Health Advisory: Increasing cases of Candida auris in Washington

July 5, 2024

Action Requested 

• Be aware that the Washington Department of Health (DOH) has reported an increase in locally acquired Candida auris (C. auris) cases in 2024. Healthcare-associated transmission is suspected for most cases; other isolated cases have been identified with no obvious source suggesting undetected transmission in Washington. We urge providers and facilities to improve infection prevention and control programs to prevent transmission of C. auris.

• Meticulous adherence to routine healthcare infection prevention activities is effective in preventing the spread of C. auris in healthcare facilities. Ensure your healthcare facility optimizes infection prevention practices that are proven to prevent transmission of C. auris, including hand hygiene, transmission-based precautions, environmental cleaning, and cleaning and disinfection of reusable medical equipment. (See also: Recommendations for Disinfection and Sterilization in Healthcare Facilities.)
  • Patients with suspected or confirmed C. auris in healthcare facilities should be managed using contact precautions and placed in a single room whenever possible. In nursing homes, consult with your local health jurisdiction about using Enhanced Barrier Precautions.
  • Reinforce and audit core infection prevention practices in healthcare facilities.
  • When C. auris is suspected, use healthcare disinfectants that are effective against C. auris (List P). List K products registered for use against Clostridioides difficile are also effective. Follow disinfectant instructions for use including proper precleaning, dilution, and wet time.  

• Increase speciation of Candida from non-sterile sites, prioritizing urine cultures over wound and respiratory sources. Review Candida speciation options with your lab. All non-albicans Candida species can be sent to the Washington Antibiotic Resistance Laboratory. 

• For laboratories working with suspect or confirmed C. auris, be aware of safety considerations including recommended personal protective equipment (PPE), disinfection, and disposal.

• Remain vigilant for any increase in Candida results in a patient care unit, including from non-sterile sites, and consider C. auris. 

• 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 (PDF).
  • Educate patients about their colonization and/or infection status and inform them that public health staff likely will be reaching out to them with some questions and more information. 
• Inquire about high-risk exposures in newly admitted patients and consider C. auris screening in patients at higher-risk for C. auris, including those who have had:
  • Close contact in a healthcare setting to another patient with C. auris; or
  • An overnight stay in a healthcare facility outside the U.S. or in a region within the U.S. with a high burden of C. auris cases in the previous year.
  • Direct admission from a ventilator-capable skilled nursing facility or a long-term acute care hospital. 
• When risk factors for C. auris are identified, coordinate any C. auris screening with public health. Testing at the public health lab requires preapproval from your local health jurisdiction (LHJ). 
• Be aware that public health offers proactive C. auris screening to hospitals and long term care facilities for certain patients or residents. Contact your local health jurisdiction to enroll in routine screening for C. auris and other targeted Multi-Drug Resistant Organisms (MDROs).
• Be aware that C. auris can be misidentified through commercial laboratory testing and specific technology is needed for correct identification. 
• Consider an infectious disease consultation for treatment options for patients with invasive C. auris infections. Even after treatment, patients generally remain colonized with C. auris for long periods, and sometimes indefinitely.
• Immediately report any suspected or confirmed C. auris cases or outbreaks in Snohomish County to the Snohomish County Health Department and submit isolates to the Public Health Laboratories.
  • Call 425-339-3503 to reach the Communicable Disease program by phone.
  • Please complete and fax the Communicable Disease Report Form (PDF) and any accompanying lab reports to 425-339-8706. 

Background

Candida auris (C. auris) is an emerging, often multi-drug resistant yeast, that was first identified in 2009. It has spread globally and can cause difficult to control outbreaks in high acuity facilities among patients with invasive devices. C. auris may colonize patients longterm and also cause invasive infections. Both colonized and infected persons can transmit the organism in healthcare settings. C. auris is not a risk to the general public nor to most hospitalized patients.

C. auris was first detected in Washington in 2023; 6 cases were reported but only 1 was locally acquired. During January through May 2024, 14 locally acquired cases were identified in Washington. Most cases have been linked to suspected transmission in a healthcare facility. However, isolated cases with no obvious healthcare-associated link have been identified in Eastern Washington. This may indicate  undetected transmission of C. auris is occurring within Washington. Therefore, the Washington State Department of Health urges facilities and healthcare providers to take steps now to improve infection prevention programs and be prepared to accept C. auris patients and other potentially exposed patients coming from facilities with C. auris transmission.

Resources

• General information about Candida auris
• Candida auris FAQ
• Candida auris notifiable conditions information
• How to enroll your facility in proactive screening for Candida auris
• WA DOH Multi-Drug Resistant Organism (MDRO) Dashboard
• WA DOH Multi-Drug Resistant Organism (MDRO) Prevention and Response Toolkit
• What to Do if you Identify a Targeted Multidrug Resistant Organism in your Facility (PDF)