Kitsap County healthcare providers should be aware of ongoing transmission of Candida auris (C. auris) at two healthcare facilities in King County.
Local transmission of C. auris was first reported in Washington in January 2024. The Washington State Department of Health (DOH) released a provider alert on July 1 highlighting an increase in reported cases. On July 30, DOH released a situation update alerting providers and the broader health community that Public Health – Seattle & King County had identified healthcare-associated C. auris transmission at Harborview Medical Center and Kindred Hospital.
Due to the increased number of facilities with ongoing transmission, DOH and Kitsap Public Health recommend facilities and healthcare providers take steps to enhance detection of C. auris, strengthen infection prevention programs, and be prepared to accept C. auris patients, as well as patients who were potentially exposed to C. auris coming from facilities with identified transmission. Facilities and healthcare providers should also ensure that there is a clear communication plan for transferring patients with history of C. auris infection or exposure to another facility or healthcare provider.
ACTIONS REQUESTED
ADMISSION SCREEN for C. auris and carbapenemase-producing organism (CPO) in patients with identified risk factors:
- Close contact in a healthcare setting (see below) to someone diagnosed with C. auris or carbapenemase-producing organism (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).
- 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.
SCREEN patients admitted from facilities with ongoing transmission:
- 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 since February 2024.
Use contact precautions (CP) in a private room until patients from these facilities have screened negative for C. auris. 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 state Public Health Laboratory (PHL); see Partners for Patient Safety page for more information.
- Screening should be coordinated through Kitsap Public Health. Washington PHL will not test specimens without receiving Public Health approval.
- If preferred, facilities can test using a commercial lab that offers C. auris testing, including (but not limited to): LabCorp, Quest, Mayo Clinic, and ARUP.
- 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 Network (ARLN).
COMMUNICATE the following information when patients transfer care to another facility, outpatient, or home care:
- Detected C. auris cases at transferring facility, potential for C. auris exposure, and any screening results or pending screening results.
- Patients’ C. auris or CPO colonization or infection status.
- Observed contact precautions.
- Consider using the CDC Interfacility transfer form (PDF).
USE CONTACT PRECAUTIONS when managing patients with suspected or confirmed C. auris and place these patients in a single room whenever possible. In nursing homes, consult with Kitsap Public Health about using Enhanced Barrier Precautions.
- Reinforce and audit core infection prevention practices. C. auris can quickly and easily colonize a 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.).
- When C. auris is suspected, use healthcare disinfectants that are effective against C. auris. Products registered for use against Clostridioides difficile are also effective. Follow disinfectant instructions for use including proper precleaning, dilution, and wet time.
- Audit and optimize your facility’s 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.
CONSIDER an infectious disease consultation for treatment options for patients with invasive C. auris infections. Note that CDC does not recommend treatment for C. auris for any patient without signs or symptoms of infection; this includes both patients with C. auris colonization and patients with C. auris detected in noninvasive sites (i.e., respiratory tract or urine).
BE AWARE that even after treatment, patients are believed to be colonized with C. auris for long periods — possibly indefinitely.
IMMEDIATELY REPORT any suspected or confirmed C. auris cases or outbreaks to Kitsap Public Health and submit isolates to the Public Health Laboratories.
BACKGROUND
C. auris is an emerging, often multi-drug-resistant yeast first identified in the U.S. 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. C. auris 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, or to most hospitalized patients.
MORE RESOURCES
Resources from WA DOH:
- General information about Candida auris
- Candida auris FAQ
- Candida auris notifiable conditions information
- How to enroll your facility in proactive screening for Candida auris
- WA DOH Multi-Drug Resistant Organism (MDRO) Dashboard
- WA DOH Multi-Drug Resistant Organism (MDRO) Prevention and Response Toolkit
- What to Do if you Identify a Targeted Multidrug Resistant Organism in your Facility (PDF)
Resources from CDC:
CONTACTING THE HEALTH DISTRICT
Call us at 360-728-2235 and you will be routed to the appropriate program. Includes reporting notifiable conditions 24 hours a day, 7 days a week.
This advisory is also posted on the health advisory page of our Provider Resources website, providers.kitsappublichealth.org.