Opportunistic HAIs (healthcare associated infections) such as C. diff, MRSA, CRE and VRE are a constant concern in healthcare settings, especially among patients who are weakened by chronic disease and compromised immune systems. The NYS Department of Health (NYSDOH) has raised a warning flag regarding a new HAI, Candida auris. NYSDOH is reaching out to healthcare facilities throughout the state to provide education and guidance in an effort to stem the spread of this serious, and potentially deadly, pathogen.

Candida auris, also known as C. auris, is a form of yeast that can cause bloodstream, wound and ear infections. Patients clinically diagnosed with C. auris have a high mortality rate. However, because these patients are typically already extremely ill, it is unknown whether C. auris is the cause of death.

Background

C. auris infection was first identified in Japan in 2009. It has since been identified in many countries throughout the world. The first U.S. case, found retrospectively in 2016, occurred in 2013. Most cases of C. auris identified in the U.S. have occurred in New York.

C. auris infection can be difficult to identify because tests for other types of yeast infection can cause false positive results. In NYS C. auris suspect specimens can only be tested at the NYSDOH Wadsworth Laboratory located in Albany. Since most strains of C. auris are resistant to some or all classes of antifungal medications, a false positive can delay effective treatment.

In addition to C. auris being hard to diagnose and treat, it is extremely hardy and, therefore, survives for long periods in the hospital environment. It can take months for a patient to clear a C. auris infection.

Patients most at risk for C. auris infection include:

• those who have been in the ICU for a long time and/or
• have had recent surgery and/or
• have a central venous catheter placed in a large vein, and
• have previously received antibiotics or antifungal medications

Symptoms of C. auris include:

• fever and chills while on antimicrobial medication
• sepsis
• isolation of Candida-like yeast from patient’s blood
• little or no patient response or improvement with conventional antifungal therapy

Infection control protocols for hospitals and nursing homes include:

• standard and contact precautions
• diligent hand hygiene
• single room (or cohorting with other C. auris-infected patients in nursing homes if single rooms not available)
• all potentially infectious surfaces and equipment must be thoroughly disinfected with an EPA-registered hospital grade disinfectant effective against C. diff spores
• both daily and terminal cleaning (NYSDOH recommends environmental cleaning monitoring include fluorescent markers and ATP bioluminescence)
• personal protective equipment including gowns and gloves
• So far healthcare workers treating patients with C. auris do not appear to be at risk for infection.

The NYS DOH is taking the following steps to contain the disease’s spread:

• developing infection control self-assessment tools for healthcare facilities
• conducting on-site surveys of hospitals and nursing homes
• developing guidance for hospitals, long-term care facilities and homecare
• developing educational materials for healthcare facility employees
• developing a new rapid test for faster C. auris identification
• meeting with stakeholders to provide information and solicit feedback

More information on C auris can be found at www.cdc.gov and www.health.ny.gov.

If you would like to discuss this issue or any other health and safety issue with NYSNA’s Occupational Health and Safety representatives, please send an e-mail to healthandsafety@nysna.org.