Guidance

Infection prevention and control (IPC)

Updated 19 March 2025

Note: numbers in round brackets refer to references which can be found in the References section.

Recommendations

Consider the recommendations outlined in this section alongside the National IPC manual for England (NIPCM) and the Health and Social Care Act 2008: code of practice on the prevention and control of infection.

Principal IPC measures to be undertaken to prevent transmission of Candidozyma auris (C. auris) in healthcare settings include:

• standard infection control and transmission-based precautions (contact precautions)
  • consistent and sustained adherence to hand hygiene
  • patient placement considerations for patients colonised or infected with C. auris and their identified contacts
• effective cleaning and disinfection of patient equipment and environment with a product effective against C. auris
• safe management of linen and waste
• comprehensive screening strategies
• clinical surveillance of cases and those at risk
• laboratory surveillance (retrospective and prospective)
• communication of C. auris results to relevant teams, organisations and stakeholders
• education of healthcare workers
• education of patients, carers and visitors

Use the same IPC measures for patients colonised or infected with C. auris.

IPC measures are essential for minimising the transmission of C. auris, in both colonised and infected patients. Healthcare workers are encouraged to work in multi-disciplinary teams, including Clinical Infection Specialists and IPC teams, to risk assess and support the management of patients infected or colonised with C. auris. Ongoing education is critical, and healthcare workers and support staff must understand and fulfill their responsibilities in preventing and controlling C. auris infection within healthcare settings (55).

C. auris is highly transmissible between patients through both direct patient-to-patient contact and indirectly through contact with the contaminated environment, equipment or via healthcare workers. Additionally, there is limited evidence that skin squames may be dispersed through the air via turbulent activities such as bed changing (16).

Factors contributing to healthcare-associated outbreaks include its propensity for frequent and long-term colonisation of skin and the environment, including the formation of biofilms. Acquisition can be rapid, as little as 4 hours from initial exposure to colonisation in affected units (7).

C. auris can persist in the healthcare environment and survive for prolonged periods of time. Environmental screening of occupied patient environments yields C. auris isolates with identical fingerprinting patterns, suggesting shedding of C. auris by colonised patients (56). Environmental contamination is extensive (57), and survival times of 7 days have been recorded on general surfaces, increasing to 4 weeks for some plastic devices (58, 59).

During outbreaks, C. auris has been detected on a range of surfaces and equipment including (60 to 63):

• beds, bedside equipment, bedding materials including mattresses, bed sheets and pillows
• ventilation grilles and air conditioning units
• radiators
• windowsills and other horizontal surfaces
• hand wash basins, sink drains and taps
• floors
• bathrooms doors and walls
• disposable and reusable equipment such as ventilators, skin-surface temperature probes, blood pressure cuffs, electrocardiogram leads, stethoscopes, pulse oximeters and cloth lanyards

Hand hygiene

Recommendations

Ensure consistent and sustained adherence to hand hygiene.

Use alcohol-based hand rubs except when hands are visibly soiled, in which case soap and water are recommended.

To mitigate the risk of C. auris transmission via contact with healthcare workers, implement effective hand hygiene and appropriate glove use as outlined in the NIPCM.

Contact precautions

Recommendation

Use standard infection control and contact precautions for patients colonised or infected with C. auris.

Contact precautions should be implemented to minimise transmission of C. auris via direct contact with the patient or indirectly from the patient’s immediate care environment or equipment and followed as outlined in the NIPCM.

Personal protective equipment (PPE)

Recommendations

Wear gloves and aprons during contact with the patient or their care environment.

Wear long-sleeved gowns when high-contact patient care activities are anticipated that would result in prolonged contact between the patient and healthcare worker’s clothing or exposed skin.

The use of gowns and gloves beyond anticipated blood and body fluid exposure is required to minimise the transfer of C. auris to the hands and clothing of health care workers during high-contact care activities.

PPE should be donned after hand hygiene and before entering the room or patient area. PPE should be removed and discarded in the room or patient environment, followed by a thorough hand wash or application of alcohol-based hand rub on dry hands before exit, as appropriate.

Following risk assessment in line with the hierarchy of controls, it will be a matter for local determination if other control measures are required for near patient tasks such as giving oral medications, distributing or collecting food trays, or writing in the patient chart. Effective hand hygiene remains essential before and after all patient contact and after contact with the patient environment.

Patient placement (including transfer and movement)

Recommendations

Place patients colonised or infected with C. auris in single rooms or cohort.

Limit patient movement within the facility to medically necessary procedures to reduce the risk of environmental contamination.

Plan and communicate visits to other departments to allow for appropriate infection prevention and control mitigations.

Place patients colonised or infected with C. auris in single rooms or cohort, with en-suite facilities wherever possible or provide a commode, as a minimum.

When considering the decision to cohort, the possibility of co-occurrence with other MDROs, including CPE and MRSA, needs to be taken into account, particularly when the organism was acquired abroad. Use dedicated staff to care for patients affected by C. auris where possible, and particularly in an outbreak situation.

To reduce the risk of environmental contamination elsewhere in the facility, patients should ideally only be moved for necessary medical procedures. Where portable imaging is available, this should be performed in the patient’s room and equipment carefully cleaned on leaving the room. The infection status of a patient must not delay urgent care or urgent procedures when these are required. Plan and communicate visits to other departments to allow for appropriate infection prevention and control mitigations, as outlined in the above sections, as well as thorough cleaning and disinfection of equipment and the environment once the patient has left.

Management of invasive medical devices

Recommendation

Review the need for invasive medical devices in patients colonised or infected with C. auris to minimise the risk of invasive disease.

Invasive medical devices cause breaches in skin and mucosal integrity and can act as a portal of entry of C. auris. Colonised patients are at increased risk of invasive disease. Review the need for medical devices on a continual basis and remove devices promptly if no longer required or if there is any sign of infection. Ward and unit policies on the insertion and care of invasive medical devices should be reviewed and practice audited.

See ‘Management of patients who test positive for C. auris (colonised or infected)’ section for further information regarding skin antisepsis prior to insertion of invasive devices.

Safe management of care equipment

Recommendations

Use single-use and disposable equipment wherever possible.

Assign dedicated, reusable non-invasive equipment to the isolation room or cohort area.

Ensure thorough cleaning and disinfection of care equipment is performed in accordance with the manufacturer’s instructions, including adherence to recommended contact times for disinfectant solutions.

Pay particular attention to the cleaning and disinfection of reusable equipment from the bed space, including mobile equipment and equipment personally owned by healthcare workers, that may act as a reservoir for cross-transmission of C. auris.

Due to the persistence of C. auris in the environment, thorough cleaning and disinfection of care equipment is important to minimise the risk of transmission to other patients.

Single patient use items, such as temperature probes and blood pressure cuffs, are advised. Limit the stock of single use or disposable equipment brought into the patient area. Dispose of any unused disposable items within the patient area on discharge.

Assign dedicated, reusable non-invasive equipment, such as stethoscopes, to the isolation room or cohort area. Ideally, allocate one item per patient. Pay particular attention to cleaning and disinfecting reusable equipment from the bed space of colonised or infected patients.

For equipment that cannot be dedicated to a single patient, avoid sharing with others unless effective decontamination can be assured between uses. This includes shared mobile equipment, such as portable ultrasound machines.

Additionally, it is important to identify commonly handled moveable objects (such as mobile devices), including all specialist medical equipment personally owned by staff members (such as stethoscopes, otoscopes, opthalmoscopes, handheld ultrasound or doppler devices and tuning forks), to allow a risk-assessment of use by the IPC team. This should include an evaluation of the ability to effectively decontaminate the object, as such items could act as a reservoir for cross-transmission of C. auris within and between wards.

Pillows and mattresses should have an entirely impervious plastic cover that is checked for breaches or ingress and cleaned and disinfected between patients. Chair cushions, air mattresses or specialist loaned equipment should undergo appropriate cleaning and decontamination and checks prior to use by other patients.

Velcro straps on medical equipment and transport bags pose a significant challenge for effective cleaning. This highlights the importance of assessing the cleanability of equipment before procurement to ensure compliance with infection prevention and control standards. Where effective cleaning is not feasible, consider single or dedicated use.

If an item cannot be effectively decontaminated, the cover of any impermeable item of patient care equipment is damaged, or there is obvious strikethrough, then the item should be appropriately sealed and disposed of.

Consider whether it is possible to thoroughly decontaminate an item after use by an infected or colonised patient, or whether it would be preferable to dispose of it instead.

Safe management of the care environment

Recommendations

Perform thorough cleaning of the care environment prior to disinfection.

Develop local cleaning and disinfection policies tailored to the level of contamination and case load, focusing on frequently touched surfaces.

Use 1,000 ppm of available chlorine, or an alternative effective disinfectant, following the recommended contact times.

Avoid using quaternary ammonium compounds due to insufficient evidence of efficacy against C. auris.

Use hydrogen peroxide vapour and ultraviolet light systems only as supplementary measures, not as replacements for full cleaning and disinfection.

Review cleaning and disinfection practices in outbreak settings to identify and implement improvements.

Thorough cleaning of the care environment before disinfection is important to ensure optimal effectiveness of the disinfectant. Frequency of daily cleaning schedules should be increased to include all surfaces and touch points of patient rooms and other areas where the patient receives care.

For shared rooms or bays, clean and disinfect as if each bed area were a different room. Mopheads and cleaning cloths must be discarded, or changed and laundered, between bed areas and after use. Excess cleaning solution should be disposed of in a designated dirty utility room. Buckets and other receptacles should be cleaned and stored dry.

One thousand ppm of available chlorine is effective against C. auris and must be applied for the correct contact time. Alternative disinfectant products may be used, with agreement of the local IPC team, and in accordance with local policies and manufacturers’ guidance (contact time and instructions for use) as well as Control of Substances Hazardous to Health (COSHH) Regulations.

Disinfectants effective against C. difficile spores are likely to be effective against C. auris, including peracetic acid, although this may be dependent on formulation and biocide concentration (46). Quaternary ammonium compounds are not recommended as disinfectants as the evidence regarding their efficacy for C. auris is not clear. Some products with C. albicans fungicidal claims may not be effective against C. auris.

The US Environmental Protection Agency has compiled a list of registered disinfectants effective against C. auris after testing of products using a standardised methodology to evaluate disinfectant efficacy. Inclusion of products does not constitute an endorsement of one product over another and the list is not inclusive of all effective products. Local IPC teams are encouraged to perform their own due diligence when selecting disinfectants for use.

Hydrogen peroxide vapour and no-touch irradiation systems, including ultraviolet light, should be used only as an additional safety measure and not instead of full cleaning and disinfection. Data appears promising but limited, and the parameters required for effective disinfection are not well understood (25, 64). If devices are to be used, the parameters chosen should be those recommended to inactivate C. difficile (65).

Individual trusts should adopt a local cleaning and disinfection policy and regimen dependent on the level of contamination and case load. As different staff groups may be responsible for different items, attention should focus on all relevant items undergoing decontamination and the importance of cleaning prior to disinfection should be emphasised.

Healthcare and domestic staff must remove and appropriately dispose of their PPE and decontaminate their hands after contact with the patient or the environment before attending to any other task.

In outbreak settings with ongoing transmission, consider a review of cleaning and disinfection practice to ensure best practice is followed and opportunities for improvement are identified.

Terminal clean

Recommendation

Perform terminal cleaning and disinfection of all surfaces in the patient’s environment as detailed in the NIPCM.

Curtains should be changed or disposed of as appropriate. Discard stocks of single use items in the immediate patient environment and consider discarding less expensive reusable items that are difficult to decontaminate effectively.

Medicines left at the bedside should be wiped with a C. difficile sporicidal wipe or alternative and either reused on the ward or discarded if deemed to have non-intact packaging.

Safe management of linen and waste

Recommendation

Refer to the NIPCM for detailed guidance on both the management of infectious linen and the disposal of clinical waste.

Clean linen should be handled, processed, transported, and stored in accordance with Health Technical Memorandum 01-04 ensuring segregation of clean from used linen at all times. Healthcare laundry should be classified as infectious linen and managed and segregated as outlined in the NIPCM, and requires sealing in a water-soluble bag and immediate placement in an impermeable bag before removal from the clinical area.

Healthcare waste from C. auris patients should be classified as clinical waste and segregated using a UN-approved orange bag and securely tied prior to removal from the immediate clinical area. For further guidance see the NIPCM for England and Health Technical Memorandum 07-01.

Visitors

Recommendation

Ensure visitors perform hand hygiene before entering and on leaving the patient environment.

Visitors do not routinely require PPE unless they are providing direct care to the individual they are visiting. They should be encouraged to perform hand hygiene before entering and on leaving the patient environment.

Laboratory surveillance (prospective and retrospective)

Recommendation

Conduct retrospective and prospective laboratory surveillance on confirmation or suspicion of a healthcare-associated case of C. auris.

When species-level identification has not occurred routinely on the unit or ward where the index patient resided, it is recommended that Trusts identify all Candida isolates for the subsequent 4 weeks to species level using an appropriate method that will detect C. auris. Additionally, a 4-week look back exercise is recommended to review the detection of Candida spp. which may indicate unrecognised transmission.