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What new CDC data means for Canadian facilities

Cases of Candida auris (C. auris) are rising at an “alarming rate” in the U.S., says the Centers for Disease Control and Prevention (CDC). According to the latest CDC data, the multi-drug resistant fungus poses an urgent public health threat, causing outbreaks and long-term endemic disease in affected healthcare facilities. With rising cases in our country as well, Canadian leadership in infection control needs to be proactive in environmental cleaning strategies.¹

C. auris on the rise in the US …

C. auris is a unique Candida species because it behaves more like a bacteria than a yeast. Its multidrug resistance (the majority of C. auris isolates are resistant to fluconazole as well as other antifungals), indefinite colonization with no proven decolonization method and its persistence allows it to spread easily via contact with affected patients and contaminated surfaces or equipment.^1-3

Clinical cases in the U.S. (in which infection is present) have increased each year since 2016, with the most rapid rise occurring during 2020-2021. Screening cases (in which the fungus is detected but not causing infection) tripled from 2020 to 2021, for a total of 4,041.^1,5 CDC has continued to see an increase in U.S. case counts for 2022, with at least 2,377 confirmed cases – a sharp jump from the 1,474 cases in 2021 and just 757 confirmed cases in 2020. ^1,5

… and raising concerns in Canada

In Canada, the Public Health Agency of Canada (PHAC) says that the global outbreaks have increased concerns about the impacts of C. auris in Canadian healthcare settings. As a result, the PHAC made updates to the 2017 PHAC C. auris interim recommendations (see below). Mortality rates of invasive C. auris infections are estimated to be greater than 40%, which is like other drug-resistant organisms.⁴ Data from the National Microbiology Laboratory (NML) and Canadian Nosocomial Infection Surveillance Program (CNISP) indicate that 31 cases of C. auris have been isolated from hospitalized patients in 6 Canadian provinces between 2012 and 2021. This includes both infected and colonized cases.⁴

Learn the basics about C. auris

What is C. auris?

• It is a type of yeast that can cause infections anywhere in the body, including severe invasive infections of the bloodstream.⁷

To get up to speed on C. auris, read our blog Facts about Candida auris.

Infection control measures for C. auris

In December 2022, the PHAC updated the following interim recommendations for C. auris infection prevention in healthcare settings including hospitals and LTC homes. They are summarized below:⁴

1. Routine patient care practices, including hand hygiene, are always required.
2. Patients being admitted should be placed on pre-emptive Contact Precautions (CP) and screened for C. auris if they have been admitted to a facility outside of Canada (including in the US) within the prior 12 months or transferred from a Canadian healthcare facility with an ongoing C. auris outbreak (if known).
3. C. auris screening should include a single bilateral swab of a patient’s axilla and groin. Single swabs of previously colonized or clinically relevant sites may also be indicated.
4. Patients suspected or confirmed to be positive for C. auris (and those identified as colonized or infected) should be cared for in a private room (with a dedicated washroom or commode) on CP with gowns and gloves.
5. When a previously unknown C. auris colonization or infection is identified in a patient not already on CP:
   1. All close patient contacts prior to the identification should be placed in a private room on pre-emptive CP and have specimens collected to test for C. auris. Screened close patient contacts should remain on CP until cleared by infection prevention and control.
   1. Ward or unit mates who are not close contacts should have point prevalence testing.
6. When a new C. aurisinfection or colonization is identified in a patient, request species-level identification on all isolates that would normally be reported as Candida for a limited period.
7. Single use and disposable patient care supplies should be used for a patient with C. auris whenever possible. Reusable, non-critical patient care equipment and supplies should be dedicated to the patient for the duration of their admission and appropriately cleaned and disinfected prior to use on another patient.
8. Environmental cleaning and disinfection of a room of a patient with C. auris should be done using Health Canada approved hospital or healthcare disinfectants with claims of efficacy against C. auris [with drug identification numbers (DIN)].
9. Terminal cleaning of the patient equipment and environment, including the removal and cleaning of hospital linens and privacy curtains, should be done upon patient discharge or transfer.

Transfer of patients colonized or infected with C. auris within or between facilities should be avoided unless medically necessary. The receiving unit, department or facility must be notified in advance.

C. auris can persist for weeks on surfaces in healthcare environments, including portable medical equipment.^2,4

Effective cleaning and disinfection of surfaces can help reduce the risk

Public Health Ontario (PHO) reports that in vitro data suggest that both sodium hypochlorite and improved hydrogen peroxide (0.5%, 1.4%) are effective agents against C. auris while on hard non-porous surfaces quaternary ammonium compounds are not.²

Clorox Healthcare^™ disinfectants meet infection control guidelines issued by the PIDAC and APIC, and the following products are registered by Health Canada to be effective against the spread of C. auris on hard non-porous surfaces, when used as directed:⁸

1. Clorox Healthcare™ Hydrogen Peroxide Wipes, DIN 02406225 – 3 Minute Contact Time
2. Clorox Healthcare™ Hydrogen Peroxide Cleaner Disinfectant DIN 02403528 – 3 Minute Contact Time

See kill times for Clorox^®products that fight C. auris.⁸

References

1. Lyman M, et al. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med. 2023;10.7326/M22-3469. https://www.acpjournals.org/doi/abs/10.7326/M22-3469?journalCode=aim. Accessed March 29, 2023
2. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Interim guide for infection prevention and control of Candida auris. Toronto, ON: Queen’s Printer for Ontario; 2019.
3. Centers for Disease Control and Prevention. Candida auris: Candida auris. https://www.cdc.gov/fungal/candida-auris/index.html. Accessed March 30, 2023.
4. Public Health Agency of Canada Communication Notice: Candida auris interim recommendations for infection prevention and control. Emerging global healthcare associated infection antimicrobial resistant issue Candida auris. https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/notice-candida-auris-interim-recommendations-infection-prevention-control.html. Accessed March 29, 2023.
5. Neukam, S. “CDC study warns of ‘dramatic increase’ in deadly fungus across US” The Hill. https://thehill.com/policy/healthcare/3909575-cdc-study-warns-of-dramatic-increase-in-deadly-fungus-across-us/. Accessed March 29, 2023.
6. Centers for Disease Control and Prevention. Candida auris: Tacking Candida auris. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html. Accessed March 29, 2023.
7. CloroxPro. What is the Candida auris (C. auris) superbug? https://www.cloroxpro.com/resource-center/candida-auris/. Accessed June 28, 2022.
8. CloroxPro . Candida auris pathogen education sheet. https://www.cloroxpro.com/resource-center/candida-auris-pathogen-info-sheet/. Accessed June 28, 2022.
9. CloroxPro Canada. Rethink bleach. https://www.cloroxpro.ca/blog/rethink-bleach/. Accessed June 28, 2022.