TABLE 4

Reported infection prevention and control recommendationsa

BodyRecommendation(s)
Patient screeningContact precaution(s)Contact screeningDecolonization procedure(s)Environmental managementCommunity management
PHE (UK)Recommended in units with ongoing cases or colonizations; those arriving from affected units (UK and abroad); screening sites such as groin, axilla, nose, throat, urine, perineal area, rectal area, and stool; consider screening, if indicated, LVS, sputum, endotracheal secretions, drain fluid, wounds, and cannula; rescreening of patients known to have been previously colonized; deisolation of screen-positive patients is not recommended apart from units with experience in managing C. aurisSide room with en suite facilities where possible; isolation of all patients from affected UK or international hospital until screening is available; strict adherence to hand hygiene using soap and water, followed by alcohol rub to dry hands; PPE with gloves and aprons or gowns if there is a high risk of body or body fluid contact; briefing of visitors regarding contact precautions; single-patient-use items such as blood pressure cuffs should be considered; for cleaning C. auris-exposed areas, glove and apron use with subsequent appropriate hand decontaminationIf there is novel detection in a unit, close contacts should be screened and isolated or cohorted; if the index patient is isolated, identify all Candida species isolates from the same unit to the species level using a method able to detect C. auris; review Candida spp. detected in the same ward areas in the 4 wk prior to diagnosis of the index patient in case of unrecognized transmission; deisolation with 3 negative screens >24 h apartStrict adherence to central and peripheral catheter care bundles, urinary catheter care bundle, care of the tracheostomy site; skin decontamination with chlorhexidine washes in critically ill patients; consider use of mouth gargles with chlorhexidine and use of topical nystatin and terbinafine for topical management of key sitesUse of chlorine-releasing agent at 1,000 ppm for cleaning contact environments; change privacy curtains; for equipment, consider single-use items or discarding less expensive items that are difficult to decontaminate; all equipment should be cleaned in accordance with the manufacturer's instructions; terminal cleaning when patient leaves the environment; schedule affected patients last for theater/procedures/imaging; for waste and linen disposal, follow local policy as for other multiresistance organisms; training and supervision of cleaning staff until competentNurse in a single room with en suite facilities when possible; if single room is not possible, the colonized individual should not share a room with an immunocompromised individual; thorough environmental cleaning with a chlorine-releasing agent at 1,000 ppm of available chlorine; follow standard infection control precautions; ensure that staff are trained in the use of PPE and hand hygiene; special care should be taken with wound, catheter, and device care
CDC (USA)Axilla and groin screening; additional sites as directed clinically or by previously positive sites; periodic reassessment for presence of colonization at 1- to 3-mo intervals; for deisolation, 2 or more assessments 1 wk apart with negative results (off antifungals)Single room with standard and contact precautions; gown and gloves; hand hygiene precautionsWait 48 h after administration of topical chlorhexidine prescreeningThorough daily and terminal cleaning/disinfection using Environmental Protection Agency-registered disinfectant effective against C. difficile sporesDo not restrict nursing home residents to rooms and perform hand hygiene; if receiving health input, gown and glove contact precautions; thorough cleaning of shared equipment
ECDC (Europe-wide)All patients from in-country or internationally affected units transferred in; conduct active surveillance in accordance with specified protocol; screening sites include urine, feces, wounds, drain fluid, respiratory samplesContact precautions, single room isolation; patient cohorting; dedicated nursing staff for colonized or infected patients; hand hygieneCross-sectional patient screening in outbreak settingTerminal cleaning of rooms using disinfectants and methods with certified antifungal activity; environmental sampling in outbreak setting
COTHI (South Africa)Routine screening not advisedSingle room with en suite or cohorting of patients; hand hygiene using soap and water or alcohol rub; gloves and aprons for patient contact; adherence to venous and urinary catheter and tracheostomy care bundles; advise visitors regarding contact precautions; notify receiving hospitals of positive statusSchedule affected patients last for theater/procedures/imaging; regular cleaning with chlorine-releasing agent at 1,000 ppm; terminal cleaning and disinfection of bed space; consider terminal cleaning with hydrogen peroxide vapor; clean multiuse equipment thoroughly; cleaning of all contact areas
  • a CDC, Centers for Disease Control and Prevention, USA; ECDC, European Centre for Disease Prevention and Control; COTHI, Centre for Opportunistic, Tropical, and Hospital Infections; LVS, low vaginal swab; PPE, personal protective equipment.