Similar to other multidrug-resistant organisms (MDROs), C. auris spreads easily in healthcare settings and can cause outbreaks. C. auris can colonize patients for many months, persist on surfaces, and is not killed by some commonly used healthcare facility disinfectants. Hand hygiene, appropriate precautions, and environmental disinfection prevent and control outbreaks.
Summary of recommendations
The primary infection control measures for prevention of C. auris transmission in healthcare settings are:
- Hand hygiene.
- Setting-based precautions.
- Environmental disinfection with product effective against C. auris.
- Patient transfers that communicate patient's C. auris status.
Environmental disinfection
C. auris can persist on surfaces in healthcare settings. C. auris has been cultured from multiple locations in patient rooms. The fungus has been found on both high-touch surfaces, such as bedside tables and bedrails, and surfaces farther away from the patient, such as windowsills.
Surface Disinfectants
Several common hospital disinfectants are not effective against C. auris. Some products with C. albicans or fungicidal claims may not be effective against C. auris. Accumulating data indicate that products solely dependent on quaternary ammonia compounds (QACs) are NOT effective.
Products with EPA-registered claims for C. auris (List P)
CDC recommends using an Environmental Protection Agency (EPA)–registered hospital-grade disinfectant effective against C. auris. See EPA's List P for a current list of EPA-approved products for C. auris.
If the products on List P are not accessible or otherwise suitable, facilities may use an EPA-registered hospital-grade disinfectant effective against C. difficile spores (List K).
It is important to follow all manufacturer's directions for use, including applying the product for the correct contact time for all products.
“No-touch” devices
Research about disinfection effective against C. auris is ongoing. Data on "no-touch" devices, such as germicidal UV irradiation and vaporized hydrogen peroxide, are limited. The parameters required for effective disinfection are not yet well understood. These methods should only be used as a supplement to standard cleaning and disinfection methods.
Thorough routine and terminal discharge
Perform thorough routine (at least daily) and terminal cleaning and disinfection of patients' rooms and areas where patients receive care. Appropriately disinfect radiology, physical therapy, and other areas of the hospital patients may have visited.
Mobile and reusable equipment
Medical equipment that is shared between patients can spread C. auris. Clean and disinfect equipment after each use. Label disinfected equipment and separate it from dirty equipment.
- Examples include:Glucometers
- Temperature probes
- Blood pressure cuffs
- Ultrasound machines
- Nursing carts
- Ventilators
- Physical therapy equipment
Responsibilities for cleaning all mobile and reusable equipment should be well-established. Healthcare personnel should be aware of which equipment they are responsible to clean and trained in disinfection methods.
Hand hygiene
When caring for patients with C. auris, healthcare providers should follow standard hand hygiene practices. Alcohol-based hand sanitizer is preferred for C. auris when hands are not visibly soiled. If hands are visibly soiled, wash with soap and water. Wearing gloves is not a substitute for hand hygiene.
Transmission-Based and Enhanced Barrier Precautions
The Transmission-Based Precautions and Enhanced Barrier Precautions for C. auris are similar to those used for other multidrug-resistant organisms (MDROs). In most instances, facilities equipped to care for patients with other MDROs or Clostridioides difficile can also care for patients with C. auris.
In acute care and long-term acute care hospitals, healthcare providers should use Contact Precautions. In nursing homes and skilled nursing facilities, healthcare providers should use either Contact Precautions or Enhanced Barrier Precautions (EBP), based on the situation and local or state jurisdiction recommendations.
Refer to the CDC Guidance on Enhanced Barrier Precautions for more details about when Contact Precautions versus Enhanced Barrier Precautions would apply.
Considerations for patient room placement
Hospitals and nursing homes
Patients on Contact Precautions should be placed in a single-patient room whenever possible. In situations where limited single-rooms are available, prioritize placing patients with higher likelihood of transmission (such as those with uncontained secretions or excretions, diarrhea, and draining wounds).
Facilities can group C. auris patients together in a dedicated unit or part of a unit. This decreases movement of healthcare personnel and equipment to non-affected areas. Facilities could also consider dedicating healthcare personnel (e.g., nurses, nursing assistants) who provide regular care to these patients during a shift.
In nursing homes, facilities with the capacity may consider placing patients with C. auris in single-patient rooms. Healthcare providers can find recommendations about patient placement in nursing homes using Enhanced Barrier Precautions (EBP) in CDC's FAQs about Enhanced Barrier Precautions in Nursing Homes.
When single rooms are not available, facilities may choose to cohort patients with C. auris together in the same room. It is preferable to cohort patients with the same MDROs together. However, facilities may assign rooms based on single (or a limited number of) high-concern MDROs (e.g., C. auris or carbapenemase-producing Enterobacterales) without regard to co-colonizing organisms.
Reducing transmission in cohort settings
Facilities must implement strategies to help minimize transmission between roommates when patients are placed in shared rooms. The following strategies apply for all shared rooms, regardless of patient colonization or infection status:
- Maintain separation of at least 3 feet between beds.
- Use privacy curtains to limit direct contact.
- Clean and disinfect as if each bed area were a different room.
- Clean and disinfect any shared or reusable equipment.
- Change mopheads, cleaning cloths, and other cleaning equipment between bed areas.
- Clean and disinfect environmental surfaces on a more frequent schedule.
- Have healthcare personnel change personal protective equipment (if worn), including gloves.
- Perform hand hygiene before and after interaction with each roommate.
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