How to Prevent a Candida Auris Infection

The Centers for Disease Control (CDC) recently raised the alarm on the increased transmission of Candida auris (C. auris) infections in U.S. healthcare facilities. While hospital-acquired infections are somewhat common, the spike of this fungal infection is concerning because it doesn’t respond to prescribed antifungal medication. This means hospitals are scrambling to control its spread.

According to the CDC, while C. auris was flagged as a public health threat back in 2018, cases skyrocketed between 2020 and 2021. The gold standard of treatment is a class of antifungal medications called echinocandins, which are administered intravenously. But the number of C. auris cases resistant to echinocandins tripled in 2021.

While C. auris infections do not pose a threat to healthy individuals or the general public, it can spread easily in hospitals if standard precautions are not used.

“Although originally identified in culture of an ear infection, most reported cases of C. auris invasive infections occur in hospitalized patients with significant underlying disease comorbidities,” Stanley Deresinski, MD, a clinical professor of infectious diseases at Stanford Health Care, told Verywell via email. “However, it is likely that C. auris causes minor infections that go unidentified.”

Here’s what you need to know about C. auris prevention to keep it from escalating to a major issue.

How Hospitals Prevent the Spread of Candida auris

Following universal standard precautions while working in or visiting a hospital or healthcare facility is key to preventing the spread of dangerous germs, including C. auris, Deresinski said. 

If you find yourself or a loved one admitted to the hospital, pay attention to standard precautions being followed on a routine basis. The primary infection prevention measures for combating C. auris should include the following standard precautions. 

Hand Hygiene

As simple as it sounds, hand hygiene is one of the most universal ways to easily stop the spread of germs, especially in the hospital setting. 

According to the CDC, alcohol-based hand sanitizer (ABHS) is the preferred hand hygiene method for C. auris when hands aren’t visibly soiled. However, if hands are visibly soiled, soap and warm water is required to remove spores from hands.

It is required that hospital staff clean hands before and after the following situations:

• Entering and exiting a patient’s room
• Touching a patient
• Touching anything connected to the patient (catheter, IV tubing, pulse oximeter, etc.)
• Wearing gloves
• Eating
• After using the restroom

Cleaning and Disinfecting 

Since C. auris can live on surfaces for weeks, it is critical to clean and disinfect surfaces and medical equipment continuously throughout the day. These products should be disinfectant cleaners or sprays listed on the Environmental Protection Agencies (EPA) List P, which have been proven to kill C. auris.

Healthcare providers should be routinely disinfecting the following:

• Any location where patient receives care (patient rooms, radiology, physical therapy, etc.)
• Shared or reusable equipment (ventilators, vital machines, nursing carts, etc.)
• High-touch surfaces (bedside tables and rails, windowsills, door knobs, etc.)

Data on whether “no-touch” disinfectant products, such as ultraviolet (UV light) and vaporized hydrogen peroxide, can kill C. auris is limited. These measures can be used, but only alongside proven EPA-recommended cleaning products.

Contact Precautions 

While standard precautions should be followed in all healthcare facilities, another layer of infection control, called transmission-based precautions, must be followed for people with confirmed common hospital-acquired infections such as C. auris and Clostridioides difficile (C. difficile), which causes inflammation of the large intestine.

Transmission-based precautions include contact precautions. This means wearing specific personal protection equipment (PPE) like gowns, gloves, and possibly eye-wear when caring for people with a specific microbe that can be easily transmitted to someone else, such as:

• C. auris
• C. difficile
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Some hepatitis infections

Proper Patient Room Placement 

Patients who are on contact precautions should also be placed in a single or private room whenever possible to minimize the spread of infection to other patients. 

If single rooms are not available, putting two patients with the same infection together to help decrease the movement of healthcare personnel and shared medical equipment.

Regular Screening 

Screening patients for C. auris is another best practice to minimize the spread in the healthcare setting.

A screening involves taking a swab sample of the armpits and groin area. The following people should be screened for C. auris:

• Close healthcare contacts of patients newly diagnosed with C. auris (roommates, etc.)
• People who have stayed the night in a healthcare facility outside the U.S. in last year
• Patients who require a higher level of care such as mechanical ventilation 
• Anyone in a facility where there is suspicion of ongoing transmission

Should the General Population be Concerned?

Since healthy people rarely develop serious infections from C. auris, it is not a concern for the general population outside of healthcare facilities.

Deresinski points out that people with underlying serious health conditions are the ones at risk for serious and often deadly infections from the C. auris fungus.

"In a recent analysis from a Brooklyn hospital, almost all [infected patients] had serious comorbidities such as cancer, and approximately half of patients had long IV catheters, which is the likely source of infection," Deresinski said. “The mortality rate in patients with bloodstream infections is reported to be greater than 30%.”

However, Nasia Safdar, MD, a professor of infectious disease and health sciences learning at the University of Wisconsin, Madison, suggests asking how healthcare facilities monitor and reduce the spread of C. auris. 

“I think it is important to recognize that this is not a broad threat for the public,” Safdar told Verywell. “Because the symptoms of a C. auris infection are not specific and many other infections can mimic it, attention to whether specific steps are taken to diagnose it when suspected is important.”