By J. Darrel Hicks, Contributing Writer

Candida auris (C. auris) is a drug-resistant fungus that health officials hoped to contain, but it is now in more than one-half the 50 states, according to researchers. Nearly one-half of patients who contract C. auris die within 90 days, according to the U.S. Centers for Disease Control and Prevention (CDC). 

But Dr. Meghan Lyman, a medical officer in the mycotic diseases branch of the CDC, says the agency did not have a good sense of the number of deaths to attribute directly to the fungus. The reason is that people who become infected are also dealing with multiple other health challenges, so C. auris can be both a cause of death and a factor that, along with other poor-health factors, hastens it. 

C. auris is not a particular threat to young, healthy people, whose immune systems can fight it off, but the condition can be transported on skin and clothing. One presentation at the recent Society of Healthcare Epidemiology in America conference highlighted the first documented case of C. auris moving from an adult to a pediatric unit of a hospital in the state of Maryland. 

The investigation into potential transmission pathways identified healthcare personnel who worked in both units — clinical teams and continuous electroencephalography (cEEG) technologists. Some of the same cEEG equipment was used on both adult and pediatric patients. 

Related: Study Finds C. auris Capable of Quick Recontamination

Fomites — objects in an environment that can support infectious pathogens and act as a vector for person-to-person transmission — can become vectors in hospitals and other healthcare facilities. One primary source of C. auris in hospitals is in dry-surface biofilm on equipment and environmental surfaces. 

C. auris can cause outbreaks of invasive infections due to its ability to resist killing by common disinfectants while remaining viable for months, mostly due to biofilm formation. When C. auris becomes firmly entrenched on patient care equipment and environmental surfaces, it is nearly impossible to eradicate without a hospital-wide, sporicidal disinfectant with a kill-claim for C. auris and biofilm. 

This single, hospital-wide, sporicidal disinfectant should appear on both the U.S. Environmental Protection Agency’s P/K Lists to disinfect computers on wheels, mobile radiology equipment, glucose meters, walkers, wheelchairs, stretchers, patient lifting equipment and other items rolling in and out of patient rooms. The nursing station, staff breakroom, pantry and other middle areas of patient care divisions also should be included in targeted disinfection at least once daily. 

Managers should consider one proactive protocol for isolation rooms: Although C. auris contaminated surfaces — think high-touch surfaces — are disinfected to a fit-for-purpose level during the daily patient room processing by the environmental services (EVS) technician, those surfaces should be disinfected a second time by EVS. Studies have proven that high-touch contamination rebounds within four-six hours after disinfection. 

One EVS technician educated about the way C. auris spreads in the environment, given the right disinfectant and the proper amount of time to do the task, will prevent more C. auris than a roomful of doctors can cure. 

J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is nationally recognized as a subject matter expert in infection prevention and control as it relates to cleaning. He is the owner and principal of Safe, Clean and Disinfected. His enterprise specializes in B2B consulting, webinar presentations, seminars and facility consulting services related to cleaning and disinfection. He can be reached at darrel@darrelhicks.com, or learn more at www.darrelhicks.com.