Candida auris

Planning, prevention and preparation for the control of C. auris, including screening, surveillance and outbreak management, should be integrated into health service organisations’ infection prevention and control and antimicrobial stewardship (AMS) programs. These programs should align with local needs and the requirements of the National Safety and Quality Health Service (NSQHS) Standards, including implementing a hand hygiene program that is consistent with the current National Hand Hygiene Initiative, and state and territory requirements.

Health service organisations should follow state and territory policies for C. auris screening. In general, screening for C. auris on admission to hospital should be performed if the patient:

• Is a direct transfer from an overseas hospital
• Is a contact of a suspected or confirmed C. auris case, or 
• Has been admitted to an overseas health or aged care facility in the previous 12 months.

Patients who test positive for C. auris should have an alert placed in their healthcare record for easy identification. 

Each health service organisation, or state or territory, should select an appropriate active surveillance strategy for C. auris. C. auris is currently monitored as one of the critical antimicrobial resistances (CARs) in CARAlert. In some states and territories, C. auris is also notifiable. Any isolate of C. auris should be monitored and reported in accordance with the relevant state and territory requirements.

For data on C. auris in Australia, see AURA 2023 and CARAlert annual reports and data updates

C. auris can be spread from person to person through direct contact with contaminated hands, equipment and environmental surfaces. Standard and contact precautions should be implemented when managing patients with suspected or confirmed C. auris infection or colonisation. The key elements of applying contact precautions are:

• Use of appropriate personal protective equipment, such as aprons, gowns, and gloves
• Patient placement (e.g. single room cohorting)
• Minimising patient movement.

C. auris can survive on equipment and environmental surfaces for up to two weeks. Health service organisations should have environmental cleaning and disinfection policies and procedures that include guidance for the management of the environment and the reprocessing of reusable equipment where there has been exposure to a suspected or confirmed C. auris case. These policies and procedures should include:

• Product selection and method of use
• Frequency of cleaning and disinfection for the patient’s room/area and bathroom, including frequently touched surfaces
• Reprocessing shared medical equipment, such as blood pressure cuffs (if unable to use dedicated patient equipment for those suspected or confirmed C. auris infection)
• Discharge cleaning and disinfection requirements.

Health service organisations should monitor and audit cleaning according to relevant state or territory policies or procedures.

Disinfection

Cleaning the environment where there is a suspected or confirmed C. auris case should involve:

• 2-step clean - a physical clean using a detergent followed by disinfection with an Australian Register of Therapeutic Goods (ARTG)-listed hospital-grade disinfectant with specific claims for activity against fungi (yeasts) or a chlorine-based product such as sodium hypochlorite, where indicated for use; or
• 2-in-1 clean - a physical clean using a combined detergent and ARTG-listed hospital-grade disinfectant with specific claims or a chlorine-based product, where indicated for use.

Quaternary ammonium compounds are commonly used disinfectants and may be ineffective against C. auris. It is important to review the manufacturer’s test reports to ensure efficacy against C. auris before use. 

• Further information on environmental cleaning

Staff education is important for preventing and controlling the spread of C. auris infections. Education helps staff to understand and follow infection prevention and control requirements, support antimicrobial stewardship, and enhance reporting and clinical communication. Education should also highlight state or territory policies for reporting breaches in infection prevention and control practice and C. auris screening requirements to promote a culture of safety and quality.

Patients and visitors also should be informed on what they can do to prevent the spread of C. auris and other infections, including:

• Promoting personal hygiene, including hand hygiene
• Encouraging patients and visitors to report symptoms and provide accurate medical history, including recent overseas hospital admissions
• Encouraging adherence to antimicrobial treatment. 

The Commission has developed a suite of fact sheets for patients and visitors about infection prevention and control, and common and emerging healthcare-associated infections.

Clearance of patients confirmed with C. auris infection should be based on a variety of factors, such as microbiological testing, clinical assessment and monitoring, appropriate treatment, evaluation of indwelling devices, discharge planning, and patient education. C. auris clearance should be determined in accordance with local and state or territory policies and in consultation with experts in clinical microbiology, infectious diseases or infection prevention and control.