Briefing title: Candida auris Infection Prevention and Control Guidelines

Briefing date: 21 October 2016

Circulated to:
 Clinical Leads; Heads of Nursing; Matrons
 Divisional Managers; Service Managers; Ward Managers
 King’s Executive (for information)

Background
Candida auris (or ‘C. auris’) is an emerging multi-drug resistant fungal pathogen that can cause
severe illness in patients within a hospital setting. Since its initial isolation in Japan in 2009, the
strain has been identified in nine countries throughout four continents, including India, Pakistan,
Venezuela and Columbia. There was also a serious outbreak in a London-based adult intensive
care unit in April 2015 where over 40 patients were colonised or infected.

This briefing is designed ensure that staff working across the Trust are aware of the potential of C.
auris to cause persistent, widespread epidemics resulting in life-threatening infections and service
disruption. It also signposts staff to the Trust’s policy on preventing the spread of C. auris at King’s.

Common features of C. auris

 The most common feature of C. auris is asymptomatic colonisation of the skin, however it can
cause infections in wounds, respiratory and urinary tracts, and most seriously, the bloodstream
 Immunosuppressed patients are especially at risk particularly after long courses of antibiotics
 C. auris is resistant to first line antifungals like fluconazole and has variable susceptibility to
other antifungal classes including echinocandins and polyenes
 Unlike other yeast infections it has the ability to transfer between hospital patients and
evidence suggests it can heavily contaminate the rooms of infected or colonised patients

What do staff need to do?

If you work in a clinical area please ensure you have read the Candida auris Infection Prevention
and Control (IPC) Guidelines which can be found on the Candida auris Kwiki page or here:
http://kingsdocs/docs/policies/DOCUMENTS%20POLICIES/Candida%20auris%20IPC%20Guidelin
es%20Oct%202016%20V6%20-%20FINAL.doc

In addition to standard infection prevention and control principles, the guidance contains details of:
 how to screen suspected cases and how to manage positive patients in strict isolation
 what personal protective equipment (PPE) staff should use when caring for infected patients
 rules for the movement and transfer of patients around the hospital and during discharge
 cleaning precautions for equipment and the environment, as well as waste and linen disposal
 briefing visitors on hand hygiene and other IPC precautions that need to be reinforced
 where to find the patient information leaflet on C. auris

Why is the Trust concerned about C. auris?

1. It is highly transmissible and has already caused outbreaks in hospital settings
2. It requires aggressive adherence to infection prevention and control interventions
3. It has strong resistance to most antifungal drugs commonly used to treat Candida infections
Frequently asked questions
Below are some commonly asked questions about C. auris; if you cannot find the answer to your
query in the list then please contact the Infection Prevention and Control (IPC) Team or the
Consultant Microbiologist at your hospital site.

 What types of infection can C. auris cause?

 C auris has caused bloodstream, wound and ear infection; it has also been isolated from
respiratory and urine specimens. Yeast infections can occur on nearly any part of the body.

 What are the common risk factors for C. auris?

 Data suggests common risk factors are broadly the same as for other types of Candida
infections, including: recent surgery, diabetes, broad-spectrum antibiotic and antifungal use,
and central venous catheter use. C. auris is mainly contracted in long-stay hospitals where
patients risk infection from contact with contaminated surfaces and equipment.

 How do we screen patients for C. auris?

 Patients with a suspected infection must be placed in a single room on admission and the
following sites must be screened: nose, throat, groin and axillae. If the patient has an
indwelling catheter then you must also take a urine sample.

 How do we screen patient contacts for C. auris?

 Where we have a confirmed case of infection, a risk of assessment will be undertaken by
the IPC team to identify patients who may have been exposed

 How is C. auris diagnosed?

 Samples from contacts of a case must be labelled as ‘Contact with Candida auris’ or
‘Candida auris screen’ in the clinical notes section on EPR for Denmark Hill, or if at the
PRUH this must be written clearly on the request form. This will ensure they are not only
screened for a bacterial culture. Diagnosis of the fungal culture is made through special
laboratory screening of blood or other bodily fluids using molecular methods.

 How do we manage patients with a C. auris infection?

 Patients colonised or infected with C. auris must remain in isolation for the duration of their
hospital stay. Three negative screens are not required as they do not indicate clearance.

 How do we treat patients with a C. auris infection?

 As some C. auris infections have been shown to have resistance to the three main classes
of antifungal medications, multiple classes of antifungals at high doses may be required to
treat the infection. Treatment decisions will therefore be made on a case by case basis.

 Can a patient die from a C. auris infection?

 Yes, C. auris can be fatal, particularly for patients with underlying complex health
conditions or serious illnesses. Prevention is the best way we can keep people safe.

 How can we prevent the spread of C. auris?

 Infection prevention and control practices are critical in helping prevent the spread of C.
auris across our hospital sites. These include ensuring strict hand hygiene and using
contact precautions including personal protective equipment. Thorough cleaning of hospital
rooms and linen, as well as careful adherence to waste disposal regulations, also contribute
significantly to the prevention of the spread of infection – please help us to enforce these.

Further information
In addition to the information found on Kwiki and Kingsdocs, you can also contact the Infection
Prevention and Control (IPC) Team with any questions, or to report a suspected case of infection:
 Denmark Hill: ext. 36532
 PRUH and Orpington: ext. 63460