Health Advisory: Increased Candida Auris Transmission in Healthcare Facilities

December 21, 2022 

Action Requested 

• Be aware that an emerging fungal pathogen, Candida auris, is spreading and causing outbreaks in healthcare facilities. Per recent Washington State Department of Health advisory, as of December 2022, no C. auris cases have been reported in Washington State, but healthcare transmission has occurred in California, Oregon (1,2), Nevada (3), the Mid-West and East Coast. 
• Be aware of growing concerns for multidrug-resistant C. auris infections in the U.S. 
• Consultation with an infectious disease specialist and Public Health is highly recommended when C. auris colonization or infection is suspected to ensure appropriate testing and treatment. 
• Inquire about high risk exposures in all newly admitted patients and consider C. auris screening in patients at high risk for C. auris, including those who have had: 
  1. Close contact in a healthcare setting to someone diagnosed with C. auris infection or colonization. 
  2. An overnight stay in a healthcare facility outside the U.S. or in a region within the U.S. with documented C. auris cases in the previous year. 
• Coordinate C. auris screening and testing with Public Health. In Snohomish County, contact the Snohomish Health District at 425-339-3503. Other counties: Find your local health jurisdiction here. 
• Be aware that C. auris can be misidentified through commercial laboratory testing and specific technology is needed for correct identification. 
• Be aware that in addition to the screening recommendations above, Public Health has started offering proactive C. auris screening to residents at long-term ventilator capable healthcare facilities. These are the settings which have been impacted heavily in California and East Coast outbreaks. 
• Immediately report any suspected or confirmed C. auris cases or outbreaks to Public Health. 
  1. C. auris becomes a notifiable condition in Washington as of January 1, 2023. 
• Ensure appropriate infection prevention and control practices: 
  1. Patients with suspected or confirmed C. auris in healthcare facilities should be managed using contact precautions and placed in a single room whenever possible. 
  2. When C. auris is suspected, use healthcare disinfectants that are effective against C. auris. 
  3. Remain vigilant for any increase in infections due to unusual Candida species in a patient care unit, including from urine specimens, and consider C. auris. Contact your LHJ to request testing.
  4. Reinforce and audit core infection prevention practices in healthcare facilities. 
  5. Communicate information about colonization or infection with C. auris during care transitions within and transfers between healthcare settings. Consider using the CDC Interfacility transfer form. 
  6. For laboratories working with suspect or confirmed C. auris, be aware of safety considerations including recommended PPE, disinfection, and disposal. 

Background 

Since its discovery in 2009, C. auris has emerged globally as a life-threatening, highly transmissible, often multidrug resistant yeast. In the past year, CDC has published several reports of ongoing transmission of highly resistant strains of C. auris in United States healthcare facilities, particularly in units caring for patients recovering from COVID-19 (4,5,6). Patients with long term acute care and indwelling devices are at highest risk for acquisition. International healthcare is often the initial source of introduction of C. auris to a region. Subsequent healthcare transmission may occur due to shedding in the healthcare environment, resistance of C. auris to standard healthcare disinfectants, and lapses in infection control practices. 

As of December 19, 2022, C. auris has not been detected in Washington but represents a serious threat to vulnerable patients. This map has details about where cases have been identified within the U.S. WA DOH performs special surveillance for C. auris by screening isolates submitted from high risk patients and sentinel lab submissions of non-albicans Candida species to the WA Public Health Laboratory for species identification. 

Information for this health advisory comes from the Washington State Department of Health’s Health Alert Network (HAN) alert on December 19, 2022.

Additional Resources

• Candida auris resources, WA Department of Health 
• Candida auris testing information, WA Department of Health 
• Antimicrobial Products Registered with EPA for Claims Against Candida auris, Environmental Protection Agency 
• Candida auris- Information for Laboratorians and Health Professionals, CDC 
• General Information about Candida auris, CDC