Candida auris Patient Transfer Recommendations – March 2023 (SNF/AL)

The Michigan Department of Health and Human Services (MDHHS), in collaboration with local public health and health care partners, is investigating the emergence of Candida auris (C. auris) associated with multiple health care facilities including acute care hospitals, long-term acute care hospitals and skilled nursing facilities. C. auris prevention is a public health priority. Patients colonized with this yeast pathogen can develop serious illness or invasive infections including bloodstream infections. C. auris is often multidrug-resistant which can make these invasive infections difficult to treat. C. auris can spread from colonized or infected patients to the hands and clothes of health care personnel (HCP) or to medical equipment and environmental surfaces.  

C. auris and MDRO Patient Care: As Michigan continues to see an increase in Candida auris cases, particularly in Southeast Michigan, health care facilities across the continuum of care have reported difficulties discharging patients to other facilities to receive their appropriate level of care. As with any multidrug-resistant organism (MDRO), decisions to transfer a patient from one level of care to another should be based on clinical criteria and the ability of the accepting facility to provide the appropriate level of care — not on the presence or absence of C. auris infection or colonization or potential exposure to C. auris. Receiving healthcare facilities should take steps to learn a patient’s C. auris status and be prepared to implement appropriate precautions when needed for C. auris. Generally, facilities that care for patients with other MDROs or Clostridioides difficile are also capable of caring for patients with C. auris.

To prevent Candida auris from spreading, Michigan health care facilities across the continuum of care should implement infection prevention and control measures, including:

• Taking steps to identify patients with C. auris infection or colonization.
• Being prepared to implement setting-appropriate infection prevention precautions, including the use of disinfectant products effective against C. auris (see the EPA List P).
• Collaborating with public health on recommended infection prevention practices and screening procedures to facilitate timely, accurate detection of C. auris.

Interfacility Patient Transfer: All health care personnel involved in the patient transfer process play a vital role in ensuring MDRO status is clearly and effectively communicated. Interfacility communication is required to ensure appropriate precautions are taken when patients are transferred including communicating any lab results finalized after the patient has been transferred. MDHHS recommends the following:

• Review both internal and external protocols to ensure the appropriate persons (including case managers, admissions coordinators, front-line clinical HCP, and transporters) are made aware of a patients’ C. auris and other MDRO status upon transfer.
• Use an interfacility transfer form to communicate infection prevention information for all discharges to other settings. For facility transfer resources and more information on Health care Associated Infections, please go to Michigan.gov/HAI.

More help available: The MDHHS Surveillance for Healthcare-Associated and Resistance Pathogens (SHARP) Unit is available to discuss care for patients with C. auris. Please call (517) 335-8165 or email [email protected]. The SHARP Unit will provide weekly updates on changing C. auris epidemiology.

You may also review the Michigan Candida auris Surveillance Update, which covers surveillance data through March 7. In addition, the SHARP Unit is offering SNF partners three virtual training opportunities on C. auris and patient management.

Educational Webinar: A free, 45-minute webinar on Candida auris will review how to safely accept resident transfers. Each session will have 25 minutes of content, followed by 20 minutes of discussion. The content will be the same on all three days. It will be posted on the Michigan Healthcare-Associated Infections website after March 21. Webinar dates: March 13 from 12 to 12:45 p.m., March 16 from 3 to 3:45 p.m. and March 21 from 2 to 2:45 p.m.