Contact

Only known since 2009, the yeast Candida auris, which is often multidrug resistant, challenges hygiene experts throughout the world. The pathogen can trigger infections that are hard to treat; ill and immunosuppressed patients are at particular risk. The United States federal agency CDC  (Centers for Disease Control and Prevention) explicitly warns against the yeast, because it is resistant to many common antifungal drugs (e.g. Fluconazole) frequently and is hard to detect by standard laboratory methods (1). Existing data suggest that, in hospitals, C. auris may spread in patterns that are similar to those of methicillin-resistant Staphylococcus aureus (MRSA) (2). In addition to a correct identification, it is key to apply targeted hygiene measures to prevent a transmission and outbreaks.

Symptoms and clinical picture

C. auris may elicit ear, surgical site and urinary tract infections. If the yeast enters the bloodstream, also fatal bloodstream infections can occur.

Risk factor surface hygiene: Recent study results

Candida auris is a particularly resistant yeast: on inanimate surfaces, it can survive for up to seven days – probably even longer. In a recent study, Piedrahita et al. compared the persistence of C. auris and other common pathogens (3). Their result: Candida auris proved to be more durable than, for example, the related Candida albicans. On damp surfaces, more than 80 % of the different Candida species were still present even after seven days. Samples from dry and damp high-touch hospital surfaces provide a similar picture: Candida yeast species were considerably more often isolated on damp surfaces than other common pathogens.

Infection control measures in case of C. auris (4)

• Contact isolation
  Patients with C. auris should be isolated to contain a spread of the fungus. If possible, the number of employees having contact to the isolated patient should be reduced to a minimum.
  
  
• Hand hygiene in case of C. auris
  When taking care of patients with C. auris, particular attention should be payed to the hygienic hand disinfection. The 5 Moments for Hand Hygiene apply here:
  
  
  • BEFORE contact with patients or residents
  • BEFORE aseptic procedures
  • AFTER body fluid exposure risk
  • AFTER contact with patients or residents
  • AFTER contact with patient/resident surroundings

When treating isolated patients, employees should additionally use gloves and avoid touching surfaces outside the patient surroundings with the gloved hands. Please note: Gloves do not replace a hand disinfection. The hands must therefore be disinfected before donning and after having removed the gloves.

• Surface disinfection in case of C. auris
  C. auris is highly resistant and can survive on surfaces for several days.
  For an effective surface hygiene in case of C. auris it is advisable to perform routine and terminal disinfections.
  
  Surface disinfectants based on QACs are possibly not active against C. auris. Hence, until further notice, CDC recommends using sporicidal products that have a proven activity against C. difficile spores.

Sources:
1. Candida auris. CDC Centers for Disease Control and Prevention.  (checked on 17 January 2018).
2. Epidemiologisches Bulletin Nr. 36. Robert Koch Institut, September 2017.
3. Piedrahita, T. et al. Environmental Surfaces in Healthcare Facilites are a Potential Source for Transmission of Candida auris and other Candida Species. Infect Control Hosp Epidemiol. 2017, 38(9):1107-1109.
4. Recommendations for Infection Control for Candida auris. CDC Centers for Disease Control and Prevention. (checked on 17 January 2018).