high acuity long-term care facilities

​Colonization Testing

  • ​When a patient with C. auris is identified, implement screening of high-risk patients and patient contacts for C. auris colonization. Patients colonized with C. auris may not need medical treatment but can be potential sources of transmission to others.
  • Colonization testing services can be accessed at no cost using the CDC Antibiotic Resistance Laboratory Network (AR Lab Network) for patients admitted to a healthcare facility, including in order of priority*:
    1. High-risk patient contacts of a confirmed C. auris case, such as roommates and other patients residing in the same unit (including for point prevalence surveys (PPS))
    2. Those admitted from facilities with known C. auris transmission
    3. Those who are colonized with carbapenemase-producing organisms; prioritize those with non-KPC carbapenemase and requiring high-level care (e.g., indwelling medical devices, mechanical ventilation)
    4. Those who have recently received healthcare outside the U.S. in the past 12 months, especially where C. auris cases have been reported; prioritize those co-colonized or -infected with carbapenemase-producing organisms
    5. On a case-by-case basis, those who have exposure to multiple healthcare facilities, particularly long-term care facilities with ventilator units, and especially in regions with C. auris transmission
      • Those who have indwelling medical devices, especially with tracheostomy or on mechanical ventilation
    6. On a case-by-case basis, preemptive PPS in facilities admitting patients from facilities with known C. auris transmission

*Availability of AR Lab Network colonization testing resources based on screening priority. Contact your local health department when considering C. auris colonization testing.

  • Please contact HAIProgram@cdph.ca.gov for assistance coordinating C. auris colonization testing through the AR Lab Network

​Infection Control Measures

​Environmental Cleaning

  • ​Ensure and audit thorough daily and terminal environment cleaning of patient care environment and reusable equipment
    • Focus on high-touch surfaces or any shared reusable patient equipment
    • CDC recommends use of an EPA registered hospital-grade disinfectant effective against Clostridioides difficile spores (List K)
    • Daily and terminal cleaning of patient environment using a List K product may be extended to an entire unit or facility where patients with C. auris are located 
  • Review environmental cleaning checklists that are available on the CDPH HAI Program website

​Adherence Monitoring

  • ​Use adherence monitoring tools to assess and track provider adherence to infection control measures. Monitoring adherence and providing feedback to staff are critical to sustained implementation of infection prevention measures
  • ​During  an outbreak, request documentation of adherence monitoring results from affected facility/facilities

​Interfacility Communication

  • ​Communicate C. auris status to the receiving facility ahead of time to ensure appropriate care is maintained when transferring a patient/resident
  • Use the HAI Program interfacility transfer form during all patient transfers available via the Interfacility Transfer Communications Guide page

  • ​Set expectations for facilities to effectively communicate C. auris status when transferring patients/residents to another healthcare facility
  • During an outbreak, consider requesting facilities notify public health of all discharges and transfers involving individuals with C. auris

​Antimicrobial Stewardship

​Regional Prevention

​Reporting

​Treatment

  • ​Consultation with an infectious disease specialist is highly recommended for patients infected with C. auris. See CDC’s guidance for more detailed treatment information
  • ​Antifungal susceptibility testing helps identify effective treatment options. Contact HAIProgram@cdph.ca.gov to coordinate submission of C. auris isolates to CDC for antifungal susceptibility testing

 

ADDITIONAL C. auris RESOURCES

For additional information, contact the HAI Program at HAIProgram@cdph.ca.gov.

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