“Emerging fungus” Candida auris is causing severe illness in hospitals in the Americas, Africa, Asia and Europe. What can FMs do to help combat it?

by Brianna Crandall — August 28, 2017 — There is a newly developing healthcare concern that facilities managers (FMs) need to be aware of and prepared to help combat. According to the U.S. Centers for Disease Control and Prevention (CDC), Candida auris (C. auris) is an emerging pathogen that presents a serious global health threat. Healthcare facilities in several countries have reported that the C. auris yeast has caused severe illness and many times death in hospitalized patients of all ages, particularly in those with compromised immune systems.

Also known as “Japanese fungus,” since it was first identified in Japan in 2009, Candida auris has been reported in at least a dozen countries since then, including Canada, Colombia, Germany, India, Israel, Japan, Kenya, Kuwait, Norway, Pakistan, Spain, South Africa, South Korea, the United Kingdom, and Venezuela, as well as the United States.

CDC researchers surmise that it was not spread from country to country, but emerged independently in multiple regions at roughly the same time. The first C. auris case was recognized in the United States in November 2016, and there were 112 cases reported as of July 31, 2017, primarily in New York and New Jersey.

An August 14 article in The Telegraph illustrates the severity of the C. auris situation in the U.K.: more than 200 patients in at least 55 U.K. hospitals and nursing homes have been infected with the C. auris fungus. London has reportedly been the worst affected, with the first and largest outbreak in Europe.

Another August 14 article in the STAT health news publication illustrates the difficulty of eradicating the fungus: since neither enhanced cleaning nor segregating infected patients stopped the dangerous fungus from spreading in the U.K.’s Royal Brompton Hospital, the hospital was finally forced to temporarily shut its ICU. This appears to have put a stop to the more than year-long outbreak involving over 50 patients. The publication warns that U.S. hospitals may be facing the same situation.

“Almost a perfect storm”

Dr. Alex Kallen of the CDC called it “almost a perfect storm kind of organism,” with “all the bad characteristics of a large number of bad pathogens.” Of particular concern, some strains of C. auris are resistant to all three major classes of antifungal drugs, which CDC says has not been seen before in other species of Candida. Also of concern, C. auris can persist on surfaces in healthcare environments and spread between patients in healthcare facilities, potentially causing large outbreaks. On top of that, the fungus is difficult to identify with standard laboratory methods.

To help healthcare providers and facilities professionals know what to do, CDC has developed identification, treatment, and infection control recommendations to help prevent the spread of Candida auris.

What can FMs do?

CDC’s Infection Control guidelines include an “Environmental Disinfection” section for those in charge of cleaning and disinfecting healthcare facilities.

According to the guidelines, Candida auris can persist on surfaces in healthcare environments, and quaternary ammonia products that are routinely used for disinfection may not be effective against C. auris. CDC recommends use of an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against Clostridium difficile (C. diff) spores (List K). It is important to follow all manufacturers’ directions for use of the surface disinfectant, including applying the product for the correct contact time, reminds CDC.

Thorough daily and terminal cleaning and disinfection of patients’ rooms and cleaning and disinfection of areas outside of their rooms where they receive care (e.g., radiology, physical therapy) is necessary. Shared equipment (e.g., ventilators, physical therapy equipment) should also be cleaned and disinfected before being used by another patient.

For further information, see the CDC’s Candida auris Web page, which includes a map of Candida auris cases in the United States and the CDC guidelines for infection control. The Telegraph and STAT articles mentioned above give helpful explanations, particularly in regards to the situation in the U.K.

CDC encourages all U.S. laboratory staff who identify C. auris to notify their state or local public health authorities and CDC at candidaauris@cdc.gov.