{"id":851,"date":"2021-05-07T12:36:11","date_gmt":"2021-05-07T12:36:11","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/clinicians\/?page_id=851"},"modified":"2022-05-23T20:42:02","modified_gmt":"2022-05-23T20:42:02","slug":"candida-auris-cases-are-on-the-rise-in-virginia","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/clinicians\/candida-auris-cases-are-on-the-rise-in-virginia\/","title":{"rendered":"Candida auris Cases are on the Rise in Virginia"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-1162\" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/2022\/05\/Letterhead-Oliver-2019-1.png\" alt=\"\" width=\"1692\" height=\"480\" \/><\/p>\n<p style=\"text-align: center\"><strong><em>Candida auris<\/em><\/strong><strong> Cases are on the Rise in Virginia<\/strong><\/p>\n<p style=\"text-align: center\">May 7, 2021<\/p>\n<p>Dear Colleague:<strong>\u00a0<\/strong><\/p>\n<p><strong>Key Messages <\/strong><\/p>\n<ul>\n<li>The Virginia Department of Health (VDH) is reporting a statistically significant increase in <em>Candida auris<\/em> (<em>C. auris<\/em>) cases over the past 10 months in multiple regions of Virginia and in multiple types of healthcare facilities. Between September 2018 and June 2020, only three cases of <em>C. auris<\/em> were identified in Virginia.\u00a0 Since the beginning of July 2020, 37 cases have been identified (Figure 1).<\/li>\n<li><em>C. auris<\/em> is an emerging fungus that is often resistant to antifungal drugs used to treat <em>Candida<\/em> infections and is difficult to identify with standard laboratory methods.<\/li>\n<li>All healthcare professionals, inpatient and outpatient, should take measures to prevent the spread of <em>C<\/em>. <em>auris<\/em> as recommended in the <a href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/candida-auris\/\">VDH August 2019 Clinician Letter. <\/a><\/li>\n<li>Patients at highest risk for <em>C<\/em>. <em>auris<\/em> colonization are those who reside in or who have had prolonged admissions to high-risk healthcare facilities (particularly long-term acute care hospitals or ventilator skilled nursing facilities) or have had recent international healthcare exposure.<\/li>\n<\/ul>\n<p><strong>Situation<br \/>\n<\/strong><em>C. auris<\/em> is an emerging fungus that presents a serious global health threat. It is often resistant to antifungal drugs used to treat <em>Candida<\/em> infections, is difficult to identify with standard laboratory methods, and can cause outbreaks in healthcare settings that have resulted in high mortality rates.<\/p>\n<p>VDH is seeing a substantial increase in the number of new <em>C. auris<\/em> cases in healthcare facilities in Virginia (Figure 1). Surrounding jurisdictions, including Maryland, <a href=\"https:\/\/www.health.pa.gov\/topics\/Documents\/HAN\/2020-PAHAN-522-08-18-ALT-Candida%20aur.pdf\">Pennsylvania<\/a>, and the <a href=\"https:\/\/dchealth.dc.gov\/sites\/default\/files\/dc\/sites\/doh\/publication\/attachments\/C.%20auris_HAN_2021.04.07_FINAL.pdf\">District of Columbia<\/a>, are also experiencing <a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/tracking-c-auris.html\">increases in cases<\/a>. Multidrug resistant organisms (MDRO) such as <em>C. auris<\/em> or carbapenem-resistant Enterobacteriaceae (CRE) may be spreading due to personal protective equipment (PPE) conservation strategies and other COVID-19 containment practices, particularly in long-term care facilities. Containment of MDROs among patients and residents is critical during the COVID-19 response to prevent concurrent outbreaks and additional spread across the Commonwealth.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-852\" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/2021\/05\/clinician-letter-image.png\" alt=\"\" width=\"978\" height=\"463\" srcset=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/2021\/05\/clinician-letter-image.png 978w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/2021\/05\/clinician-letter-image-300x142.png 300w, https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/134\/2021\/05\/clinician-letter-image-768x364.png 768w\" sizes=\"auto, (max-width: 978px) 100vw, 978px\" \/><\/p>\n<p>*Data reported to VDH as of May 3, 2021<\/p>\n<p><strong>Actions Requested <\/strong><\/p>\n<p><em>Infection Prevention and Control<\/em><\/p>\n<ul>\n<li>Cohort patients by MDRO status and COVID-19 status.<\/li>\n<li>Do not reuse gloves and gowns between patients with different (or unknown) MDRO and COVID-19 status.<\/li>\n<li>Place all suspected or confirmed <em>C.<\/em> <em>auris<\/em> cases on contact precautions. The same infection control precautions are recommended for patients with <em>C. auris<\/em> infection and colonization. See <a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/c-auris-infection-control.html\">CDC\u2019s C. auris Infection Prevention and Control Measures<\/a>.<\/li>\n<li>Use an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against <em>C<\/em>. <em>auris<\/em> (<a href=\"https:\/\/www.epa.gov\/pesticide-registration\/list-k-epas-registered-antimicrobial-products-effective-against-clostridium\">List K<\/a> or <a href=\"https:\/\/www.epa.gov\/pesticide-registration\/selected-epa-registered-disinfectants#candida-auris\">EPA-claim<\/a>) to disinfect the rooms of and any shared equipment used by confirmed, presumptive, or suspect <em>C. auris<\/em>-positive residents.\n<ul>\n<li>Consider doing this universally in facilities with patients with or at high-risk for <em>C.<\/em> <em>auris<\/em> and in units of confirmed or high-risk patients.\n<ul>\n<li>Examples of high-risk patients include patients with tracheostomies, those who are ventilator dependent, those colonized with other MDROs, or those who have recently received antibiotics or antifungals<\/li>\n<\/ul>\n<\/li>\n<li>Continue to implement other MDRO containment practices including:\n<ul>\n<li>Perform hand hygiene before putting on PPE, after removing PPE, before and after patient contact, and after contact with the patient&#8217;s immediate surroundings.<\/li>\n<li>Perform routine cleaning and disinfection of surfaces and shared medical equipment with an EPA-registered hospital-grade disinfectant effective against <em>C<\/em>. <em>auris<\/em> (<a href=\"https:\/\/www.epa.gov\/pesticide-registration\/list-k-epas-registered-antimicrobial-products-effective-against-clostridium\">List K<\/a> or <a href=\"https:\/\/www.epa.gov\/pesticide-registration\/selected-epa-registered-disinfectants#candida-auris\">EPA-claim<\/a>), COVID-19 (<a href=\"https:\/\/www.epa.gov\/pesticide-registration\/list-n-disinfectants-coronavirus-covid-19\">List N<\/a>), and\/or <a href=\"https:\/\/www.epa.gov\/pesticide-registration\/selected-epa-registered-disinfectants#pathogens\">other pathogens <\/a><a href=\"https:\/\/www.epa.gov\/pesticide-registration\/selected-epa-registered-disinfectants#pathogens\">according to the manufacturer\u2019s instructions<\/a>.<\/li>\n<li>Use checklists to identify who is responsible for cleaning each item and cleaning frequency (e.g. environmental services staff versus clinical staff).<\/li>\n<li>Educate staff on the appropriate infection prevention and control practices and the application of safety sciences.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><em>Communication<\/em><\/p>\n<ul>\n<li>Communicate a patient\u2019s MDRO status to any receiving healthcare facility. This is especially important so that patients with MDROs can be placed on appropriate precautions.<\/li>\n<li>Obtain patient history about any recent international healthcare exposure, exposure to <em>C. auris<\/em>, prior MDRO status, or stays in a healthcare facility with known transmission of <em>C. auris<\/em>.\n<ul>\n<li>Screen patients at high risk for <em>C.<\/em> <em>auris<\/em>. Place high risk patients on empiric contact precautions while test results are pending.<\/li>\n<li>If you need assistance determining screening criteria for high-risk or potentially exposed patients for <em>C.<\/em> <em>auris<\/em>, please contact VDH at <a href=\"mailto:hai@vdh.virginia.gov\">hai@vdh.virginia.gov<\/a> for assistance.<\/li>\n<\/ul>\n<\/li>\n<li>Report all suspected and confirmed <em>C.<\/em> <em>auris<\/em> cases to your <a href=\"https:\/\/www.vdh.virginia.gov\/local-health-districts\/\">local health department<\/a> per the <a href=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/13\/2018\/11\/Reportable_Disease_List.pdf\">Virginia Reportable Disease List<\/a>.<\/li>\n<\/ul>\n<p><em>Testing<\/em><\/p>\n<ul>\n<li><em>C. auris<\/em> can be <a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/pdf\/Testing-algorithm_by-Method_508.pdf\">misidentified as a number of other organisms<\/a> when using traditional biochemical methods for yeast identification. Labs should review the <a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/identification.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffungal%2Fcandida-auris%2Frecommendations.html#identify\">CDC\u2019s Identification of <\/a><a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/identification.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffungal%2Fcandida-auris%2Frecommendations.html#identify\"><em>Candida auris<\/em><\/a> recommendations. Therefore, it is important to confirm that your laboratory can detect <em>C. auris<\/em> or presumptive <em>C. auris<\/em>.<\/li>\n<li>As a provider, it is also important to recognize the importance of <em>C<\/em>. <em>auris<\/em> upon receipt of a lab report so that it is not inadvertently confused with other <em>Candida<\/em> species. Speciation of <em>Candida<\/em> from non-sterile sites is not usually performed, so clinicians should request their laboratory to identify the species of <em>Candida<\/em> isolates obtained from both sterile and non-sterile sites, particularly for patients at high risk for <em>C. auris<\/em>:\n<ul>\n<li>Patients admitted to facilities where a case of <em>C<\/em>. <em>auris<\/em> colonization or infection has been detected<\/li>\n<li>Patients currently or recently residing in skilled nursing facilities with ventilated patients or in long-term acute care hospitals<\/li>\n<li>Patients with an overnight stay in a healthcare facility outside the U.S. in the previous year, especially in a country with <a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/tracking-c-auris.html\">documented<\/a> <em>C.<\/em> <em>auris <\/em>transmission.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Resources<\/strong><\/p>\n<ul>\n<li>CDC <em>C.<\/em> <em>auris<\/em> website: <a href=\"https:\/\/www.cdc.gov\/fungal\/candida-auris\/health-professionals.html\">https:\/\/www.cdc.gov\/fungal\/candida-auris\/health-professionals.html<\/a><\/li>\n<li>VDH <em>C.<\/em> <em>auris<\/em> website: <a href=\"https:\/\/www.vdh.virginia.gov\/haiar\/diseases-organisms\/candida-auris\/\">https:\/\/www.vdh.virginia.gov\/haiar\/diseases-organisms\/candida-auris\/<\/a><\/li>\n<\/ul>\n<p>Thank you for your continued efforts to protect Virginians from multidrug resistant organisms, particularly in the context of the COVID-19 pandemic.<\/p>\n<p>Sincerely,<\/p>\n<p>M. Norman Oliver, MD, MA<\/p>\n<p>State Health Commissioner<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Candida auris Cases are on the Rise in Virginia May 7, 2021 Dear Colleague:\u00a0 Key Messages The Virginia Department of Health (VDH) is reporting a statistically significant increase in Candida auris (C. auris) cases over the past 10 months in multiple regions of Virginia and in multiple types of healthcare facilities. Between September 2018 and [&hellip;]<\/p>\n","protected":false},"author":78,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-851","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Candida auris Cases are on the Rise in Virginia - Clinicians<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/clinicians\/candida-auris-cases-are-on-the-rise-in-virginia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Candida auris Cases are on the Rise in Virginia - Clinicians\" \/>\n<meta property=\"og:description\" content=\"Candida auris Cases are on the Rise in Virginia May 7, 2021 Dear Colleague:\u00a0 Key Messages The Virginia Department of Health (VDH) is reporting a statistically significant increase in Candida auris (C. auris) cases over the past 10 months in multiple regions of Virginia and in multiple types of healthcare facilities. 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