A Looming Threat: Candida Auris

Over the past year, our headlines have been dominated by COVID-19 and its effects on a global scale. But what if I told you that there is an even deadlier looming threat in healthcare facilities? Fungi can be found almost anywhere, whether that be in water or on dry surfaces or even in the human body. One fungus, in particular, has been ravaging hospitalized patients for about 5 years in the United States but has been put on the backburner due to the COVID-19 pandemic. It is now boiling over and leading to entire hospital units closing down to contain it. Candida auris is a dangerous fungus that is typically found in patients who are on broad-spectrum antibiotics or steroids, have co-morbidities like diabetes, or are intubated/placed on mechanical ventilation. We often think of a fungus as causing rust or even mold, but in the body it is detrimental. It has an estimated mortality rate of up to 72% and is resistant to normal anti-fungal therapies (Dyer 20). Candida species are known for causing urinary tract infections and are typically seen in patients with indwelling catheters, bloodstream infections, and pneumonia.  

Are you safe? Knowing the Risks and Understanding the Spread

In an ever-changing world, drug-resistant pathogens are preying on vulnerable patients in healthcare facilities across the globe. Normal and healthy Americans are relatively safe from this pathogen. However, individuals may be at risk if they suffer from other illnesses or have a weakened immune system. Due to the increased use of antibiotics and steroid medications, patients battling COVID-19 may be more vulnerable to C. auris per the CDC. A recent study performed in an ICU found that 15 COVID-19 infected patients developed severe fungal infections after being admitted to an ICU. A shocking 2/3 of the patients had positive cultures for C. auris and 60% of them succumbed to their infections during their hospital stays (Chowdhary 1).

Another risk with fungal infections like C. auris is that a patient may become colonized, meaning that the fungus is growing on their skin. They still shed and spread the fungus but might not develop an invasive infection until a later time. Simply touching the patient or an object that they have come in contact with, like a bedside table, might lead to another person contracting the fungus. Infection control is crucial in these cases.

Implementing effective infection control requires understanding underlying conditions and identifying potential correlations. To that end, California has been battling C. auris cases during the COVID-19 pandemic and the California Department of Public Health (CDPH) released data that found a possible link between COVID-19 and C. auris. The data collected throughout the SARS-CoV-2 pandemic thus far demonstrates a correlation of C. auris cases increasing or decreasing with the number of COVID-19 cases (Epson Slide 6). Presumably, this is because there was an increased number of patients admitted to the ICU. It is believed that the shortage of personal protective equipment (PPE) forcing healthcare personnel to reuse or wear their PPE longer, including between multiple patients, has contributed to the spread of fungal infections since pathogens can be carried on clothing. It is also important to note that C. auris is well known for contaminating medical equipment, such as pulse oximeters, blood pressure cuffs, ventilators, etc. During an outbreak in the UK, 7 infections stemmed from reusable thermometers (Eyre 1).

Hospitals are not the only places where cases are popping up. Acute care facilities, nursing homes, and long-term care facilities will often cause mini outbreaks while transferring patients in between each other without screening the patients before they leave. High touch point areas, such as bed rails, bedside tables, medical equipment, floors and chairs, can harbor deadly fungi for around two weeks. To make matters worse, this superbug is challenging to detect without specialty equipment because of its ability to mimic other types of yeast (CDPH 1).

HHP™ Technology And Candida Auris Disinfection

As the reach of C. auris widens, solutions must be found to limit the spread of this and other fungal infections. The staggering rates of infection are on the rise and 75,000 people in the United States are hospitalized by fungal infections each year (McKenna 1). If that was not astonishing enough, an additional 8.9 million cases are treated as outpatients (McKenna 1). Candida strains are typically resistant to multiple disinfectants and anti-fungal therapies, and containing an outbreak is challenging because of the two-week period that it can survive on surfaces (Dyer 20). Disinfection of every surface within patient rooms after an infected patient leaves is vital to preventing further contamination. According to Infection Control Today, “…hydrogen peroxide-based products are the most successful, so far, at reducing C. auris colony forming units” (Dyer 20). This is something CURIS System knows well. CURIS System devices and solution are dual registered with the EPA as a Hybrid Hydrogen Peroxide™ disinfection system.  The pair act as a sporicidal fogging disinfectant system and achieve a 99.9999% kill that is efficacious against Clostridium difficile, a hardier resistant organism, in a tri-part soil load.  CURIS System products can also be found on the EPA’s lists K and N for an effective environmental decontamination of SARS-CoV-2 and have been used extensively during this pandemic to treat COVID-19 wards around the country. The system’s popularity is due to its ability to reach every nook, cranny, and crevice where pathogens may hide, leaving nothing to chance.

Swabbing patient rooms after a confirmed case of C. auris is crucial to preventing the spread of the pathogen. The reuse of PPE without proper decontamination should be avoided if possible because this increases the chance of spreading any pathogens which may be carried. Patients transferring to high-risk facilities, like long-term care or nursing homes, should be tested for certain MDROs. This reduces the likelihood of causing another small outbreak. Making healthcare environments safer for patients is the key to stopping dangerous and drug-resistant organisms from spreading further.

To mitigate the spread of this dangerous pathogen, facilities can:

• incorporate a robust environmental swabbing protocol,
• implement a vetted PPE decontamination process,
• increase the appropriate labs on suspected patients, and
• work quickly to institute an efficacious and thorough Candida auris disinfection plan.

—by Alyssa DeLotte, CURIS Research Team

Dyer, Jan. “COVID-19 Is Able to Unleash 'Lurking Scourge' Candida Auris.” Infection Control Today, vol. 24, no. 10, Dec. 2010, pp. 20–22., https://www.infectioncontroltoday.com/view/covid-unleashes-the-lurking-scourge-candida-auris. 

Michelson, Andrea. “Deadly Fungi Are Becoming Drug-Resistant, and It's the next Big Public Health Threat, Experts Say.” Business Insider, Business Insider, 19 May 2021, www.businessinsider.com/deadly-drug-resistant-fungi-are-next-big-public-health-threat-2021-5. 

Eyre DW, Sheppard AE, Madder H, et al. A Candida auris outbreak and its control in an intensive care setting. N Engl J Med. 2018; 379:1322-1331.

McKenna, Maryn. “Deadly Fungi Are the Newest Emerging Microbe Threat All Over the World.” Scientific American, Scientific American, 1 June 2021, www.scientificamerican.com/article/deadly-fungi-are-the-newest-emerging-microbe-threat-all-over-the-world/. 

Epson, Erin. “Containment of Candida Auris and Other Multidrug-Resistant Organisms (MDRO) in the Context of COVID-19.” California Department of Public Health, California Department of Public Health, 1 Sept. 2020, www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/COVID-19_MDRO_All_Facilitis_090120_V3_EE.pdf. 

“Candida Auris Quicksheet – Interim.” California Department of Public Health, HAI Program, July 2020, www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/C%20auris%20Quicksheet_Interim_070720_ADA.pdf. 

“Multidrug-Resistant Candida Auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020 - Volume 26, Number 11-November 2020 - Emerging Infectious Diseases Journal - CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Nov. 2020, wwwnc.cdc.gov/eid/article/26/11/20-3504_article. 

Schelenz S, Hagen F, Rhodes JL, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control. 2016;5:35–41.

“Medications that Weaken Your Immune System and Fungal Infections.” CDC website https://www.cdc.gov/fungal/infections/immune-system.html

Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April-July 2020. Emerg Infect Dis. 2020 Nov;26(11):2694-2696. doi: 10.3201/eid2611.203504. Epub 2020 Aug 27. PMID: 32852265; PMCID: PMC7588547.