Health Advisory: Candida auris identified in Snohomish and other counties

January 31, 2024

Action Requested 

• Be aware that several locally acquired cases of Candida auris (C. auris) have been recently identified in multiple counties, including Snohomish and King counties.

• A King County long-term acute care hospital (LTACH) has identified an outbreak involving multiple patients with C.auris. Two of those patients also received care at facilities in Snohomish County, and the Snohomish County Health Department is working with two facilities in the county on screening and infection prevention. No C. auris deaths have been reported. 
• Facilities should screen for C. auris patients who are currently admitted and had a prior admission at Kindred Hospital Seattle – First Hill since October 1, 2023. 
  • Out of an abundance of caution, healthcare facilities can consider screening more broadly as resources allow to include patients with a stay at Kindred since June 1, 2023, or at other LTACHs or ventilator-capable Skilled Nursing Facilities (vSNF). If screening is performed, transmission-based precautions should be implemented.

• Coordinate screening for facilities in Snohomish County with the Snohomish County Health Department. Call 425-339-3503 to reach the Communicable Disease program by phone.
• The Washington State Department of Health recommends that ventilator capable skilled nursing facilities in Washington screen their current patients for C. auris using DOH-provided free testing.
• Other healthcare facilities should identify high-risk exposures in newly admitted patients and consider C. auris screening for those who have had: 
  • Close contact in a healthcare setting to someone diagnosed with C. auris or a carbapenemase-producing organism (CPO) infection or colonization. Close contact may include: 
    • Sharing a room, bathroom, or patient care equipment
    • Being cared for by the same healthcare staff
    • Staying in a room near a person with C. auris or CPO
  • Direct admission from a ventilator-capable skilled nursing facility (vSNF) or a long-term acute care hospital (LTACH)
  • Colonization or infection with a CPO
  • An overnight stay in the prior year in a healthcare facility: 
    • Outside the U.S., or
    • In a region of the U.S. with a high burden of C. auris cases

• Be aware that C. auris can be misidentified through commercial laboratory testing and specific technology is needed for correct identification.  

• Report any suspected or confirmed cases or outbreaks in Snohomish County to the Snohomish County Health Department.
  • Call 425-339-3503 to reach the Communicable Disease program by phone.
  • Please complete and fax the Communicable Disease Report Form (PDF) and any accompanying lab reports to 425-339-8706. 
• Ensure adherence to CDC recommendations for infection control for patients with suspected or confirmed C. auris, including immediately: 
  • Placing patients infected or colonized with C. auris on Transmission-Based Precautions and, whenever possible, in a single room.  
  • Making sure gown and gloves are accessible and used appropriately. 
  • Reinforcing hand hygiene.
  • Ensure appropriate cleaning and disinfection, using an Environmental Protection Agency (EPA) List P (or List K) product.

Background

On January 22, 2024, an outbreak involving 3 patients colonized with C. auris was reported in a long-term acute care hospital in King County. On January 26, an additional patient colonized with C. auris was reported in a skilled nursing facility in Snohomish County. One other locally acquired C. auris colonized patient was reported in Washington in July 2023. In addition to these patients, Public Health is aware of at least 5 other patients who acquired their C. auris colonization outside of Washington and have since received healthcare in Washington.

C. auris is an emerging fungus that was first reported in 2009 in Japan and has spread globally. When causing infection, it is a life-threatening, highly transmissible, often multidrug resistant yeast that can cause difficult to control healthcare outbreaks among vulnerable patients. Based on information from a limited number of patients, more than 1 in 3 people with C. auris infections have died. Patients needing long term acute care and indwelling medical devices are at the highest risk for acquisition, and once colonized, for infection.

Since 2022, DOH has provided free screening to certain patients who are at higher risk for C. auris and other highly antibiotic resistant organisms through the Partners for Patient Safety Program. The locally acquired C. auris cases in Washington have been identified through this program. DOH released a prior health advisory in July 2023 with C. auris infection prevention guidance.

Resources

• Candida auris | Washington State Department of Health
• Testing information: ARLN Lab Test Menu | Washington State Department of Health
• List P: Antimicrobial Products Registered with EPA for Claims Against Candida Auris | US EPA
• Information for Laboratorians and Health Professionals | Candida auris | Fungal Diseases | CDC
• About Candida auris (C. auris) | Candida auris | Fungal Diseases | CDC