Guidelines on infection prevention and control: Guidelines

Descriptive epidemiology

• Candida auris (C. auris) is a multi-drug resistant fungal pathogen that can cause healthcare-associated invasive infections and outbreaks and, therefore, poses a serious threat to global human health.

• Mortality rates of invasive C. auris infections are estimated to be greater than 40%, which is similar to other drug-resistant microorganisms.^{Footnote 1}

• Ninety-six percent (n=105/109) of CNISP hospitals participate in C. auris surveillance. Between CNISP and the National Microbiology Laboratory surveillance, a total of 43 isolates (colonizations and infections) has been reported from 2020 to 2024: 19 (44%) from CNISP hospitals and 24 (56%) from other hospital laboratories reported through the National Microbiology Laboratory.^{Footnote 2}

• The number of C. auris cases detected per year was four in 2020, three in 2021, 12 in 2022, 10 in 2023, 14 in 2024, and 31 in 2025.^{Footnote 3}

Organization: Public Health Agency of Canada

Date published: 2024
Cat.: HP40-378/2025E-PDF
ISBN: 978-0-660-75111-5
Pub.: 240731

Candida auris (C. auris) is an antimicrobial-resistant fungal organism that can persist in the environment, has a high mortality rate and is resistant to quaternary ammonium disinfectants.

Transmission

• Contact transmission requiring contact precautions in a private room with a private washroom or dedicated commode.

Personal Protective Equipment (PPE)

• Healthcare workers should wear gloves and a long sleeved gown at all times while in the patient care area.
• Visitors should wear the same PPE as healthcare workers when in patient care area.

Disinfection

• Health Canada approved hospital disinfectant with claims of efficacy against C. auris.
• In-vitro data suggests that both chlorine and hydrogen peroxide based disinfectants are also effective against C. auris.

Screening

• Admission screening (a single bilateral swab of axilla and groin) should be performed for any patient being admitted to a healthcare facility, if:
  • They have been admitted to a hospital or long term care home outside of Canada (including in the United States) within the prior 12 months, or
  • They have been transferred from a Canadian healthcare facility with a known ongoing C. auris outbreak.

Outbreak management

• Any nosocomial transmission of C. auris among patients should be considered an outbreak.
• Decolonization of patients positive for C. auris is not recommended.
• Increased cleaning and disinfection should be implemented.
• Laboratory confirmation of C. auris from a clinical or screening specimen is needed to identify cases.
• Point prevalence surveys should be performed at least weekly and based on epidemiology and degree of transmission.

Descriptive epidemiology

• Hantaviruses are a group of zoonotic RNA viruses found in rodent reservoir hosts (such as mice, rats and other rodents) worldwide, including in Canada. Hantavirus infections are rare, and the risk of getting a hantavirus infection in Canada or in other parts of the world is low.^{Footnote 1}

• Worldwide, it is estimated that from 10,000 to over 100,000 infections occur each year^{Footnote 2},^{Footnote 3},^{Footnote 4}, with the largest burden in Asia and Europe. Person-to-person transmission of hantaviruses is uncommon. Limited person-to-person transmission has only been reported with the Andes species of hantavirus, usually following prolonged close contact.

• Available evidence indicates that the risk of healthcare associated transmission of hantavirus, including Andes virus, is very low when appropriate infection prevention and control measures are applied. ^{Footnote 5}

• On May 17^th, 2026, the National Microbiology Laboratory in Winnipeg confirmed a Canadian passenger from the MV Hondius cruise ship tested positive for Andes hantavirus.

Organization: Public Health Agency of Canada

Date published: 2026

ANDV is not endemic to Canada and is epidemiologically distinct from the hantavirus species endemic in Canada.

Transmission

• Infection with a hantavirus is mainly associated with direct contact with rodents or their droppings and urine.
• The Andes hantavirus (ANDV) species is capable of person-to-person transmission, mainly with close and prolonged contact. It has not demonstrated the capacity for widespread prolonged transmission.
• Incubation period: 1 to 8 weeks, with most individuals becoming symptomatic between 2 to 4 weeks after exposure.

Additional precautions

• Airborne, droplet and contact precautions should be used for suspected, probable and confirmed cases of ANDV and high risk contacts.
• If a case of ANDV is suspected, immediately notify local public health authorities.

Personal protective equipment and patient placement

Recommended personal protective equipment (PPE) includes, at minimum:

• Gloves
• A fluid-resistant or impermeable gown
• Eye protection, such as goggles or a face shield
• A fit-tested N95 respirator, or equivalent or higher protection

• This PPE should be worn for the care of suspected, probable and confirmed cases of ANDV, and when caring for high risk contacts.
• Patients with suspected, probable or confirmed ANDV should preferably be placed in an airborne infection isolation room (AIIR).

Waste, environmental cleaning and disinfection

• Use disposable patient care equipment where possible. Reusable equipment should be dedicated to the use of one patient.
• Use disposable dishes and cutlery.
• Waste should be managed according to regional and local regulations, policies and procedures.
• The care environment should be cleaned and disinfected using Health Canada-approved hospital or health care disinfectants. Clean and disinfect high-touch surfaces more frequently.

Visitors

• Avoid entry of visitors into the patient room.
• Consider virtual visits.
• If required, caregivers and visitors should also wear a fluid-resistant or impermeable gown, gloves, eye protection and a respirator, or equivalent or higher protection.

Descriptive epidemiology

• Carbapenemase-producing Enterobacterales  (CPE) are an important healthcare-associated infections (HAI) due to their limited treatment options. They have been associated with outbreaks in healthcare facilities worldwide and can lead to adverse clinical outcomes, and higher healthcare costs. ^{Footnote 1}

• In Canada, CPE were first detected in 2008. Case numbers have been increasing since, with several large outbreaks reported.^{Footnote 1}

• Rates of CPE in Canada have increased from 0.05 per 10,000 patient days in 2020, to 0.20 per 10,000 patient days in 2024. However, all-cause mortality of CPE has decreased from 18.0 deaths per 100 cases in 2020, to 15.1 deaths per 100 cases in 2024.^{Footnote 2}

Organization: Public Health Agency of Canada

Date published: 2026
Cat.: HP40-404/2026E-PDF
ISBN: 978-0-662-03949-5
Pub.: 260118

Carbapenemase-Producing Enterobacterales (CPE) are a group of antibiotic-resistant organisms capable of producing enzymes that can break down carbapenem antibiotics.

Transmission

• Contact transmission requiring contact precautions in a private room with a private washroom or dedicated commode.
• Contaminated sinks and drains can form biofilms of CPE and result in transmission from splashing.
• Patients should be placed a minimum distance of 1 metre (3 feet), or greater, from sinks, showers and drains.

Personal protective equipment (PPE)

• Gloves should be worn at all times while in the patient care environment.
• A long-sleeved gown should be worn if clothing or forearms will be in contact with the patient or patient care environment.
• Visitors should wear the same PPE as health care workers when in the patient care environment.

Disinfection

• All horizontal and frequently touched surfaces should be cleaned a minimum of once daily using a Health Canada-approved hospital disinfectant with claims of efficacy against CPE.
• Given their complex structure and documented role in transmission, endoscopes should be effectively reprocessed.

Screening

Individuals with any of the following risk factors are considered high risk and should be screened upon admission:

• Hospitalization outside of the country in the past 12 months
• Previous CPE infection or colonization
• Transfer from, or previous admission to, a facility with a CPE outbreak in the past 12 months
• Epidemiological linkage to a confirmed case of CPE infection or colonization
• Residence in an area with a high community incidence of CPE

Screening should include a swab of the rectum, previously positive sites and any clinically relevant sites.

Outbreak management

• An outbreak is considered 2 or more confirmed cases of CPE, not known to be colonized or infected prior to or upon admission, epidemiologically linked in time and place.
• Health care facilities should conduct contact tracing of close contacts.
• Close contacts are patients who have shared the same room or bathroom as a patient colonized or infected with CPE for an extended period of time, such as 24 hours.
• Increased cleaning and disinfection of the care environment should be implemented.