Candida Auris FAQ

Candida auris (or C. auris) is a yeast that can cause life-threatening infections in patients with serious medical problems in hospitals and nursing homes. It is one of many multi-drug resistant organisms (MDROs) that are of public health concern. For more information about C. auris and other MDROs that are targeted by public health to prevent spread, click on the following links:

• Candida Auris Fact Sheet 
• Carbapenem Resistant Enterobacterales (CRE) Fact Sheet 
• Acinetobacter (CRAB) Fact Sheet 
• Pseudomonas (CRPA) Fact Sheet

C. auris typically only colonizes and causes illness in medically vulnerable patients. It is not a risk to healthy people, including family members and healthcare workers interacting with people with C. auris or to the general public. Patients are at higher risk for C. auris colonization or infection if they have one or more risk factors:

• Prolonged hospital stay.
• Long-term intravenous line (central venous catheter) or other tubes entering the body (e.g., feeding tube, breathing tube).
• Need chronic mechanical ventilation (breathing tube and breathing machine)

Residents in a Skilled Nursing or other long term care settings who do not currently have the risk factors above are at a very low risk of colonization and/or infection -- and if they are diagnosed as being a C. auris carrier, it is rare to have an infection.

• If a patient is colonized, the yeast is in or on the body but is not causing illness symptoms. Colonization can last for many months and even years.
• Clinical infection happens when C. auris invades the body and causes illness symptoms. C. auris infections can be difficult to treat and even cause death. About 1 in 3 patients with invasive C. auris infection dies.

Approximately 5-10% of high-risk individuals who are colonized with C. auris subsequently develop a C. auris infection. It is rare for a patient without high-risk conditions to have an infection, even if they are colonized.

There are no symptoms of colonization. It is detected through a screening test by swabbing the underarms and groin.

The symptoms of C. auris infection are related to where the infection occurs in the body. The most common symptoms of C. auris infection are fever and chills but these symptoms can occur with many different infections so most people with fever and chills will not have C. auris infection. The most common illnesses caused by C. auris are infections of the urine and blood stream.

Yes, C. auris infection can be serious, especially if in the blood. About 1/3rd of those with C. auris infection dies, but because these patients already have critical medical issues, it can be difficult to determine whether death is due to their underlying illness or due to C. auris infection.

Yes, C. auris infections can be treated. However, some C. auris infections are resistant to all three main classes of antifungal medications, making these resistant cases difficult to treat. The Washington State Public Health Laboratories can perform antifungal susceptibility testing to help clinicians select the best treatment.

Only patients with C. auris infection should be treated. There is no recommended or effective treatment to eliminate colonization with C. auris. Usually, once a person is colonized with C. auris, colonization persists for the rest of their life.

• Patients with infection or colonization with C. auris can shed the germs in skin cells and in body fluids.
• C. auris can contaminate healthcare workers hands, clothing, and other items in the healthcare environment – like doorknobs, bed rails, stethoscopes, blood pressure cuffs, and thermometers—and can easily spread to other vulnerable patients if these items are not adequately cleaned.
• The risk of spread is highest to and from those with risk factors described above.

C. auris spreads easily in healthcare settings but robust infection prevention programs can prevent spread by:

• Placing patients who are colonized or infected with C. auris in a private room or with another C. auris patient.
• Ensuring that patients with C. auris are on “Contact Precautions” (CP) or, if in a skilled nursing facility and if appropriate, on “Enhanced Barrier Precautions” (EBP). CP means that the patient is isolated in their room and all caregivers who enter put on a gown and gloves. EBP means that all care that requires close contact is provided by caregivers wearing gown and gloves.
• Making sure that all medical equipment that is used frequently for a patient with C. auris, like stethoscope, blood pressure cuff, gait belt, thermometer, is not used on other patients.
• Cleaning and disinfecting all other shared equipment between use on patients.
• Cleaning hands before and after touching a patient or their environment, before a procedure, and after removing gloves.
• Using a disinfectant that is effective against C. auris for the patient’s environment and for any equipment that is used on other patients.
• Auditing practices and making improvements when needed.

Once a person tests positive for C. auris, Public Health does not recommend they be re-screened. Infection prevention precautions should continue indefinitely as long as he/she is in a healthcare facility, but these precautions are not necessary once people go home.

Public Health recommends facilities screen patients at high risk for C. auris, including those who have certain risk factors or who may have been exposed to other patients with C. auris. Screening helps facilities to identify those who have C. auris so they can act quickly to prevent spread. Facilities also screen some or all patients when there is suspected or confirmed transmission in the facility.

C. auris is spread through contact, so any healthcare providers you see should be informed so they know to use proper precautions to prevent the organism from spreading to other susceptible people. If you are admitted to a healthcare facility, the caregivers may put you in a private room or in a shared room with another patient with the same MDRO.

No, patients with C. auris can still have visitors, as long as the visitors follow the precautions rules outlined by the healthcare facility. The visitors should always clean their hands when entering and before leaving the room. In addition, some healthcare facilities may ask visitors to wear a gown and gloves during the visit. Visitors should always dispose of the contaminated gown and gloves before leaving the room and clean their hands after removing gloves.

Patients on “Contact Precautions” must remain in isolation except for medically necessary care. Nursing Home residents on “Enhanced Barrier Precautions” can take part in therapy and activities outside of their room. They should have clean hands, clothing, equipment, and all drainage or discharge must be covered and contained.  Surfaces touched by the patient in common areas should be cleaned and disinfected using a disinfectant that is effective against C. auris. For therapy, showers, dialysis, and other procedures, when possible, the patient should be scheduled for the last time slot in the day to allow ample time for proper disinfection before the next patient.

No, as long as you do not live with other people who are at risk (such as those who have medical lines or tubes entering the body, are on breathing machines, or have a severely weakened immune system). Healthy people are not at risk for C. auris colonization or infection. Fortunately, good handwashing is very effective at preventing spread of C. auris to others.

Public Health does not recommend testing healthy family members or healthcare workers who care for patients with C. auris.

C. auris has been spreading in healthcare facilities in the US since 2016. Seeing rapid spread of C. auris in other parts of the US and recognizing the risk in our region, the Washington State Department of Health and local health jurisdictions (LHJ) have been preparing for several years to prevent transmission here by providing:

• Information for laboratories on how to accurately identify C. auris
• C. auris infection prevention guidance for healthcare facilities
• Free C. auris and other MDRO testing to healthcare facilities through our Partners for Patient Safety Program (facilities should request screening through their LHJ).
  • Ventilator capable skilled nursing facilities and long term acute care hospitals can perform twice yearly screening of patients
  • Long term acute care hospitals can screen all patients each time they are admitted
  • All other hospitals can screen certain patients when they are admitted
• Free C. auris screening in healthcare facilities in response to identification of a new case
• Free onsite assessments of healthcare facilities’ infection prevention programs to identify areas for improvement

• All ventilator capable skilled nursing facilities and long term acute care hospitals in Washington should join the Partners for Patient Safety Program and screen their patients for C. auris (and certain other MDROs) on a regular basis as recommended by Public Health.
• Ventilator capable skilled nursing facilities should consider admission screening of incoming patients to their respiratory units.
• All other hospitals should review the Partners for Patient Safety Program and consider starting admission screening for C. auris (and certain other MDROs) in patients with identified risk factors.
• All healthcare facilities should consider having a free assessment of their infection prevention program by experts from DOH or from the LHJ and should optimize their infection prevention programs by following CDC guidance on Infection Prevention and Control for C. auris.

If you are at home, you do not need to be screened. If you get readmitted to a healthcare facility within 6 months of your discharge from the outbreak facility, Public Health recommends screening you for C. auris at that time. If you, your family,  or your caregivers have questions about whether you should be screened,  please contact your Local Health Jurisdiction.