To infection prevention specialists at Orange County acute care hospitals, long term acute care hospitals, and skilled nursing facilities:

Recent increases in C. auris transmission inside Orange and Los Angeles Counties remains ongoing. Transmission is up compared to this time last year, so please remain vigilant in your infection control practices. Periodic audits of both healthcare and EVS staff are recommended by OCHCA, and there are tools to help you complete these audits available upon request.

Communication between healthcare facilities:
 
Communicating the MDRO status of patients between healthcare facilities continues to be an issue in Orange County. We have witnessed multiple occasions where lapses in communication have occurred between acute care hospitals, LTACHs, and skilled nursing facilities. All MDROs should be clearly communicated between facilities, especially when patients are colonized with unusual organisms like Candida auris.

  • Interfacility transfer forms or equivalent communication should be used any time patients colonized or infected with MDROs are transferred between healthcare facilities. Your facility may choose to use OCHCA's Infection Control Transfer Form, which is available online here.

  • It is recommended that if your facility is transferring a patient who is known to be colonized or infected with Candida auris that your staff make a call to the receiving facility to make sure they are aware of the patient’s status.

Healthcare facilities to monitor:

There have been no changes to OC's list since the last distribution of this announcement. San Bernardino added one sub-acute.

Orange County facilities:
  • Kindred Hospital – Westminster

Los Angeles facilities:
  • Kindred Hospital – Baldwin Park
  • Kindred Hospital – La Mirada
  • Kindred Hospital – Los Angeles
  • Kindred Hospital – Paramount
  • Kindred Hospital – San Gabriel Valley
  • Kindred Hospital – South Bay
  • Southern California Hospital at Hollywood (ICU only)

Long Beach Facilities
  • Regency Oaks Post Acute (sub-acute only)
  • Country Villa Belmont Heights (sub-acute only)

San Bernardino Facilities
  • Kindred Hospital - Ontario
  • Kindred Hospital - Rancho
  • Kaiser Ontario (ICU only)
  • Upland Rehabilitation and Care Center *new

Riverside Facilities
  • Kindred Hospital - Riverside

If your facility admits a patient from any one of the facilities listed above please follow the following steps:

Confirm the patient’s C. auris status with the transferring facility. There have been instances where a patient’s C. auris status was not communicated effectively to everyone involved with the patient’s care. If a patient’s status is unknown, please check with the transferring facility.

  • For area hospitals:
  • Place C. auris-negative patients received from the above facilities in empiric contact precautions. Unless a prolonged hospital stay is anticipated, screening is not recommended, as results take over a week to come back.
  • To request screening for patients with anticipated prolonged stays please reach out to OCHCA (contact information below).
  • C. auris-positive patients should be placed in contact precautions.

  • For subacute units in vSNFs:
  • Place C. auris-negative patients from the above facilities in empiric contact precautions and have C. auris screening arranged through OCHCA.
  • C. auris-positive patients should be placed in contact precautions.

  • For regular skilled nursing facilities, including non-subacute units of vSNFS:
  • Outbreaks of C. auris have been rarely seen in the regular SNF population outside of subacute units.
  • Patients from these facilities who have not tested C. auris positive and are going to non-subacute SNF units can be placed in standard precautions (unless other MDRO risk factors exist) and do not need to be screened for C. auris routinely.
  • Staff caring for these patients should not practice extended use of gowns, including in COVID-19 units. 

  • For acute rehab units (ARUs):
  • Outbreaks of C. auris have been rarely seen in this setting. ARUs may follow the same recommendations as regular SNFs.

For all the above facilities, please contact OCHCA at 714-834-8620 to receive your admission screening C. auris kit. If the patient is discharged before screening has taken place, please both inform the receiving facility of the need for empiric isolation, and contact OCHCA to report the patient has been transferred.

We will provide updates on this situation weekly. For more information about C. auris, please see OCHCA’s most recent C. auris provider advisory at https://www.ochealthinfo.com/phs/about/epidasmt/epi/dip/prevention/candida_auris.

To arrange for screening testing of patients or for other questions regarding Candida auris, please contact Alissa Dratch at 714-834-8620 or email ADratch@ochca.com (preferred) .

Note that this update is intended to inform healthcare staff as to which facilities’ admissions should be monitored. This list is meant for internal use only.

Thanks,

Matt Zahn, MD
Medical Director, Communicable Disease Control
Orange County Health Care Agency