Candida auris Disinfection Best Practices

Though the public mind has been understandably occupied with COVID-19 concerns, another deadly pathogen is proliferating, causing heightened concern in healthcare settings across the world: Candida auris (C. auris).  

First identified in 2009, C. auris is an emerging multidrug-resistant fungus that can cause invasive and often deadly infections. By 2016, there were 13 cases reported in the United States, prompting the U.S. Centers for Disease Control and Prevention (CDC) to issue a clinical alert classifying C. auris as a serious global health threat.  

Case counts accelerated during the pandemic, nearly doubling from 2019 to 2020. Between May 1, 2020, and April 30, 2021, there were 1,081 reported cases.    

The increase in outbreaks during the COVID-19 pandemic has been attributed to several factors, including increased hospital occupancies, altered routine infection control practices, changes in cleaning and disinfection procedures, and reduced screenings as more resources were diverted to the COVID-19 response.   

Increased Vigilance  

While the incidence of C. auris has taken a back seat to COVID-19, it poses a growing threat to patients in hospitals and long-term care facilities. All healthcare staff, including environmental services teams, need to be especially vigilant in preventing the emergence of this insidious fungus for the following reasons:   

• Mortality is high: 30-60 percent of patients with the C. auris infection succumb to the illness. 
• Effective antifungal treatment options are limited due to rapidly developing drug resistance.  
• C. auris is highly persistent in the environment, surviving for weeks on surfaces.
• Standard disinfectants do not eradicate C. auris.
• Hospitalized patients with COVID-19 are at increased risk for C. auris infections.
• Long-term care residents are vulnerable to C. auris.
• C. auris spreads easily from person to person, and via contact with contaminated surfaces or equipment.
• A person can be colonized with C. auris and spread it without an active infection.
• Both infected and colonized patients can shed C. auris onto bed mattresses and other components of the hospital environment.
• The transfer of colonized or infected patients between healthcare facilities poses a significant risk of transmission. 

How Cleaning Combats C. auris 

In addition to screening patients, providing early treatment, practicing strict hand hygiene, and enforcing contact precautions for colonized and infected patients, environmental cleaning and disinfection is a key intervention for preventing and containing C. auris outbreaks.  

By implementing this five-step best-practice approach, environmental service teams can play an integral role in mitigating the spread of C. auris in their facilities:  

Use an EPA-registered disinfectant. Properly cleaning and disinfecting surfaces is the best way to control the spread of C. auris. The Environmental Protection Agency (EPA) maintains a list — known as List P —  of approved hospital-grade antimicrobial products that are effective against C. auris. In addition to these EPA-registered products, environmental services teams can consider disinfectants from List K, which are effective against Clostridium difficile (C. diff) spores. List N agents, which kill all strains and variants of the coronavirus SARS-CoV-2 (the virus that causes COVID-19), are not effective against C. auris. 

Read and follow the label. For maximum efficacy, always strictly follow the manufacturer’s directions on the product label of the surface disinfectant being used, including applying the chemical for the correct amount of time, which may range from one to 10 minutes.   

Ensure material compatibility. Before applying any environmental disinfectant solution to an equipment surface, confirm material compatibility. Some medical equipment surfaces, such as inflatable mattresses or electronic devices, are more sensitive to chemical solutions and could be damaged over time, compromising patient safety. Read the equipment manufacturer’s cleaning and disinfection instructions to make sure the disinfectant aligns with those recommendations.      

Clean and disinfect thoroughly. Comprehensive daily and post-discharge wipe-down and disinfection of patients’ rooms and other areas where patients receive care is essential. Always use a cleaning product to remove any organic material and soil before disinfecting. Be sure to include high-touch surfaces such as bed rails, and environmental surfaces located further from the patient such as windowsills. All shared equipment (ventilators, glucometers, physical therapy equipment, etc.) must be cleaned and disinfected between patients.    

Educate all healthcare staff. Ongoing education of all healthcare personnel ensures adherence to C. auris infection prevention and control measures. Training should address the implementation of proper hand hygiene, contact precautions, and environmental cleaning and disinfection procedures, as well as reinforce why these measures are essential. Plan follow-up education to account for staff turnover, reinforce learning and provide updates on any changes in protocol.   

Phil Carrizales is the Director of the Hygiene and Facilities Solutions Division at Acme Paper and Supply Company, supplier of sanitation solutions, disposable food service packaging, restaurant equipment and supply, retail and industrial packaging, and custom-designed packaging. Carrizales has over 20 years of experience in account management for major cleaning suppliers and is ISSA certified.