Candida Auris Disinfection Best Practices
Contributed by Phil Carrizales, Director of the Hygiene and Facilities Solutions Division at Acme Paper and Supply Company
While all eyes have been on COVID-19, another deadly pathogen is proliferating, causing heightened concern in healthcare settings across the world: Candida auris (C. auris).
First identified in 2009, C. auris is an emerging multidrug-resistant fungus that can cause invasive and often deadly infections. By 2016, there were 13 cases reported in the United States, prompting the U.S. Centers for Disease Control and Prevention (CDC) to issue a clinical alert classifying C. auris as a serious global health threat.
Case counts accelerated during the pandemic, nearly doubling from 2019 to 2020. Between May 1, 2020, and April 30, 2021, there were 1,081 reported cases.
The increase in outbreaks during the COVID-19 pandemic has been attributed to several factors, including increased hospital occupancies, altered routine infection control practices, changes in cleaning and disinfection procedures, and reduced screenings as more resources were diverted to the COVID-19 response.
While the incidence of C. auris has taken a back seat to COVID-19, it poses a growing threat to patients in hospitals and long-term care facilities. All healthcare staff, including environmental services teams, need to be especially vigilant in preventing this insidious fungus for the following reasons:
- Mortality is high: 30-60 percent of patients with the C. auris infection succumb to the illness.
- Effective antifungal treatment options are limited due to rapidly developing drug resistance.
- C. auris is highly persistent in the environment, surviving for weeks on surfaces.
- Standard disinfectants do not eradicate C. auris.
- Hospitalized patients with COVID-19 are at increased risk for C. auris infections.
- Long-term care residents are vulnerable to C. auris.
- It spreads easily from person to person or via contact with contaminated surfaces or equipment.
- A person can be colonized with C. auris and spread it without an active infection.
- Both infected and colonized patients can shed C. auris onto bed mattresses and other areas of the hospital environment.
- There’s a significant risk of transmission between healthcare facilities during transfers of colonized or infected patients.
How Cleaning Combats C. auris
In addition to screening patients, providing early treatment, practicing strict hand hygiene, and enforcing contact precautions for colonized and infected patients, environmental cleaning and disinfection is a key intervention for preventing and containing C. auris outbreaks.
By implementing this five-step best-practice approach, environmental service teams can play an integral role in mitigating the spread of C. auris in their facilities:
Use an EPA-registered disinfectant. Disinfecting surfaces is the best way to control the spread of C. auris. The Environmental Protection Agency (EPA) maintains a list — known as List P — of approved hospital-grade antimicrobial products that are effective against C. auris. In addition to these EPA-registered products, environmental services teams can consider disinfectants from List K, which are effective against Clostridium difficile (C. diff) spores. List N agents, which kill all strains and variants of the coronavirus SARS-CoV-2 (COVID-19), are not effective against C. auris.
Read and follow the label. For maximum efficacy, always strictly follow the manufacturer’s directions on the label of the surface disinfectant being used, including applying the chemical for the correct amount of time, which may range from one to 10 minutes.
Ensure material compatibility. Before applying any environmental disinfectant solution to an equipment surface, confirm material compatibility. Some medical equipment surfaces, such as inflatable mattresses or electronic devices, are more sensitive to chemical solutions and could be damaged over time, compromising patient safety. Read the equipment manufacturer’s cleaning and disinfection instructions to make sure the disinfectant aligns with those recommendations.
Clean and disinfect thoroughly. Comprehensive daily and post-discharge wipe-down and disinfection of patients’ rooms and other areas where patients receive care is essential. Always use a cleaning product to remove any organic material and soil before disinfecting. Be sure to include high-touch surfaces such as bed rails, and environmental surfaces located further from the patient such as windowsills. All shared equipment (ventilators, glucometers, physical therapy equipment, etc.) must be cleaned and disinfected between patients.
Educate all healthcare staff. Ongoing education of all healthcare personnel ensures adherence to C. auris infection prevention and control measures. Training should cover how to carry out proper hand hygiene, contact precautions, and environmental cleaning and disinfection procedures, as well as why these measures are essential. Plan follow-up education to account for staff turnover, reinforce learning and provide updates on any changes in protocol.