08/01/24 Provider Alert: Ongoing transmission of Candida auris identified in Washington.

| August 1, 2024

Background

C. auris is an emerging, often multi-drug resistant yeast, that was first identified in the US in 2009. The first locally acquired case of C. auris in Washington was reported in 2023, and the first outbreak was  reported in January 2024. It can cause difficult to control outbreaks in high acuity facilities, especially among patients with invasive devices and wounds. C. auris may colonize patients long term and also cause invasive infections. Both colonized and infected persons can transmit the organism in healthcare settings. C. auris is not a risk to the general public, nor to most hospitalized patients.

Current Situation in Washington

Local transmission of C. auris was first reported in Washington in January 2024; on July 1, 2024, DOH released a Provider Alert highlighting an increase in reported cases. Since that Provider Alert, Public Health – Seattle & King County has identified facilities with healthcare-associated C. auris transmission: Harborview Medical Center and Kindred Hospital. Due to the increased number of facilities with ongoing transmission, DOH recommends facilities and healthcare providers to take steps to enhance detection of targeted MDROs such as C. auris and CPOs, strengthen infection prevention programs, and be prepared to accept C. auris patients and other potentially exposed patients coming from facilities with identified C. auris transmission.

Actions Requested

  • Recommend admission screening for C. auris and carbapenemase-producing organisms (CPO) in patients with identified risk factors:
    • Close contact in a healthcare setting (see below) to someone diagnosed with C. auris or CPO infection or colonization.
    • Admitted with a stay of 24 hours or more in any healthcare facility that is experiencing transmission of C. auris or CPO. Exposure information may be available in a patient’s electronic medical record in CareEverywhere and in Artificial Intelligence Discharge Agent (AIDA).
    • An overnight stay in the prior year in a healthcare facility outside the U.S. or in a region of the U.S. with a high burden of C. auris cases.
  • Direct admission from a ventilator-capable skilled nursing facility or a long-term acute care hospital.
    • Colonization or infection with a CPO.
    • Presence of a tracheostomy.
  • Recommend C. auris admission screening and contact precautions (CP) in private room until screened negative for patients admitted from the following facilities:
    • Harborview Medical Center: admitted with an overnight stay since April 1, 2024; if available, see CareEverywhere flags with information about C. auris exposure and screening recommendations.
    • Kindred Hospital: admitted in the prior 6 months.

Using CP for these patients is the most cautious approach. If CP are not feasible, the next most cautious action would be to use Enhanced Barrier Precautions for both the screened patient and any roommate until screening is negative.

  • Be aware that C. auris screening is available through the Washington State PHL; see Partners for Patient Safety page for more information.
    • Coordinate screening at PHL with your LHJ.
    • Facilities may use a commercial lab if available and preferred as some major commercial labs in Washington now provide C. auris testing.
  • Consider laboratory species identification of Candida isolates from non-sterile sites, prioritizing urine cultures over wound and respiratory sources. Review Candida species identification options with your lab. All non-albicans Candida species can be sent to the Washington Antimicrobial Resistance Laboratory.
  • Facilities with active C. auris investigations and clusters should disclose potential for C. auris exposure and any screening results to receiving facilities when patients transfer care.
  • Communicate patients’ C. auris or CPO colonization or infection status when they transfer care. Consider using the CDC Interfacility transfer form (PDF).
  • When receiving patients in transfer, facilities should inquire whether the discharging facility has detected cases or transmission of C. auris or CPOs and use the information for decisions about need for transmission-based precautions and admission screening.
  • Ensure your facility audits and optimizes 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. (See also: Recommendations for Disinfection and Sterilization in Healthcare Facilities.)
    • Manage patients with suspected or confirmed C. auris using contact precautions and place these patients in a single room whenever possible. Nursing homes, call Jefferson County Public Health at (360) 385-9400 about using Enhanced Barrier Precautions. Reinforce and audit core infection prevention practices. C. auris can quickly and easily colonize the patient’s environment. For positive cases or exposed contacts, ensure any items that cannot be dedicated or disposed are disinfected and cleaned appropriately (e.g., x-ray machines, vitals equipment, blood pressure cuffs, stethoscopes, etc.).
  • Remain vigilant for any increase in Candida results in a patient care unit, including from non-sterile sites, and consider C. auris.
  • Consider an infectious disease consultation for treatment options for patients with invasive C. auris infections. Even after treatment, patients are believed to be colonized with C. auris for long periods, and possibly indefinitely.
  • Immediately report any suspected or confirmed C. auris cases or outbreaks to Jefferson County Public Health and submit isolates to the Public Health Laboratories.

Resources for Providers from Washington DOH

Reporting C. auris

To report suspected cases, or for any other questions, please call the reporting line: 360-385-9400 during business hours, (360) 385-9400 and select option 3 after hours, or fax a form to (360) 385-3878.