Candida Auris for Healthcare Providers

Key recommendations for suspected or confirmed C. auris infection or colonization

Laboratory Identification and Reporting

  • Laboratories should notify the facility infection control department of any suspicious isolates.
  • Notify the NYSDOH regional epidemiologist to arrange for submission of specimens to the NYSDOH Wadsworth Center Mycology Laboratory for further characterization.
  • Suspected or confirmed cases of C. auris infection or colonization that occur in hospitals, nursing homes, and other healthcare facilities licensed under Article 28 of the NYS Public Health Law should be reported to the facility infection control contacts and to the NYSDOH Regional Epidemiologist or the NYSDOH Bureau of Healthcare Associated Infections Central Office.
    • NYSDOH Regional and Central Office Contact Information:
      • Western Regional Office (716) 847-4503
      • Central New York Regional Office (315) 477-8166
      • Metropolitan Area Regional Office (914) 654-7149
      • Capital District Regional Office (518) 474-1142
      • Central Office (518) 474-1142
  • Reporting requirements and instructions for NYSDOH facilities licensed under Article 28 of the Public Health Law are available at: Reporting Requirements
  • This webinar PowerPoint presentation contains important updated information that will be used to support healthcare providers who manage Candida auris patients, and clinical laboratories that are required to test and refer clinical specimens that might contain Candida auris.
  • Suspected or confirmed C. auris isolates that are identified in other healthcare settings can be reported to the local health department where the patient resides: County Health Departments
  • Forward clinical isolates to: The Mycology Laboratory at Wadsworth Center as directed in the November 3, 2016 advisory: NYSDOH Health Advisory. Alert to New York State Clinical Laboratories Identification and Reporting of Suspected Candida auris Isolates

Infection Prevention and Control

  • If C. auris infection or colonization is suspected, the patient or resident should be placed on Standard and Contact Precautions.
  • In acute-care settings, patients should be housed in single rooms.
  • In nursing homes,residents should be housed in single rooms.
    • If single rooms are not available, residents may be cohorted with other residents colonized or infected with C. auris.
    • Facilities should consult with the NYSDOH regional epidemiologist for guidance on acceptable ways to modify Contact Precautions for highly functional residents who can perform hand hygiene.
  • In dialysis settings, if available,use a separate room (that is not a hepatitis B isolation room) for patient treatment.
    • If a separate room is not available, dialyze the patient at a station with as few adjacent stations as possible (e.g., at the end or corner of the unit).
    • Educate and inform the appropriate personnel about the presence of a patient with C. auris and the need for Contact Precautions.
    • Disposable gowns and gloves should be worn when caring for patients or touching equipment at the dialysis station. Gowns and gloves should be removed and disposed of carefully, and hand hygiene should be performed when leaving the patient's station.
    • Items brought to the dialysis station should be cleaned and disinfected after use. Items not able to be cleaned and disinfected should be discarded. Thoroughly clean and disinfect the dialysis station (e.g., chairs, beds, tables, machines) between patients. Use an EPA-registered hospital grade disinfectant effective against Clostridium difficile spores.
    • Information specific to cleaning and disinfection in dialysis facilities is available at: Environmental Surface Disinfection in Dialysis Facilities: Notes for Clinical Managers and Checklist: Dialysis Station Routine Disinfection.

Environmental Cleaning and Disinfection

  • All healthcare settings should ensure that thorough daily and terminal cleaning and disinfection is performed in rooms, units, and procedure/treatment areas where patients or residents with C. auris are located or have been present.
  • Facilities and practices should verify that they are using an EPA-registered hospital grade disinfectant effective against Clostridium difficile spores for disinfection related to C. auris.
  • Infection preventionists are strongly encouraged to directly monitor compliance with hand hygiene, use and disposal of personal protective equipment, and environmental cleaning and disinfection.

Interfacility Transfers

  • Before patients or residents are transferred to another healthcare facility, notify the NYSDOH regional epidemiologist.
  • The transferring facility also should notify the receiving facility by telephone of the patient's C. auris infection or colonization and the level of precautions required. Facilities should include the C. auris diagnosis and infection prevention and control measures prominently in the patient's or resident's discharge or transfer documentation.
  • Healthcare facilities, including nursing homes, should have infection prevention and control procedures and competencies for implementing Standard and Contact Precautions and are expected to maintain the capacity to manage infection control for patients or residents infected or colonized with C. auris or any multi-drug resistant organism.

Surveillance cultures

  • Once a case of C. auris infection or colonization is identified in a facility, NYSDOH regional epidemiologists will provide recommendations for collecting surveillance cultures from close contacts and environmental surfaces. At the direction of regional epidemiologists, NYSDOH Wadsworth Center can provide supplies and shipping as well as process primary samples from both patient and environmental samples.

Candida auris Screening Information

Frequently Asked Questions (FAQs):

When should laboratories and healthcare providers suspect C. auris?

C. auris can be misidentified as a number of different organisms when using traditional biochemical methods for yeast identification. Information on laboratory diagnosis including how C. auris can be misidentified and when C. auris should be suspected is available on the CDC website: Candida auris Interim Recommendations for Healthcare Facilities and Laboratories.

How can laboratories identify C. auris?

  • Diagnostic instruments based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) can differentiate C. auris from other Candida species including Candida haemulonii. Laboratories should ensure they are strictly following manufacturer's instructions when using MALDI-TOF-MS instruments for Candida identification. Please note that at this time, C. auris is not in the FDA-approved MALDI-TOF-MS databases. Labs need to submit validation data to the NYSDOH Clinical Laboratory Evaluation Program (CLEP) for approval before using for patient testing (www.wadsworth.org/regulatory/clep).
  • Molecular methods based on the sequencing of the internal transcribed spacer (ITS) and D1-D2 regions of the ribosomal gene can also identify C. auris. Labs need to submit validation data to NYSDOH CLEP for approval before using this method for patient testing.
  • Diagnostic methods other than MALDI-TOF-MS and sequencing may not be able to distinguish C. auris from other yeasts, especially Candida haemulonii.

How can the spread of C. auris be prevented?

  • Meticulous attention to infection prevention and control, including good hand hygiene (either hand washing with soap and water or hand sanitizing with an alcohol-based hand sanitizer), proper selection, use, and disposal of personal protective equipment, and appropriate and effective environmental cleaning and disinfection are keys to prevention.
  • Healthcare facilities should review all interim recommendations from the NYSDOH and the CDC regarding C. auris infection prevention and control and should monitor the NYSDOH and CDC websites for new information and revisions to current recommendations.
  • Key CDC recommendations are summarized below along with additional NYSDOH recommendations.

When should antifungal susceptibility testing for C. auris be performed and how should results be interpreted?

What are the suggested treatment regimens for invasive C. auris infections (e.g., bloodstream infections, intra-abdominal infections) in adults?

Based on the limited data available to date, echinocandins are recommended as initial therapy for treatment of C. auris infections. Further treatment considerations are available within the CDC "Candida auris Interim Recommendations for Healthcare Facilities and Laboratories"

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