Candida auris FAQ

Candida auris (or C. auris) is a type of fungus (also called a yeast) that can cause severe illness and spreads easily among patients in healthcare facilities. C. auris can cause a range of infections from superficial (skin) infections to more severe, life-threatening infections, such as bloodstream infections. C. auris mostly affects patients requiring complex medical care including patients with invasive medical devices like breathing or feeding tubes, or catheters. C. auris infections can be difficult to treat and even cause death. It is one of many multidrug-resistant organisms (MDROs) that are of public 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 causes illness in patients who have been very sick in a healthcare facility. It is not a risk to the general public or healthy people, including family members and healthcare workers interacting with people with C. auris. Patients are at higher risk for C. auris colonization or infection if they have one or more risk factors, such as:

• Mechanical ventilation
• Indwelling medical devices, including central lines, feeding tubes, and urinary catheters
• Receipt of complex or high acuity medical care
• Frequent or long healthcare stays, especially in facilities that provide long-term acute care
• Colonization or infection with other multidrug-resistant organisms

Residents in a nursing home or other long-term care settings who do not currently have the risk factors above are at a low risk of 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.

Approximately 5-10% of people with risk factors (see "Who can get C. auris infection?" above) who are colonized with C. auris subsequently develop a C. auris infection. Healthy people typically do not get C. auris infections. 

There are no symptoms of colonization. It is detected through a screening test by swabbing the underarms, groin, or other places on the body.

During hospitalizations and healthcare visits, healthcare personnel will take precautions such as placing you in a private room and using personal protective equipment during your stay or visit. There is no recommended treatment for colonization. Minimizing use of indwelling medical devices such as catheters and avoiding unnecessary antibiotics can reduce the risk of a C. auris infection. 

The symptoms of C. auris infection depend on the site of infection. 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 urine, blood, and wounds.

Yes, C. auris infection can be serious, especially if in the blood. About 30-60% of those with invasive C. auris infection die, 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 several 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 treatment to eliminate colonization with C. auris. Usually, once a person is colonized with C. auris, colonization persists for a long time and sometimes 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 cleaned properly.
• C. auris is resistant to some common healthcare disinfectants and can survive for a long time in the healthcare environment. 

Robust infection prevention programs can prevent the spread of C. auris. Facilities should:

• Place patients who are colonized or infected with C. auris in a private room or with another C. auris patient.
• Ensure 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 gowns and gloves.
• Make sure that all medical equipment that is used frequently for a patient with C. auris, like a stethoscope, blood pressure cuff, gait belt, and thermometer, are not used on other patients.
• Clean and disinfect all other shared equipment between use on patients.
• Clean hands before and after touching a patient or their environment, before a procedure, and after removing gloves.
• Use a disinfectant that is effective against C. auris for the patient’s environment and for any patient equipment.
• Audit infection prevention practices and make 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 the patient is in a healthcare facility, but these precautions are not necessary once people go home.

Public Health recommends that facilities screen patients who are more likely to have C. auris, including those who have certain risk factors or who may have been exposed to other patients with C. auris. Screening helps facilities 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. Some facilities screen patients at the time of admission as well.

C. auris is spread through contact. Be sure to inform your healthcare providers if you have C. auris so they know to use proper precautions to prevent it from spreading to other patients. If you are admitted to a healthcare facility, the caregivers may put you in a private room or a shared room with another patient with C. auris.

No, patients with C. auris can still have visitors if the visitors follow the rules of the healthcare facility. 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” should remain in their room 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 with C. auris should be scheduled for the last time slot in the day to allow ample time for proper disinfection before the next patient.

There are no special precautions needed at home once you have been discharged from a healthcare facility. 

It is important that you and your family follow good general hygiene practices, such as: 

• Always wash your hands with soap and water:
  • Before preparing or eating food
  • After using the bathroom
  • Before and after touching any wounds or medical devices that you may have
• Do not share personal care items like towels and washcloths with other people.
• Cover any wounds with a bandage whenever possible.

When cleaning your home: 

• Your clothing may be washed in the usual manner, along with the rest of the household laundry.
• All eating utensils and dishes can be washed the way you normally do.
• You do not need to take special precautions around your pets. 

Public Health does not recommend testing healthy family members or healthcare workers who care for patients with C. auris. However, healthcare facilities may decide to screen household contacts of patients with C. auris if they become ill and are admitted to a healthcare facility.

C. auris has been spreading in healthcare facilities in the US since 2016. 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 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 (for information, contact your local health jurisdiction)
• 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

• Strengthen infection prevention practices that are proven to prevent transmission of C. auris, including hand hygiene, transmission-based precautions, environmental cleaning, and cleaning and disinfection of reusable medical equipment. 
• Request a free assessment of their infection prevention program by Public Health.
• Perform screening for C. auris
  • All long-term acute care hospitals (LTACH) and ventilator capable skilled nursing facilities (vSNF) in Washington should follow Partners for Patient Safety Program guidance and screen their patients/residents regularly. 
  • LTACHs should perform admission screening in all incoming patients and vSNFs should screen all incoming residents to 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 risk factors.
• Healthcare facilities that opt to expand C. auris screening beyond the categories supported by Public Health can seek C. auris testing at commercial labs (e.g., Labcorp, Quest, University of Washington) or by validating and implementing C. auris testing in their own lab. 

If you are at home, you do not need to be screened. In some situations, Public Health may recommend you are screened if you are admitted to a healthcare facility within six months of your discharge from the outbreak facility. If you, your family, or your caregivers have questions about whether you should be screened, please contact your local health jurisdiction.

In most situations, shelters will not be aware of infectious conditions in their guests. Shelters can help prevent the spread of C. auris and other infectious organisms by following these general infection prevention guidelines:

• Have assigned bunk beds
• Disinfect cots and provide clean sheets between residents
• Have liquid soap, water, and disposable paper towels for handwashing
• Provide signage in restrooms and other locations with sinks reminding of proper handwashing practice
• Provide hand sanitizer in communal areas
• Disinfect high touch surfaces daily (e.g., tables, doorknobs, faucets, railings, phones)
• Provide residents plastic bags for soiled laundry
• Wash and dry laundry on hot settings only
• Staff should wear gloves when disinfecting surfaces and washing laundry
• Provide bandages for residents with open sores
• Ensure that staff are trained in accordance with the safely cleaning and disinfecting public spaces guidance

Shelters that learn one of their guests has C. auris colonization or infection should ensure that the disinfectant in use is effective against C. auris. Refer to the EPA list P.