Key
Points
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”).
Specifics:
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.
Disinfection Practices:
·
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.
Resources:
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
Contact Information:
·
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
This information has been broadcast to: Animal Health Organizations; Animal Health Professionals; Blood Banks; Community Health Centers (FQHCs); Emergency Medical Services / First Responders; EMS Council; Long-term Care; Health Care Facilities / Other; Health Care Organizations; Health Care Providers; Hospital Staff Directory; Hospital CEOs; Hospital Emerg Preparedness Coords; Hospital ER Medical Directors; Hospital Infection Control Practitioners; Hospital Medical Directors; Hospital Nursing Directors; Hospital Patient Safety Liaisons; Hospital Quality Liaisons; Hospital Security Directors; ICU Administrator; Lab Director; Hospitals / Acute Care; Hospitals / Other; Hospitals / Veterans; Labs / Non-Sentinel; Labs / Sentinel; Occupational Health Organizations; Pharmaceutical Suppliers; Health Care Sector; Local Boards of Health; Board of Public Utilities; Department of Children & Families; Department of Agriculture; Department of Community Affairs; Department of Corrections; Department of Education; Department of Environmental Protection; Department of Human Services; Department of Labor & Workforce Development; Department of Law and Public Safety; Department of Transportation; EMS Task Force; NJ Hospital Association; Office of Information Technology(OIT); Office of the Governor; New Jersey Departments & Agencies; DHSS Staff; NJDOH Staff; NJLINCS and Local Contacts; NJLINCS Community; Alabama; Alaska; American Samoa; Arizona; Arkansas; California; Colorado; Connecticut; Delaware; District of Columbia; Federated State of Micronesia; Florida; Georgia; Guam; Hawaii; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Louisiana; Maine; Marshalls Island; Maryland; Massachusetts; Michigan; Minnesota; Mississippi; Missouri; Montana; Nebraska; Nevada; New Hamsphire; New Jersey; New Mexico; New York; North Carolina; North Dakota; North Mariana Islands; Ohio; Oklahoma; Oregon; Palau; Pennsylvania; Puerto Rico; Rhode Island; South Carolina; South Dakota; Tennnesse; Texas; Utah; Vermont; Virgin Islands; Virginia; Washington; West Virginia; Wisconsin; Wyoming; Other State Partners; Public Health Associations; Public Health Council; Public Health Sector