CloroxPro Blog – Professional Cleaning and Disinfection Insights

What you need to know about this emerging pathogen

Candida auris (C. auris)is an emerging fungal pathogen capable of causing invasive disease, particularly in critically ill patient populations.¹ Since the first case reported in Japan in 2009, C. auris has spread around the world resulting in difficult to control hospital outbreaks and long-term endemic disease in affected facilities. The majority of C. auris isolates are resistant to fluconazole as well as other antifungals, which makes environmental cleaning a necessary priority for healthcare leadership. ¹

C. auris in Canada and the U.S.

In Canada, the first known case of multidrug-resistant C. auris was reported in 2017.² While accurate data on its incidence in Canada are not available, there have been identified cases across the country, with the overall burden likely to increase over time.¹ In the U.S. between June 1, 2021 and May 31, 2022, 1,631 clinical cases of C. auris have been identified in health care facilities in 24 states including NY, OH, IL, MN, CA and OR.³

C. auris transmits rapidly within the healthcare setting

In 2019, Public Health Ontario (PHO) published an Interim guide for infection prevention and control of C. auris., which stated “the identification of a single case is a sentinel event that should trigger a full investigation, and the identification of two cases—even if they are on different units and present months apart—should be considered an outbreak even if no direct linkage between cases is apparent. For all C. auris outbreaks, advice from infection prevention and control experts with experience managing outbreaks should be sought.”¹

One facility documented transmission between patients based on exposures as short as 4 hours¹—which is one reason why a report published by The Public Health Agency of Canada advised that rooms where C. auris infected or colonized patients are isolating should be cleaned daily with sporicidal disinfectants.² 

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.⁴

What types of infections can it cause?

• C. auris can cause bloodstream infections, wound infections, and ear infections.⁵ C. auris has also been detected in respiratory and urine samples, but it is currently not known if it causes infections of the lungs or bladder.⁵

What are the symptoms of C. auris infection?

• The symptoms of C. auris infection vary, and depend on the part of the body that is infected.⁴

How does C. auris spread?

• Person-to-person contact and through contaminated surfaces or equipment

C. auris can be hard to identify using standard laboratory testing and is often misidentified. ^1,4

Infection control measures for C. auris

In light of the discovery of C. auris in Canada, the Public Health Agency of Canada (PHAC) has issued the following interim recommendations for infection prevention in healthcare settings:⁷

1. Consistent application of routine practices for all patients.
2. C. auris patients (suspected or confirmed) should be cared for in a single room. Take additional contact precautions for these patients.
3. Reusable non-critical patient care equipment should be used only for the patient with C. auris and cleaned and disinfected before being used on another patient.
4. All equipment and supplies should be identified and stored in a manner that prevents use by or for other patients.
5. Cleaning and disinfection of the patient environment should be done with chlorine-containing cleaning agents (at least 1,000 ppm) or other sporicidal agents.
6. Frequently touched surfaces, and all horizontal surfaces, should be cleaned at least twice daily and when soiled.
7. Terminal cleaning of the patient environment, including the removal and cleaning of the privacy curtains, should be done upon discharge or discontinuation of contact precautions.
8. Duration of contact precautions should be determined in conjunction with the infection prevention and control professional or delegate.
9. Transfer of patients within and between facilities should be avoided unless medically indicated. If a medically indicated transfer is unavoidable, the transferring service, receiving unit, or facility or home care agency should be advised of the necessary precautions.
10. Additional infection prevention and control strategies will be required if transmission within the healthcare setting is identified.

C. auris can persist for weeks on surfaces in healthcare environments, including portable medical equipment.⁸

Effective cleaning and disinfection can help reduce the risk

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 quaternary ammonium compounds are not.¹

Clorox Healthcare^™ disinfectants meet infection control guidelines issued by the PIDAC and APIC, and the following products are approved by Health Canada to prevent the spread of C. auris:⁶

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

Find out more about the Clorox^® products with claims against C. auris.⁶

References

1. 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.
2. Schwartz IS et al. Something wicked this way comes: What healthcare providers need to know about Candida auris. an Commun Dis Rep 2018;44(11):271-76.
3. Centers for Disease Control and Prevention. Tracking Candida auris. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html. Accessed Aug 10, 2022.  
4. CloroxPro. What is the Candida auris (C. auris superbug? https://www.cloroxpro.com/resource-center/candida-auris/. Accessed June 28, 2022.
5. Centers for Disease Control and Prevention. General information about Candida auris. https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html. Accessed June 28, 2022.
6. CloroxPro . Candida auris pathogen education sheet. https://www.cloroxpro.com/resource-center/candida-auris-pathogen-info-sheet/. Accessed June 28, 2022.
7. Public Health Agency of Canada Communication Notice. Emerging global healthcare associated infection antimicrobial resistant issue Candida auris. https://ipac-canada.org/photos/custom/Members/pdf/July%206_PHAC%20notice_Candida%20auris%20-%20V3.pdf. Accessed June 28, 2022.
8. CloroxPro Canada. Rethink bleach. https://www.cloroxpro.ca/blog/rethink-bleach/. Accessed June 28, 2022.