State of California—Health and Human Services Agency
California Department of Public Health

Health Update

TO: Healthcare Professionals

Ongoing Transmission of Candida auris in Healthcare Facilities in Northern and Central California

6/11/2025

Key Messages

As an update to the March 2023 Health Advisory describing the emergence of Candida auris (C. auris) in Northern California [1], the California Department of Public Health (CDPH) and local public health partners are alerting health care providers of an increase in C. auris cases identified across Northern and Central California (Figure 1).
In addition, there has been ongoing transmission in acute care hospital (ACH) [2] and long-term acute care hospital (LTACH) settings in the Bay Area and Central Valley since November 2024, with more spread likely in the region than has been identified to date.
Patients and residents who have had prolonged admission in healthcare settings, particularly high-acuity care settings including LTACHs, ventilator-equipped skilled nursing facilities (vSNFs) and high-acuity ACH units (e.g., intensive care units (ICUs)), are at highest risk of C. auris and other multidrug-resistant organism (MDRO) colonization and infection.

Recommendations

To proactively identify and prevent further spread of C. auris in California, the CDPH Healthcare-Associated Infections (HAI) Program emphasizes the need for the following enhanced surveillance strategies in Northern and Central California healthcare facilities.

ACHs should implement admission screening strategies based on patient- and unit-level risks for C. auris colonization and transmission, which include screening patients upon admission:

from a facility with known transmission;
from LTACHs or vSNF ventilator units;
with healthcare exposure outside of the U.S., or in regions with known C. auris endemicity, e.g., Southern California, Nevada, New York;
wherever feasible, to units with high-acuity patients and prolonged (e.g., > 1 week) lengths of stay (e.g., some ICUs, burn units).

LTACHs facility-wide: conduct admission screening and regular (e.g., every 1-3 months) proactive point prevalence surveys (PPSs).
vSNF ventilator units: conduct a proactive point prevalence survey (PPS) if not done within the past one month. Continue to conduct regular (e.g., every 3-6 months) PPSs and consider admission screening as resources allow.
SNFs:

A very small proportion (<1%) of C. auris cases have been identified in regular SNFs (Figure 2), and extensive transmission and outbreaks have been uncommon in this setting.
SNFs should be prepared to admit and safely care for residents with known or suspected C. auris colonization, including implementation of Enhanced Barrier Precautions (EBP) per AFL 24-15 [3].
All SNFs in compliance with the Centers for Medicare & Medicaid's EBP requirement are able to admit and provide care for residents with MDROs, including C. auris. Thus, there is no basis for a SNF to refuse admission of a resident based on their need for EBP or MDRO status.
Residents on EBP do not require placement in a single-person room, even when known to be infected or colonized with an MDRO. CDPH provides additional guidance for cohorting multiple residents in the same room or designated area of the facility, based on MDRO status, in the Cohorting Guidance for Patients or Residents Infected or Colonized with Multidrug-resistant Organisms [4].

For additional infection prevention and control strategies, including environmental cleaning and disinfection for facilities statewide, refer to the CDPH C. auris Quicksheet and Regional Prevention and Response Strategy [5].

Public Health Testing

C. auris isolate and colonization testing resources are available at some local public health laboratories, the CDPH Microbial Diseases Laboratory (MDL)[6], and the CDC Antimicrobial Resistance Laboratory Network.
Contact your local health department to access public health testing services.