This memo is to raise awareness of the increase in Candida auris cases in North Carolina in 2026 and recommend preventative actions for acute care hospitals to consider for implementation, including targeted admission screening and control measures. This guidance is intended to reduce the risk of C. auris transmission.
Background
C. auris can be multidrug-resistant and can cause life-threatening illness. It spreads easily in health care facilities and mostly affects people who are already very sick. People without risk factors generally do not become infected or colonized with C. auris.
C. auris has been increasing in the United States since the first case in 2016. Historically, North Carolina (NC) has had a low number of cases reported each year compared to other states in the region. Long-term acute care hospitals (LTACH) and ventilator-capable skilled nursing facilities (vSNF) are at higher risk of importation and sustained transmission because they provide care to high-acuity patients and have long average lengths of stay.
In 2026, NC has seen an increase in cases of C. auris and outbreaks in LTACHs. NC saw 15 reported clinical and screening cases of C. auris in 2024 and 22 in 2025. Preliminary analysis showed 47 reported clinical and screening cases in the first three months of 2026, already far surpassing 2025 case counts.
Admission screening can identify patients who need infection prevention interventions to prevent C. auris spread in your hospital. Screening eligible patients for C. auris upon admission is one way your facility can support patient safety efforts. This action can also help us better understand how widespread this organism is in NC.
Actions to Consider at your Facility
NCDHHS Division of Public Health recommends acute care hospitals consider C. auris colonization admission screening of patients transferring from LTACHs or vSNFs. Admission screening involves collecting axilla/groin swabs within 24 hours of admission. If admission screening is performed, facilities should consider contact precautions for screened patients until negative results are reported. If C. auris colonization screening results are positive, the patient should be placed on contact precautions for the duration of their stay, and the chart should be flagged in case of readmission. Disinfectants should be EPA registered and effective against C. auris (EPA’s List P). Disinfectants should be used per the manufacturer’s instructions, including adherence to contact time. Positive C. auris results should be communicated to transferring facilities upon discharge.
Implementation Considerations
Should your facility implement C. auris admission screening of patients transferring from a LTACH or vSNF, diagnostic testing and materials are currently available through public health for free from the regional Antimicrobial Resistance Laboratory Network (ARLN) in Maryland (MD) upon request. This resource is subject to change depending on federal funding availability. To request testing assistance, please email nchai@dhhs.nc.gov.
C. auris Colonization Screening via MD ARLN
- Specimen source: Composite swabs of the axilla and groin. Acceptable swabs include BD or Copan Eswabs.
- Testing method: RealTime-PCR positive specimens may be reflexed to culture for organism identification and whole genome sequencing.
- Turnaround time: Five working days from specimen receipt.
References
MDRO Prevention Strategies (CDC)
Maryland Department of Health ARLN
EPA’s Registered Antimicrobial Products Effective Against Candida auris [List P] (US EPA)