Stop the Spread of C auris: Know the Myths and Follow the Science

Culture colonies Gram-stained Microscopic 100x show Candida spp, fungi, and emerging multidrug fungus. Candida albicans, C auris, and other yeast fungi. Close-up micrograph.

(Adobe Stock 472332177 by Arif Biswas)

Candida auris, initially identified in Japan in 2009, is an emerging multidrug-resistant type of fungus that is also classified as a yeast that can cause severe illness among patients, creating a significant global health threat in health care settings.^1,2

As part of my job as an infection preventionist (IP), I have witnessed the profound impact of emerging pathogens in health care settings, among which C auris stands out.
Misinformation and assumptions have surrounded this organism, which is not a newly discovered one. Clarifying these misconceptions and providing evidence-based truths that people need to know is critical.

This article aims to clarify some of the most common myths surrounding C auris by providing proven facts and offering practical tips for IPs to help our battle against this pathogen.

Myth 1: Candida auris is just another Candida species

Truth: Although C auris belongs to the same genus as other Candida species, it behaves differently. C auris demonstrates an alarming multidrug resistance to multiple classes of antifungals, rendering the regular treatment strategies ineffective. C auris can also survive on surfaces and equipment for weeks, a key factor in its transmission within health care settings if the proper environmental disinfectant is not used. C auris mimics multidrug-resistant organisms (MDROs) in its transmission via direct and indirect contact, which necessitates the implementation of contact precautions, unlike other Candida species.³

Pro tip for IPs: Treat C auris as a distinct MDRO. Implement enhanced infection control precautions, environmental cleaning, and communication between departments or hospitals to prevent further spread.

Myth 2: Only immunocompromised patients are at risk

Truth: Immunocompromised patients, such as those undergoing cancer treatment, organ transplant, or on immunosuppressive therapy, are at higher risk for developing invasive C auris infections. However, C auris can also infect nonimmunocompromised patients, especially those with indwelling devices (eg, central lines and urinary catheters), those with prolonged hospital stays, and those with frequent or prolonged exposure to broad-spectrum antibiotics.³

Colonization is another concern, as some patients can carry C auris on their skin without exhibiting any symptoms of infection. However, they can still shed the organism into their environment, and hence could be easily spread to vulnerable patients through the contaminated environment.

Pro tip for IPs: Do not limit screening to immunocompromised patients. Consider all the risk factors to identify patients at risk for colonization or infection.

Myth 3: Hand hygiene is not as critical with fungal pathogens

Truth: Hand hygiene is critical in the prevention of transmission of C auris, and it remains the most effective way in preventing the spread of infectious pathogens, including C auris.³

C auris is transmitted through direct contact with colonized or infected individuals and indirectly through contact via health care workers’ hands or contaminated surfaces or medical equipment in a patient room. Alcohol-based hand rubs (ABHRs) are effective against C auris when performed correctly and consistently (before and after touching a patient or a patient’s surroundings).

Pro tip for IPs: Reinforce consistent use of ABHRs or proper handwashing techniques as part of a multimodal strategy. Continuous education, training, and hand hygiene auditing are key elements in preventing the spread of infections.

Myth 4: All routine disinfectants are sufficient for environmental cleaning

Truth: Not all routine disinfectants are effective against C auris.⁴ The US Environmental Protection Agency (EPA) List P identifies the disinfectants that meet efficacy criteria against C auris.⁴ Facilities must verify that their disinfectants are on this list and ensure compliance with contact times. Failure to observe the required contact time leads to false assurance of environmental cleanliness and persistence of the organism on surfaces. Environmental cleaning protocols should emphasize routine disinfection of high-touch surfaces.

Pro tip for IPs: Facilities should audit their disinfectant inventory. Verify that all products used for environmental cleaning and equipment disinfecting are listed on EPA List P. Ensure staff are trained to use disinfectant products effectively. (Table)

Myth 5: Screening and surveillance are only necessary if there is an outbreak

Truth: Waiting for an outbreak to occur is too late; transmission may have already occurred, affecting multiple patients or different areas in the hospital. Proactive, rather than reactive, screening and surveillance help detect colonized patients early and prevent outbreaks.

The CDC recommends proactive screening for C auris colonization/infection in patients who meet specific criteria, which typically include recent health care exposure outside the US (within the past year); patients transferred from facilities with ongoing or recent C auris transmission; and history of colonization with other MDROs.³

Pro tip for IPs: Establish criteria for admission screening based on the patient’s risk factors. Place colonized patients under contact precautions and maintain rigorous environmental cleaning to mitigate the spread. Early identification is the key to preventing an outbreak.

Myth 6: C auris can be eradicated once colonized

Truth: Decolonization of C auris is not recommended or shown to be effective.

Colonization can persist for months, even after apparent clinical resolution. There should be strict adherence to transmission-based precautions, hand hygiene, environmental cleaning with appropriate agents, and ongoing surveillance cultures in outbreak settings.⁵

Pro tip for IPs: Early identification through surveillance cultures can prevent facility-wide outbreaks. Do not assume a patient is clear from C auris unless repeated negative cultures are obtained.

Myth 7: C auris is easily identified by standard laboratory methods

Truth: C auris poses a diagnostic challenge because it often looks and behaves similarly to other Candida species in culture (eg, C haemulonii, C famata, C guilliermondii, C lusitaniae, C parapsilosis), making it difficult to distinguish without specialized methods.³ Many standard laboratory systems, including commonly used biochemical identification platforms, misidentify it, which delays appropriate treatment and infection prevention measures.

Pro tip for IPs: Confirm with your microbiology lab whether its current systems can accurately identify C auris. If there are limitations, implement a protocol that sends suspicious isolates to a public health lab (eg, CDC or state lab) for confirmatory testing. Early and accurate identification is key to timely infection control action.

Final Thoughts

C auris is not like other fungal pathogens, so we should deal with it differently. As IPs, our role is to educate staff, emphasize the importance of environmental cleaning, reinforce hand hygiene adherence and other infection control practices, and stay updated with evolving guidelines from the CDC and the US Department of Health and Human Services.

Like other MDROs, C auris spreads easily in health care settings and can cause outbreaks. C auris can colonize patients for months, persist on surfaces, and is not killed by some commonly used health care facility disinfectants. Hand hygiene, appropriate precautions, and environmental disinfection prevent and control outbreaks.

By addressing different myths with evidence-based action, we can help contain the spread of this pathogen. 

References

1. Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA. Candida auris: a fungus with identity crisis. Pathog Dis. 2020;78(4):ftaa034. doi:10.1093/femspd/ftaa034

2. Tetz G, Tetz V. Bacterial extracellular DNA promotes β-amyloid aggregation. Microorganisms. 2021;9(6):1301. doi:10.3390/microorganisms9061301

3. Candida auris. CDC. Updated July 25, 2023. Accessed August 5, 2025. https://www.cdc.gov/candida-auris/

4. EPA’s registered antimicrobial products effective against Candida auris (List P). Environmental Protection Agency. Updated April 1, 2025. Accessed on August 5, 2025. https://www.epa.gov/pesticide-registration/list-p-antimicrobial- products-registered-epa-claims-against-candida-auris

5. Get the facts about Candida auris (C auris). New York State Department of Health. Updated July 2025. Accessed July 28, 2025. https://www.health.ny.gov/diseases/communicable/c_auris/