Orange County Candida auris Update
August 05, 2020
New cases of Candida auris continue to be reported in Orange County, and routine surveillance in county facilities has shown a recent spike in newly colonized patients. An increase in cases has also been reported in Los Angeles County. Transmission has occurred related to multiple healthcare facilities, including acute care hospitals, long-term acute care hospitals and skilled nursing facilities. Conservation and reuse of personal protective equipment (PPE) in units designated to care for COVID-19 patients, particularly reuse of gowns, leads to an increased risk of C. auris transmission. Although the focus is currently on COVID-19, it is important to stay vigilant to contain the spread of multi-drug resistant organisms (MDROs) in the county.  
  • Patients should be cohorted by both COVID-19 status and MDRO status. Within a COVID-19-designated unit, efforts should be made to cohort patients with both C. auris and COVID-19 together and separate from those with COVID-19 only
  • Reuse of gowns between patients can spread MDROs such as C. auris. Staff in many COVID-19 units are reusing gowns for an entire shift to minimize the risk of self-contamination. If a facility has known C. auris cases, gowns should be changed when going from a COVID + C. auris room to a COVID – C. auris room. If necessary, consider prioritizing gown use for high-contact care activities only (see Enhanced Standard Precautions) and implement the extended use of gowns only when patients are known to have the same MDRO and COVID-19 status, and when these patients are housed in the same room.
  • Staff should strictly adhere to recommended central venous catheter and urinary catheter insertion and maintenance practices and practice meticulous care of tracheostomy sites. Clinicians should continually assess the need for invasive devices and promptly remove them when they are no longer needed.
  • Healthcare facilities affected by C. auris should adhere to appropriate environmental cleaning standards.
  • Report any C. auris invasive disease events to the Orange County Health Care Agency at 714-834-8180.
Continued Surveillance
The Orange County Healthcare Agency continues to monitor C. auris activity in all high-risk facilities in the county. Point prevalence surveys (PPSs) continue to be routinely performed at intervals at all long-term acute care hospitals (LTACHs) and skilled nursing facilities that provide ventilator care (vSNFs) in Orange County, as well as any other facility where transmission has been detected. 

Clinical laboratories who serve acute care hospitals, LTACHS, and vSNFs in the county should also be performing surveillance for C. auris by speciating selected organisms when Candida is isolated in cultures taken from sterile and non-sterile body sites. This speciation surveillance is extremely important to controlling the spread of C. auris in the county and has aided in the identification of multiple cases not found by traditional PPS surveillance since the organism’s introduction into the county.
Transmission Can Occur Anywhere
Efforts to curb the transmission of C. auris have been targeted to high-risk facilities including LTACHs and vSNFs. These facilities’ patients are at particular risk due to their underlying health status and lengths of stay: patients who have been hospitalized long term, have a central venous catheter or other lines or tubes entering their body, are immunocompromised, or have previously received antibiotics or antifungal medications are at highest risk of infection with this yeast. OCHCA has seen transmission events occur inside of vSNFs, LTACHs and acute care hospitals due to lapses in both infection control practices and environmental cleaning. This organism survives well in the environment so it is critical to adhere to all environmental cleaning and infection control recommendations, particularly when known C. auris-colonized patients are admitted.  Many facilities have changed their environmental cleaning products as a response to COVID-19, please confirm with your environmental services team that the cleaner used for terminal room cleaning is effective against C. auris.  
Prevention of Invasive Infections
When a new case of C. auris infection or colonization is identified, staff should review protocols for care of medical devices and evaluate current adherence to protocols. More information on appropriate care of medical devices is available in the Infection Control Guidelines Library. 
Clinical Isolate Submission
OCHCA requests that all C. auris isolates are submitted to the Orange County Public Health Laboratory, not only those where confirmatory testing is needed. Please confirm with your laboratory that they are sending all C. auris isolates. The HCA laboratory confirms speciation and also performs antifungal susceptibility testing and whole genome sequencing.   
Contact Information
Please contact Communicable Disease Control Division at 714-834-8180 with questions or concerns. Please note that this number is now operational 24/7 for medical providers. Please do not share this number with patients.
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