Candida Auris: 5 Infection Control Guidelines for Bedside Nurses

Arleen Veloria, BSN, RN

Candida auris is an emerging strain of fungus that has caused outbreaks in healthcare settings and is spreading rapidly across the U.S. Bedside nurses have critical roles in containing the spread of this deadly pathogen. Here are five guidelines to help with infection control.

What is Candida auris, and why is it deadly for patients?

Candida auris is a strain of fungus perceived as a serious global health threat. In the U.S., clinical cases increased from 476 in 2019 to 1,471 in 2021.

C. auris infections remain difficult to treat and control because:

It is resistant to multiple antifungal medications.
Laboratories have difficulty detecting this fungus due to standard testing methods often mistaking C. auris for other strains of yeast.
Healthcare facilities have poor infection control protocols.

Signs and symptoms of C. auris infection include fever and chills that do not subside with antibiotics or standard antifungal drugs. Once a vulnerable patient is infected, the fungus can quickly spread to the bloodstream and vital organs, which can be deadly.

The most vulnerable are patients who:

Take immunosuppressants, such as corticosteroids
Have diabetes
Used antibiotics recently
Have invasive devices, including indwelling urinary catheters and central lines
Had an organ transplant
Have been in the hospital or nursing home for a long time

According to the Centers for Disease Control and Prevention (CDC), one in three patients infected with C. auris will die. Your role as a nurse is critical in containing the spread of this emerging pathogen. Here are five ways you can stop the spread.

Infection Control Guidelines for Nurses

1. Practice good hand hygiene.

Good hand hygiene remains the gold standard for all infection control efforts. Use an alcohol-based hand sanitizer if your hands are not visibly soiled, and wash your hands thoroughly with soap and water for at least 20 seconds if they are visibly soiled. You can also rub your hands with an alcohol-based hand sanitizer after washing your hands. Remember: using gloves is not a replacement for good hand hygiene.

2. Implement Contact Precautions.

The CDC recommends using Contact Precautions to manage patients with C. auris, which can spread through direct or indirect contact with a patient or their environment. Gloves and gowns provide an extra barrier between you and your patients.

Make sure alcohol-based hand sanitizer, gowns, gloves, and other essential supplies are easily accessible for anyone entering your patients' rooms. Hang the appropriate sign for Contact Precautions near the entrance to the rooms for everyone to see.

Keep your patients with C. auris on Contact Precautions for the entire length of their hospital stay, even though they may no longer be showing any signs or symptoms of infection.

3. Disinfect contaminated surfaces and equipment regularly.

C. auris can live on surfaces for several weeks. Regularly disinfect all surfaces and equipment that may have come into contact with your patient, such as:

Tray tables
Hospital beds and bed rails
Vital signs machines
Glucometers
Thermometers
Call lights
Other reusable and shareable supplies and equipment

If possible, try not to share equipment between patients who are infected and patients who are most vulnerable.

For disinfection, you can use chlorine-based products, such as CaviWipes and household bleach. Click here for the Environmental Protection Agency's full list of approved disinfectants against C. auris.

Assign roles and provide training on proper cleaning procedures. Additionally, inform all hospital staff on who is responsible for cleaning reusable equipment. Across numerous investigations, the CDC has found that hospital personnel are often unaware of who should be cleaning equipment and how the equipment should be cleaned.

4. Clearly communicate C. auris infection during handoff.

When performing handoff or turnover to another nurse, unit, or facility, highlight your patient's C. auris infection and include essential infection control guidelines in your report.

You can also use appropriate tools to facilitate clear communication during transfers, such as standardized Transfer Forms that go on top of the patient's chart.

5. Educate others on infection control protocols.

Not everyone may understand infection control concepts. Be prepared to teach non-healthcare personnel who may come into direct or indirect contact with your patient, such as:

Family members
Other visitors
Social workers
Dietary staff
Housekeeping
Patient transport teams

Follow these basic guidelines, and consult an Infectious Disease specialist at your workplace if you have any specific questions regarding your patient's plan of care.

Do you have any experience with Candida auris in your workplace? What are other ways nurses can help with infection control?

Key Takeaways

Candida auris is an emerging strain of fungus that is resistant to multiple antifungal medications.
Candida auris is difficult to identify in laboratories using standard testing methods, and it is often mistaken for other strains of yeast, which contributes to ineffective medical management.
Candida auris has caused outbreaks in healthcare settings and is spreading rapidly across hospitals and acute care settings in the United States. Most hospitals have poor infection control protocols for this pathogen.
As a nurse, you have an essential role in implementing and enforcing proper infection control guidelines.
Infection control guidelines include: 1) practicing good hand hygiene, 2) implementing Contact Precautions, 3) regularly disinfecting the patient environment using household bleach, CaviWipes, or other approved disinfectants, 4) communicating clearly during turnover, and 5) educating others on infection control protocols.