C. auris was first identified in 2009 and is an emerging, often multidrug-resistant yeast. C. auris colonizes the skin and other body sites and can cause serious infections, including bloodstream infections.
Risk factors include presence of indwelling medical devices and broad-spectrum antibiotic or antifungal use. In California, C. auris has been increasingly identified primarily among patients in long-term acute care hospitals (LTACHs) as well as in acute care hospitals (ACHs), likely a result of wider admission screening. The remaining cases have mainly been identified in ventilator-equipped skilled nursing facilities (vSNFs). C. auris can spread patient-to-patient via transient contamination of the hands or clothing of healthcare personnel (HCP), or via contaminated equipment or the healthcare environment, where C. auris can persist for weeks. Early detection, infection prevention control, and interfacility communication can limit the spread of C. auris. To proactively identify and prevent further spread of C. auris in California, the following enhanced surveillance strategies are recommended for healthcare facilities in Northern and Central California, including in Santa Clara County: - Acute care hospitals (ACHs) should implement admission screening strategies based on patient and unit-level risks for C. auris colonization and transmission, which include screening patients upon admission:
- from a facility with known transmission;
- from long-term acute care hospitals (LTACHs) or ventilator-equipped skilled nursing facility (vSNF) ventilator units;
- with healthcare exposure outside of the U.S., or in regions with known C. auris endemicity (e.g., Southern California, Nevada, New York);
- wherever feasible, to units with high-acuity patients and prolonged (e.g., > 1 week) lengths of stay (e.g., some ICUs, burn units).
- LTACHs facility-wide should conduct admission screening and regular (e.g., every 1-3 months) proactive point prevalence surveys (PPSs).
- vSNF ventilator units should conduct a proactive point prevalence survey (PPS) if not done within the past one month. Continue to conduct regular (e.g., every 3-6 months) PPSs and consider admission screening as resources allow.
- Skilled nursing facilities (SNFs):
- SNFs should be prepared to admit and safely care for residents with known or suspected C. auris colonization, including implementation of Enhanced Barrier Precautions (EBP) per AFL 24-15.
- All SNFs in compliance with the Centers for Medicare & Medicaid's EBP requirement are able to admit and provide care for residents with multidrug resistant organisms (MDRO), including C. auris. Thus, there is no basis for a SNF to refuse admission of a resident based on their need for EBP or MDRO status.
- Residents on EBP do not require placement in a single-person room, even when known to be infected or colonized with an MDRO. CDPH provides additional guidance for cohorting multiple residents in the same room or designated area of the facility, based on MDRO status.
For questions about C. auris infection prevention strategies or requests for C. auris isolate and colonization testing, contact the Communicable Disease Prevention & Control team by emailing [email protected] or by calling (408) 885-4214 and select option 3. This report summarizes the California Department of Public Health’s Health Update: Ongoing Transmission of Candida auris in Healthcare Facilities in Northern and Central California. Resources: - Candida auris (C. auris) information (California Department of Public Health)
- Candida auris Quicksheet and Regional Prevention and Response Strategy (California Department of Public Health)
- Antimicrobial Resistance (AR) Health Advisories (California Health Alert Network)
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