Guidance

Screening of patients and contacts

Updated 19 March 2025

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

Screening

Recommendations

All trusts are encouraged to develop a screening policy, informed by local risk assessment, that aligns with their specific circumstances and resources.

The risk assessment should consider:

• patient risk factors, including high-risk groups
• organisation-specific factors, such as high-risk units
• local and regional epidemiology
• laboratory capability and capacity
• infection prevention and control (IPC) infrastructure
• resource availability
• outbreak preparedness

Patient screening

Recommendations

Screen:

• patients who have had an overnight stay in a healthcare facility outside of the UK in the previous year
• patients coming from affected units in the UK ^{[footnote 1]}

Consider screening patients on high-risk wards or units, subject to local risk assessment.

Colonisation usually precedes infection. Early identification of patients colonised or infected with Candidozyma auris (C. auris) may help minimise transmissions, inform therapy (where required) and allow the early implementation of interventions to prevent invasive infections.

The advice to screen patients who have had an overnight stay in a healthcare facility outside of the UK is a pragmatic decision based on expert opinion and mirrors screening recommendations for carbapenem-resistant organisms, which will facilitate implementation at Trust level. Additionally, patients found to harbour carbapenemase-producing organisms (CPO) may share similar risk factors for C. auris colonisation and infection, and co-occurrence has been reported (24).

For certain organisations, dependent on epidemiology and case mix, it may be appropriate to extend screening to include patients on high-risk wards or units as identified through local risk assessment.

Please refer to the ‘Management of patients who test positive for C. auris (colonised or infected)’ section for screening recommendations related to readmission of the previously positive patient.

Screening sites

Recommendations

Swab the axilla, groin and nose with additional sites added depending on the clinical presentation.

Develop and implement local protocols to ensure the correct collection of screening swabs.

Sites commonly colonised by C. auris in hospitalised patients include the axilla, groin, nose, rectum, and respiratory and urinary tracts. Suggested sampling sites, based on the predilection of Candida spp. to colonise the skin and mucosal surfaces are the axilla and groin (usually composite), followed by the nose (26, 27). For the greatest yield, it is advised to pre-moisten swabs with sterile water or saline.

If clinically indicated or previously positive from a prior admission, the following sites may be considered for sampling:

• urine (especially if there is a urinary catheter in-situ, including intermittent self-catheterisation)
• throat swab
• perineal swab
• rectal swab
• low vaginal swab
• sputum or endotracheal secretions
• drain fluid (abdominal, pelvic or mediastinal)
• vascular access sites
• wounds or broken skin
• ear
• umbilical area (neonates)

Contact screening

Recommendations

Screen contacts of patients with C. auris.

Screen all patients on units or wards with ongoing transmission of cases.

Consider the need to conduct periodic patient screens as part of active surveillance on units or wards where C. auris patients are being managed.

Screening of contacts can help to identify additional cases, the extent of spread, and reduce the likelihood of further transmission by implementing effective IPC measures and mitigations. It can be undertaken to support the management of any novel detection in a Trust and as part of outbreak management.

A C. auris contact is defined as a patient who has been in contact with another patient colonised or infected with C. auris, either through person-to-person interaction or exposure to contaminated equipment or environment. C. auris contacts are at risk of C. auris carriage and should be screened. Acquisition can be rapid, as little as 4 hours from initial exposure to colonisation in affected units (7). 

The patient journey should be reviewed to identify healthcare exposures and patient contacts of the index patient over the previous month, or date of admission if less. One month is suggested but not evidence-based and is subject to local discretion following a risk assessment. Prioritise contacts within the immediate clinical environment, past room contacts and those with the highest risk of transmission who remain hospitalised. This will include patients at higher risk of invasive disease, including those with indwelling lines and devices, and those who spent time in augmented care settings ^{[footnote 2]}, including critical care.

If regular C. auris screens are performed, time from last negative screen could be used as a screening start date.

In certain circumstances, it may be appropriate to extend screening to include patients being cared for by the same clinical team as the C. auris case, including those on different wards. Extended screening strategies may be considered during ongoing outbreaks or where there is a case of hospital acquisition but the source remains unknown, and the role of healthcare staff in transmission remains uncertain.

Periodic patient screens (point prevalence, weekly or more frequent), including admission and/or discharge screening, as part of active surveillance or in clinical environments where C. auris patients are managed, may offer additional reassurance that onward transmission is not occurring. Factors influencing this approach include the presence of highly vulnerable patient populations, patient cohorting practices, shared healthcare personnel between C. auris-affected and unaffected patients or identified concerns regarding lapses in IPC. This may include concerns related to contaminated equipment, healthcare environment or inappropriate use of personal protective equipment (PPE). However, there are no cost-effectiveness studies to determine whether this is an effective strategy.

Setting-specific screening

Recommendation

Conduct a point prevalence screen on augmented ^{[footnote 2]} or critical care settings following a novel, suspected or confirmed healthcare-associated case of C. auris.

Consider the need for an initial point prevalence screen on other ward settings as determined by the incident management team.

If a novel, suspected or confirmed healthcare-associated case of C. auris is detected on an augmented ^{[footnote 2]} or critical care setting, point prevalence screening of the entire unit or ward may be useful to determine the burden of disease. This is recommended due to the increased likelihood of transmission and the increased vulnerability of patients in these areas. This approach may also be adopted for other wards as defined by the incident management team. Early, decisive action to control the newly emerging organism may be more effective and efficient in controlling transmission than responding when more widespread.

Patient movement-related contact should be reviewed and include contacts identified through shared clinical spaces, sanitary facilities, intervention and recovery rooms, therapy rooms or ward social areas. Where relevant, this may include interventions identified through review of prior admissions and attendance at outpatient settings particularly in the context of ongoing transmissions.

More extensive contact tracing and screening to include additional wards, units or outpatient settings, and the use of periodic point prevalence surveys (including admission and/or discharge screening) in the context of ongoing transmission may be considered on a case-by-case basis, particularly if concerns arise regarding poor IPC practice, contaminated equipment or commonalities in patient interventions or settings are identified.

Healthcare worker screening

Recommendation

Do not routinely screen healthcare workers for C. auris.

There is insufficient evidence to recommend routine screening of healthcare workers. This may be considered on a case-by-case basis in outbreak settings by recommendation of the incident management team, for example, if epidemiological investigations suggest a healthcare worker as a possible source.

Environmental screening

Recommendation

Do not routinely screen the environment for C. auris.

There is insufficient evidence to recommend routine screening of the patient environment in healthcare settings. This may be considered on a case-by-case basis in outbreak settings by recommendation of the incident management team; for example, where epidemiological evidence links the environment to transmissions, or where transmissions persist despite other interventions. Environmental screening is not recommended to assess cleaning and disinfection processes and cannot be used to confirm absence of C. auris.

Management and de-isolation of contacts

Recommendations

Consider isolating or cohorting contacts of C. auris cases until screening results are available.

Contacts may be de-isolated after 3 consecutive negative screens at least 24 hours apart.

The isolation or cohorting of C. auris contacts is supported by evidence from published outbreak management outcomes (14 to 16). Enhanced IPC measures should be implemented for contacts until screening results are available.

Three consecutive negative screens at least 24 hours apart is a pragmatic approach, however, some UK units have reported cases of positivity, following repeated negative screens in contacts. Whether this is due to ‘missed’ initial screens, further undetected transmissions or later environmental contamination remains unclear. Due diligence and ongoing clinical surveillance of at-risk groups are recommended, with screening and de-isolation strategies adjusted based on specific context and findings.

Transferred and discharged contacts

Recommendation

Inform receiving healthcare providers of C. auris contacts.

If a contact has been transferred to another acute care facility, IPC teams at the receiving organisation should be informed of the contact and their current status.

For contacts discharged home before completion of screening, consider adding an infection control flag to the patient’s electronic record (where this is feasible), to prompt isolation and C. auris screening if or when the patient is re-admitted to hospital.

For individuals at high risk of invasive C. auris infection, consider informing their usual care team, or community IPC team and recommend screening for C. auris at their next patient contact. Specific high-risk patient groups include patients receiving dialysis, haematology or oncology patients, patients with long-term vascular access or peripherally inserted central catheter (PICC) lines and patients attending diabetic foot or surgical clinics with skin and soft tissue lesions or ulcers.

Discharge letters should reflect the most recent infection status of the patient with information relayed to the general practitioner.

1. It is expected that affected organisations will share information with relevant NHS and independent hospitals and organisations (including commissioners, providers and regulatory bodies as appropriate) within their locality and referral networks. IPC teams should share information directly with receiving hospitals when patients are being transferred from any affected units. ↩

2. Augmented care settings are defined in Box 2 in the UKHSA Framework of actions to contain carbapenemase-producing Enterobacterales. ↩ ↩² ↩³