Caitlin Stowe, MPH, CPH, CPHQ, CIC, VA-BC 

"Patient shedding leads to contamination of the patient environment, which, through inadequate hand hygiene and environmental disinfection practices, allows for horizontal transmission. health care facility." 

in the US in 2013, one thing has remained consistent: how difficult it can be to stop the perpetuation of an outbreak. 

 is an opportunistic pathogen that was first isolated from the ear of a patient in Japan in 2009 and quickly spread around the world.

 Once infected, patients usually become colonized with 

 in the nares or skin, which results in long-term shedding ofthe fungi into the environment. Prior evidence has shown colonization of over 200 days in some patients, which allows innumerable opportunities for this pathogen to spread across health care environments.

Patient shedding leads to contamination of the patient environment, which, through inadequate hand hygiene and environmental disinfection practices, allows for horizontal transmission through a health care facility. Welsh et al found that 

 was able to survive on plastic health care surfaces for 2 weeks, which can perpetuate outbreaks.

 Additionally, Pacilli et al found continued contamination of patient care equipment like blood pressure cuffs and temperature probes despite the use of a sporicidal disinfectant.

 Invasive devices, such as central lines, can also become colonized and cause long-term infections in patients with such devices. Unfortunately, 

 has multiple mechanisms that allow the pathogen to thrive and survive in the environment.

 environment persistence can be due to several factors: It can adhere to and survive on moist or dry surfaces, including medical equipment, patient room surfaces, and even fabrics for days to weeks. It can form a biofilm and has an intrinsic resistance to certain disinfectants. 

’s ability to adhere to environmental surfaces, medical devices, and even patient skin has been well documented.

 This is theorized to be due partly to a newly characterized adhesin named Surface Colonization Factor 1 (SCF1), which differentiates 

 Researchers theorize that this SCF1 adhesin, a molecule found on the surface of bacteria or fungi, allows 

 to bind to surfaces more effectively and makes removal more difficult. Like most other 

 can form a biofilm, a community of cells contained within an extracellular matrix.This extracellular matrix provides additional protection to the cells against disinfectant exposure and makes them hardier, allowing them to survive on surfaces even when the biofilm dries.

 is intrinsically resistant to some of the most used health care disinfectants. Prior research showed that 

 was resistant to almost all quaternary ammonium and hydrogen peroxide–based disinfectants.

 Only chlorine-based disinfectants and those with a sporicidal claim were shown to be effective against 

 and stop outbreaks before they begin, infection preventionists must ensure the perfect trifecta of people, products, and practices is in place to mitigate transmission. First, all persons should be trained on adhering to transmission-based precautions, including the correct donning and doffing of personal protective equipment to prevent further spread of the pathogen. Second, the appropriate product with a kill claim specifically for 

 should be used when there is a suspected or confirmed case. The contact time, which can vary from 1 to 10 minutes, should be looked up and adhered to. The US Environmental Protection Agency has a list, aptly named List P, which includes all antimicrobial products that have a kill claim specifically for 

Finally, the personnel responsible for the cleaning and disinfection of surfaces and patient equipment should all be trained in proper practices. The hospital policy or standard operating procedure should do this, and all stakeholders, including nursing leadership, environmental services, and infection prevention, should monitor practices. This helps ensure adherence to utilizing the correct product, dwell/contact time, and order of cleaning. Although preventing transmission of 

 can be difficult, understanding how it is transmitted, using effective disinfectant products, and practicing correct disinfection procedures can prevent outbreaks and protect patients, staff, and visitors. 

1.	Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. 

 sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. 

l. 2009;53(1):41-44. doi:10.1111/j.1348-0421.2008.00083.x

2.	Adams E, Quinn M, Tsay S, et al; Candida auris Investigation Workgroup. Candida auris in healthcare facilities, New York, USA, 2013-2017. 

. 2018;24(10):1816-1824. doi:10.3201/eid2410.180649

3.	Welsh RM, Bentz ML, Shams A, et al. Survival, persistence, and isolation of the emerging multidrug-resistant pathogenic yeast Candida auris on a plastic health care surface. 

2017;55(10):2996-3005. doi:10.1128/JCM.00921-17

4.	Pacilli M, Kerins JL, Clegg WJ, et al. Regional emergence of Candida auris in Chicago and lessons learned from intensive follow-up at 1 ventilator-capable skilled nursing facility. 

2020;71(11):e718-e725. doi:10.1093/cid/ciaa435

5.	Akinbobola AB, Kean R, Hanifi SMA, Quilliam RS. Environmental reservoirs of the drug-resistant pathogenic yeast 

. 2023;19(4):e1011268. doi:10.1371/journal.ppat.1011268

6.	Dire O, Ahmad A, Duze S, Patel M. Survival of Candida auris on environmental surface materials and low-level resistance to disinfectant. 

 2023;137:17-23. doi:10.1016/j.jhin.2023.04.007

7.	Santana DJ, Anku JAE, Zhao G, et al. A 

-specific adhesin, Scf1, governs surface association, colonization, and virulence. Science. 2023;381(6665):1461-1467. doi:10.1126/science.adf8972

8.	Haq MF, Pearlmutter BS, Cadnum JL, Donskey CJ. Efficacy of 23 commonly used liquid disinfectants against 

2024;45(1):127-131. doi:10.1017/ice.2023.157

9.	EPA’s registered antimicrobial products effective against 

 (List P). US Environmental Protection Agency. Updated April 1, 2025. Accessed August 5, 2025. https://www.epa.gov/pesticide-registration/epas-registered-antimicrobial-products-effective-against-candida-auris-list

Articles

Candida auris is the pathogen that won’t take a hint—clinging to surfaces, nesting in biofilms, and outlasting rushed wipe-downs. Yet the chemistries potent enough to kill it can be punishing to people, devices, and environments. This piece tackles the tightrope: how to choose, use, and verify C auris effective disinfection without trading one risk for another.

Toxic and Tenacious: Disinfection Dilemmas With Candida auris

If you’ve worked in healthcare for any amount of time, you’re probably familiar with the term “high-touch” surfaces. These are surfaces that are usually found in the patient room or patient care area, such as light switches, bedrails, and overbed tables. Disinfection of these surfaces is a critical part of infection prevention efforts because they are more likely to be contaminated with potential pathogens. With inadequate disinfection practices, healthcare workers are much more likely to acquire pathogens on their hands after touching these surfaces, potentially passing them on to patients.1 However, there are many surfaces and areas that are frequently touched yet often overlooked.

: Healthcare workers must work extremely hard and therefore deserve a nice, clean space to relax in during their breaks. Unfortunately, the reality is that these spaces tend to be dirty, sticky, and sometimes smelly depending when the fridge was last cleared out. When was the last time the coffee maker or microwave were cleaned? What about staff lockers? All of these break room surfaces are frequently used but are almost never considered for daily cleaning. These areas and machines should be disinfected with an EPA-registered healthcare grade disinfectant that is also be considered food safe. We owe it to healthcare workers to make sure that they aren’t transmitting pathogens while taking a break.

: While the vast majority of healthcare documentation has digitized in the last decade, the need for paper hasn’t fully gone away. In fact, it’s often the first port of call for incoming patients. Who cleans all of those clipboards and charts? These are being frequently touched by a rotation of people throughout the day, which means they should be treated like any other “high-touch” surface. Your facility should implement a policy that defines who is responsible for cleaning clipboards and charts and what EPA-registered disinfectants can be used without degrading the plastics or acrylics.

: These systems are fantastic for saving time and improving healthcare efficiencies as they rapidly send lab samples, paperwork and medications throughout the hospital. Unfortunately, unintended spills and dirty hands can cause these systems to accumulate and traffic pathogens within the facility if they’re not disinfected frequently. The carrier tubes should be disinfected in between uses and the entire tube system should be cleaned on a scheduled basis to ensure that only the intended items (and not pesky pathogens) are being delivered.

: One of the workhorses of patient care are the machines used by healthcare workers to safely store and dispense patient medications. They may be touched hundreds of times per day by healthcare workers, who may or may not have cleaned their hands prior to use. By comparison, they are often cleaned just once in that same time frame. To prevent pathogens from being dispensed alongside patient medications, hospitals should ensure that the machines are cleaned and disinfected at regular intervals throughout the day.

: Last, but certainly not least, are personal cell phones. Some 86% of clinicians now use their phone during work hours—but how often are they cleaning them?2 Even more concerning, a recent study found that over 90% of healthcare worker phones tested positive for pathogens such as MRSA and other multidrug resistant bacteria.3 Cell phones should be cleaned frequently, especially if they are being used at work. The challenge is finding products that are approved by the manufacturer. To protect phones and their warranty, healthcare workers should use an approved cleaner, such as a 70% isopropyl alcohol wipe. 

 will help prevent the (real-life) transmission of viruses and germs.

Caitlin Stowe, MPH, CPH, CPHQ, CIC, VA-BC is a Clinical Affairs Research Manager at PDI Healthcare. She has over 10 years of experience in infection prevention. She has previously served as an infection prevention specialist at several hospitals around the United States and as a clinical science liaison at PDI.

1. Kundrapu S, Sunkesula V, Jury LA, Sitzlar BM, Donskey CJ. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. 

. 2012;33(10):1039-1042. doi:10.1086/667730

2. “Mobile Trends Report.” Epocrates, 2014.

3. Morubagal RR, Shivappa SG, Mahale RP, Neelambike SM. Study of bacterial flora associated with mobile phones of healthcare workers and non-healthcare workers. 

. 2017;9(3):143-151. http://www.ncbi.nlm.nih.gov/pubmed/29225753.

With inadequate disinfection practices, healthcare workers are much more likely to acquire pathogens on their hands after touching these surfaces, potentially passing them on to patients.

Caitlin Stowe, MPH, CPH, CPHQ, CIC, VA-BC

Articles

Toxic and Tenacious: Disinfection Dilemmas With Candida auris

5 Overlooked High-Touch Hospital Surfaces