1) Candida auris (C. auris) is an emerging pathogen that is classified as a multidrug-resistant organism (MDRO) of urgent threat by the Centers for Disease Control and Prevention (CDC). Healthcare facilities that identify or suspect C. auris cases and facilities transferring known C. auris cases to out-of-state facilities should contact the New Jersey Department of Health (see “Contact Information”).
2) Most healthcare facilities can provide adequate care for C. auris positive individuals and therefore should not deny admission to patients based upon their C. auris diagnosis. Resources provided below (and attached) can guide those facilities that have questions on how to proceed.
3) The Environmental Protection Agency (EPA) has released List P (see “Resources”), a list of antimicrobial disinfectants registered for claims against C. auris, which should be utilized for regular, daily, and terminal cleanings to disinfect supplies, equipment, surfaces, etc. with which C. auris positive (i.e. colonized or infected) patients come in contact with. Proactive use of a cleaning product from List P is recommended, particularly for facilities located in areas with high case counts (see “Resources”).
Candida auris: An Emerging Multidrug-resistant Pathogen
· C. auris was first identified in the United States in 2016 and subsequently found in New Jersey in 2017. CDC has classified C. auris as an MDRO of urgent public health threat. C. auris can colonize individuals without causing signs or symptoms, lead to infection especially among immunocompromised individuals, and once infected may cause serious illness or fatality.
· C. auris is primarily healthcare-associated. People who have recently spent time in hospital Intensive care units (ICUs), ventilator-capable facilities and nursing homes; patients who have lines and tubes that go into their body (e.g., breathing tubes, feeding tubes, urinary catheters, and central venous catheters) are at the highest risk for C. auris (see “Resources”).
· Healthcare facilities who identify suspect or positive C. auris patients should contact the NJ Department of Health (NJDOH) Communicable Disease Service (CDS) to report the case and for further education and guidance regarding management and response activities.
Candida auris Case Reporting and Communication Upon Transfer
· C. auris positive patients should be reported to NJDOH CDS by digitally completing and submitting the current Candida auris Case Report Form (see “Resources”).
· Healthcare facilities should utilize the NJDOH Novel MDRO Transfer Cover Sheet (see “Resources”) to ensure communication of the MDRO status of individuals positive for C. auris and/or any other MDRO(s) during every patient/resident transfer.
Infection Prevention and Control
· C. auris is believed to colonize individuals indefinitely, even if acute infection has been treated and resolved. Existing data suggests that colonization persists for years and the results of repeat colonization swabs may alternate between C. auris being detected and not detected. A considerable number of patients have a positive C. auris specimen after multiple negative swabs. Since colonization may persist despite negative testing, ongoing use of setting appropriate Transmission-Based Precautions for the entire duration of the patient’s stay in any/all healthcare facilities following the positive identification of C. auris colonization or infection is recommended.
· C. auris transmission can be managed using infection prevention practices that are effective against other MDROs. Patients in acute care settings who are identified to be colonized (asymptomatic) or infected (symptomatic) should remain on Contact Precautions for the duration of their care.
· Residents in long-term care facilities should typically be on Enhanced Barrier Precautions (see “Resources”), unless excretions cannot be contained, in which case they should be maintained on Contact Precautions until those conditions are no longer met.
· Regardless of healthcare facility type, all personnel should adhere to hand hygiene (alcohol-based hand rub is effective against C. auris is the CDC recommended method in most situations, see “Resources”), proper personal protective equipment, and visit C. auris positive patients last during routine rounds. Individuals should be in single rooms, if possible, or cohorted with other C. auris positive patients.
· C. auris is an environmentally hardy organism and requires specific products for disinfection (EPA List P—see “Resources”).
· Disposable supplies for individual patients are preferred to circumvent the need to disinfect altogether, and where possible, dedicated equipment should be provided for C. auris patient care to reduce risk of transmission.
· All reusable equipment should be disinfected with the Environmental Protection Agency’s registered products with C. auris claims—named List P. Environmental services should utilize List P products when performing routine and terminal cleaning of patients’ or residents’ living quarters and common spaces.
NJDOH Candida auris Case Report Form: https://www.nj.gov/health/cd/documents/topics/hai/CAuris-CaseReportForm.pdf
NJDOH Novel MDRO Transfer Cover Sheet: https://www.nj.gov/health/cd/documents/topics/hai/NJDOH_Novel%20MDRO%20Transfer%20Sheet_May%202022.pdf
NJDOH Candida auris webpage with case count map: https://www.nj.gov/health/cd/topics/cauris.shtml
NJDOH Candida auris Risk Factors Infographic: https://www.nj.gov/health/cd/documents/topics/hai/High%20Risk%20Patients%20for%20C.%20auris.pdf
EPA List P: Antimicrobial Products Registered with EPA for Claims Against Candida Auris: https://www.epa.gov/pesticide-registration/list-p-antimicrobial-products-registered-epa-claims-against-candida-auris
Enhanced Barrier Precautions: https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html
Hand Hygiene FAQs: https://www.cdc.gov/oralhealth/infectioncontrol/faqs/hand-hygiene.html
· Adrienne Sherman, Healthcare-Associated Infections/AR Epidemiologist, NJDOH; Email: Adrienne.Sherman@doh.nj.gov
· NJDOH CDS HAI/AR Team; Email: DOH.CDS.HAIAR.EPI@doh.nj.gov
· NJDOH Communicable Disease Service, (609) 826-5964 during business hours
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