Public health and facility response

Given the relative rarity of C. auris in the pediatric population, collaboration and communication with local IPC (see SM Table 2) and public health partners are essential. ^14,30,39

General recommendations

• • Report possible or confirmed cases of C. auris infection immediately to the clinical team, local IPC, and public health partners. Reporting thresholds may vary by jurisdiction resulting in different recommendations in certain circumstances ^7,14,39,40 ; however, healthcare facilities should have a low threshold for reporting cases in pediatric patients to public health partners.

• • Collaborate with local IPC and public health partners to receive guidance and determine the response for newly identified cases of C. auris, suspected or confirmed transmission of C. auris in a healthcare facility, or high rates of local community transmission. ^14,30,39

No additional pediatric recommendations.

Identifying patient risk factors and risk mitigation

General recommendations

• • Identify the patient’s risk factors for C. auris colonization or infection which may include ^{Reference Alvarado-Socarras, Vargas-Soler, Franco-Paredes, Villegas-Lamus, Rojas-Torres and Rodriguez-Morales15,Reference Danielsen, Odeskaug and Raastad28,30,41} :

  • ○ Known epidemiologic link to C. auris and/or clinical risk factors:

    • ▪ Exposure in a healthcare facility, eg, sharing the same room, spending time in a shared care area with a patient with C. auris even if the person with C. auris has been discharged or is no longer in the care area, or using mobile equipment that was used by a patient with C. auris colonization or infection.

    • ▪ Care in a healthcare facility with current, suspected, or confirmed C. auris transmission or in a community with high C. auris transmission rates.

    • ▪ Whenever a patient who is colonized or infected with C. auris is transferred to another facility, include their C. auris status in the medical record and in verbal and written transfer information. Also provide whether the facility has current, suspected, or confirmed C. auris transmission.

  • ○ Clinical factors:

    • ▪ Presence of an indwelling medical device (eg, CVC, tracheostomy tube, gastrostomy tube, urinary catheter), mechanical ventilation, or the use of parenteral nutrition.

    • ▪ Treatment with broad spectrum antimicrobials such as third generation cephalosporins or carbapenem agents or prolonged antifungal prophylaxis.

• • Risk mitigation:

  • ▪ Assess the need for all modifiable risk factors daily, including use of indwelling medical device(s) and antimicrobials. ^41–45

  • ▪ Adhere to care bundles for medical device care. ^{Reference Buetti, Marschall and Drees42–Reference Patel, Advani and Kofman44}

No additional pediatric recommendations. See Background, Risk Factors section for risk factors unique to pediatric populations.

Education, training, monitoring, and adherence

At the time of developing these recommendations, C. auris infection or colonization remains relatively rare in pediatrics. HCP, caregivers, and other close contacts (see SM Table 2), for example household members, may be unaware of this pathogen and unfamiliar with strategies to prevent transmission in pediatric healthcare and non-healthcare settings. ¹

This section applies to the following circumstances:

• • Caregivers or HCP who interact with pediatric patients who are colonized or infected with C. auris

• • Caregivers who are known to be colonized or infected with C. auris

• • Caregivers who are at higher risk of C. auris colonization or infection due to a known exposure to C. auris (see Risk Factors) and their underlying health status

• • HCP and support staff working in healthcare settings with suspected, confirmed, or ongoing C. auris transmission

General recommendations

• • Provide HCP and support staff in facilities with suspected, confirmed, or ongoing C. auris transmission with regular education and training on prevention of C. auris. ^{Reference Popovich, Aureden and Ham46} Include the following ^1,2,47 :

  • • Risks of environmental transmission of C. auris

  • • Proper cleaning and disinfection protocols

  • • IPC protocols

  • • When to suspect C. auris based on epidemiologic risk factors and clinical context and when to notify local IPC or infectious diseases specialists.

• • Monitor adherence to IPC protocols and provide feedback to staff and leadership. ^2,13

Additional pediatric recommendations

1. (unanimous consensus) Educate the caregivers, family members, and visitors of a child in an acute care setting who is infected or colonized with C. auris about strategies to reduce the risk of acquisition or transmission of C. auris during hospitalization. ^2,13 Include the following education:

• • Components of Standard Precautions (see SM Table 2)

• • When and how to perform hand hygiene

• • When and how to safely don and doff PPE, especially gloves and gowns.

Remarks:

• • As children require close contact with their caregivers for their care and well-being, provide verbal and written education in plain language describing prevention strategies for C. auris during hospitalization and at hospital discharge to mitigate the risk of C. auris transmission. ¹³

• • Caregivers and visitors should be educated to avoid shared spaces and contact with other patients, and their movement within the facility should be limited to direct room-to-exit routes. ¹

• • Educate visitors to always wear PPE for Contact Precautions (ie, gloves and gowns) while in the patient room. ^2,13 This does not apply to caregivers who are rooming in with patients (see Recommendation 8).

• • Reinforce education during prolonged hospitalizations (expert opinion).

2. (unanimous consensus) Educate caregivers and visitors who are known to be colonized or infected with C. auris about strategies to reduce transmission to the hospitalized pediatric patient and reduce transmission to close contacts after discharge (see Recommendation 1 for topics of education). ^2,13,48

Remark:

• • If a caregiver or visitor is known to be colonized or infected with C. auris, document this in the child’s medical record.

3. (consensus) Provide caregivers with discharge information on C. auris in plain language that includes disclosure information (see Recommendations 34 and 35) and strategies to prevent transmission of C. auris in healthcare and non-healthcare congregate settings. ^{2,Reference Guzman-Cottrill, Blatt and Bryant27,Reference Shope and Hashikawa49,Reference Rathore and Jackson50}

Remarks:

• • The information may be shared with HCP in ambulatory care and non-healthcare congregate settings.

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 0 disagreed and 1 abstained).

Surveillance and screening

Currently, approaches to surveillance and screening for C. auris vary across settings and epidemiologic context and are not standardized. ^{Reference Hennessee, Forsberg, Beekmann, Polgreen, Gold and Lyman51} Screening may be used to determine if exposed patients (see SM Table 2) have become colonized.

General recommendations

• • Place exposed patients who have a positive screening test for C. auris on Contact Precautions.

• • When a facility suspects or identifies ongoing C. auris transmission, perform point prevalence surveys every 7 to 14 days on the entire unit, not just sub-sections of the unit. ^{Reference Shuping, Maphanga and Naicker18,39,Reference Aldejohann, Wiese-Posselt, Gastmeier and Kurzai52}

  • • Reduce the frequency of the surveys as transmission decreases. ³⁹

• • Perform contact tracing of additional patients (not on the unit) at high risk for C. auris and include in point prevalence surveys (see Risk Factors). ^{14,Reference Alvarado-Socarras, Vargas-Soler, Franco-Paredes, Villegas-Lamus, Rojas-Torres and Rodriguez-Morales15,Reference Danielsen, Odeskaug and Raastad28,39,41,Reference McPherson, Walblay and Roop53}

• • Do not re-screen patients with known C. auris colonization or infection to assess their status or to remove Contact Precautions. ⁴¹

• • Do not screen healthcare personnel (HCP) for C. auris. ⁴¹

Additional pediatric recommendations

4. (unanimous consensus) Do not screen patients admitted to the NICU or other acute units unless one of following known exposures to C. auris exists (expert consensus):

• • A birth parent, caregiver, or other close contact is colonized or infected with C. auris.

• • The patient is breastfed by a caregiver who is colonized or infected with C. auris.

• • The patient is sharing space or equipment with patients, including adult patients, who have C. auris colonization or infection.

• • The patient was transferred from a facility with suspected, confirmed, or ongoing C. auris transmission.

Remarks:

• • Undertake screening in coordination with local IPC and public health partners.

• • For healthy newborns who (1) are rooming in (see SM Table 2) with a birth parent colonized or infected with C. auris and (2) do not require NICU care, routine screening is not recommended because screening results would not alter immediate management (see Recommendation 10).

• • Do not perform screening solely on the basis of transfer from another healthcare facility, including acute care hospitals, institutions with mixed adult and pediatric patients, long-term care or rehabilitation facilities, or facilities outside of the United States, unless there is suspected, confirmed, or ongoing C. auris transmission in the transferring facility. ^{14,Reference Alvarado-Socarras, Vargas-Soler, Franco-Paredes, Villegas-Lamus, Rojas-Torres and Rodriguez-Morales15,Reference Danielsen, Odeskaug and Raastad28,39,41,Reference McPherson, Walblay and Roop53} The risk of interfacility transmission is lower for pediatric patients because: C. auris is rare in pediatric facilities; pediatric long-term care and postacute care facilities have fewer transfers to acute care hospitals; and pediatric facilities are sparsely distributed and patient volumes are lower. ^{Reference McPherson, Walblay and Roop53,Reference Straka, Franca, Franks and McManus54}

• • If pediatric patients share spaces (eg, radiology suite, surgical suite, procedure room) or equipment with other patients, including adult patients, with C. auris colonization or infection or with adult or pediatric patients linked to C. auris transmission, consult local IPC partners to determine which pediatric patients should be screened. ^{14,Reference Alvarado-Socarras, Vargas-Soler, Franco-Paredes, Villegas-Lamus, Rojas-Torres and Rodriguez-Morales15,Reference Danielsen, Odeskaug and Raastad28,39,41,Reference McPherson, Walblay and Roop53}

• • Identified evidence was insufficient to inform the timing and frequency for screening children for C. auris who have ongoing, prolonged exposure to a caregiver or other close contact who is colonized or infected with C. auris.

5. (consensus) For an infant in the NICU whose birth parent is colonized or infected with C. auris, screen the infant to inform IPC decisions and empiric antimicrobial therapy, using the following recommended screening intervals ^{Reference Mesini, Saffioti and Mariani31,Reference Magnasco, Mikulska and Sepulcri55,Reference Biswal, Rudramurthy and Jain56} :

• • At birth, after bathing

• • On the seventh day of life if the neonate (see SM Table 2) remains hospitalized

• • Every 2 weeks thereafter if the infant remains hospitalized

• • As needed to inform decision-making

• • At hospital discharge

• • At readmission.

Remarks:

• • Identified evidence was insufficient to determine how long an infant who was discharged from the NICU remains at risk of colonization or infection.

• • An 800-gram, 25-week neonate acquired C. auris within hours of birth following vaginal delivery to a birth parent with a positive vaginal swab. ^{Reference Mesini, Saffioti and Mariani31}

• • In patients with recent admission to an adult ICU setting with ongoing C. auris transmission, the median interval between the last negative and first positive screening sample was 6 days (IQR 4–12). ^{Reference Magnasco, Mikulska and Sepulcri55}

• • In an adult trauma ICU outbreak, all patients (n = 10) became colonized with C. auris by hospital day 4. ^{Reference Biswal, Rudramurthy and Jain56}

• • Consensus achieved with 85% agreement (17 of 20 panelists agreed, 0 disagreed and 3 abstained).

6. (consensus) Do not screen caregivers and other close contacts of pediatric patients colonized or infected with C. auris unless the caregiver or other close contact requires frequent inpatient healthcare interactions. ^14,39,41,57

Remarks:

• • Advise caregivers and other close contacts with frequent inpatient healthcare hospitalizations to discuss being screened for C. auris with the healthcare team managing their inpatient care. Screening results can inform whether Contact Precautions are needed for their subsequent admissions and/or empiric antimicrobial treatment. ^2,39,57

• • Identified evidence was insufficient to inform the timing and frequency of screening high-risk caregivers and other close contacts expected to have repeated, long-term exposure to their child, including with bodily fluids and skin.

• • Consensus achieved with 85% agreement (17 of 20 panelists agreed, 2 disagreed and 1 abstained).

Contact precautions and hand hygiene

General recommendations

• • Implement Contact and Standard Precautions for patients infected or colonized with C. auris. ²

• • Ensure HCP, caregivers, and visitors perform hand hygiene before entering and after exiting the room of a patient infected or colonized with C. auris and before and after direct contact with a patient or their environment or items. ²

• • Perform hand hygiene using alcohol-based hand sanitizer or soap and water when hands are visibly soiled. ^{2,39,62,Reference Boyce and Pittet63}

• • Gloves are not a substitute for hand hygiene. ^{2,62,Reference Boyce and Pittet63} Perform hand hygiene before putting on gloves and after removing gloves.

• • Maintain Contact Precautions for the duration of hospitalization and during future acute care admissions. ^2,41

Additional pediatric recommendations: Infants and children colonized or infected with C. auris

8. (consensus) Implement Contact and Standard Precautions for C. auris per local IPC and public health recommendations.

Remarks:

• • For pediatric patients with prolonged hospitalizations who experience mental health decline attributable to environmental monotony, collaborate with local IPC partners to assess whether children can safely leave their hospital room for reasons other than a medical procedure (expert opinion).

• • Caregivers are not expected to wear PPE continuously while rooming in. Caregivers should follow facility policies for PPE outside the patient’s room (see Room placement and cohorting).

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 1 disagreed and 0 abstained).

9. (consensus) Work with local IPC and public health partners to determine the duration of Contact Precautions for a pediatric patient’s current and future admissions to acute care (expert opinion).

Remarks:

• • Identified evidence was insufficient to inform the duration of Contact Precautions for C. auris for infants and children for current and future admissions.

• • Contact precautions for all future admissions may impact the clinical care of infants or children with complex medical needs who will have frequent healthcare interactions over many years or may cause anxiety and stress in such children and/or their caregivers. ^{Reference Sakai, Iensue and Pereira64,Reference Alvarez, Pike and Godwin65}

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 2 disagreed and 0 abstained).

Additional pediatric recommendations: Caregivers colonized or infected with C. auris

10. (consensus) Place hospitalized newborns, infants (including those in the NICU), and children on Contact Precautions if their caregiver is known to be colonized or infected with C. auris (expert opinion).

Remarks:

• • When a rooming in caregiver is colonized with C. auris and the child is in a single room, the caregiver does not need to wear PPE while in the patient’s room. The patient should remain on Contact Precautions so that HCP will continue to implement all required components.

• • Caregivers should avoid shared spaces and contact with other patients, and movement within the facility should be limited to direct room-to-exit routes. ¹

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 0 disagreed and 2 abstained).

11. (consensus) If known, document the caregiver’s colonization or infection with C. auris in the patient’s medical record for implementation of Contact Precautions for C. auris for the patient in the case of future healthcare admissions, including non-acute healthcare facilities (expert opinion).

Remarks:

• • Identified evidence was insufficient to inform the use of Contact Precautions for C. auris for future admissions if the child’s screening cultures are negative. However, the risk remains for transmission of C. auris to the child from continued close contact with their caregiver or other close contacts colonized or infected with C. auris.

• • Consensus achieved with 85% agreement (17 of 20 panelists agreed, 0 disagreed and 3 abstained).

12. (consensus) For current and future healthcare admissions, including long-term care, consult local IPC and public health partners to determine the appropriate duration for Contact Precautions for the child of a caregiver who is colonized or infected with C. auris (expert opinion).

Remarks:

• • Identified evidence was insufficient to inform the duration of Contact Precautions for infants and children with a caregiver who is colonized or infected with C. auris.

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 0 disagreed and 2 abstained).

Room placement and cohorting

General recommendations

• • Place a patient who has C. auris colonization or infection in a single-patient room with a dedicated bathroom, whenever possible. ²

• • If single rooms are unavailable, cohort patients together who have C. auris colonization or infection. ^{2,Reference Shuping, Maphanga and Naicker18}

Additional pediatric recommendations: Infants and children colonized or infected with C. auris

13. (consensus) Allow caregivers to room-in with pediatric patients colonized or infected with C. auris. ^{Reference Darby, Falco, McNeil, Campbell and Crews19,Reference Munoz-Price, Banach and Bearman66}

Remarks:

• • For overnight stays or extended visits, continuous use of PPE by caregivers may be impractical. ^{Reference Munoz-Price, Banach and Bearman66} Caregivers who are rooming in are not expected to wear PPE continuously while in the patient’s room, regardless of whether the caregiver or child is colonized or infected with C. auris; however, caregivers should follow facility policies for use of PPE outside the patient’s room (see Recommendation 8).

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 1 disagreed and 0 abstained).

14. (consensus) For NICUs with open bays or pods, follow local IPC and public health partner guidance for placement of isolettes or cribs of infants with C. auris colonization or infection (expert opinion).

Remarks:

• • The distance between isolettes or cribs recommended by local IPC and public health partners may vary depending on local resources.

• • The American Academy of Pediatrics and Facilities Guidelines Institute recommend 8 feet of distance between isolettes to facilitate care, privacy, and family involvement and to reduce the risk of transmission of potential pathogens. ^67,68

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 1 disagreed and 0 abstained).

Additional pediatric recommendations: Caregivers colonized or infected with C. auris

15. (unanimous consensus) Allow caregivers who are colonized with C. auris to room-in with their child. ^{Reference Darby, Falco, McNeil, Campbell and Crews19,Reference Munoz-Price, Banach and Bearman66}

16. (consensus) In accordance with local IPC guidance, before a caregiver with active C. auris infection rooms-in with a pediatric patient, confirm that they have received appropriate antifungal treatment and are showing signs of improvement. ^{Reference Banach, Bearman, Morgan and Munoz-Price69}

Remarks:

• • Compassionate care visitation laws vary among US states.

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 0 disagreed and 1 abstained).

Breastfeeding and skin-to-skin practices

No general recommendations.

Pediatric recommendations: Infants and children colonized or infected with C. auris

17. (unanimous consensus) Encourage and facilitate breastfeeding and skin-to-skin practices. ^{Reference Patnode, Henrikson, Webber, Blasi, Senger and Guirguis-Blake23–Reference Parker, Stellwagen and Miller26,Reference Akinboyo, Zangwill, Berg, Cantey, Huizinga and Milstone70}

Remark:

• • Identified evidence was insufficient to inform the risk of C. auris transmission from infants with C. auris colonization or infection to parents or caregivers during breastfeeding or skin-to-skin practices.

18. (unanimous consensus) Use shared decision-making (see SM Table 2) to guide breastfeeding and skin-to-skin practices for caregivers with underlying medical conditions or frequent inpatient healthcare exposures (expert opinion).

Remark:

• • Extrapolating from other guidance, if expressed breast milk (EBM) is stored, double-bag EBM and place in a separate freezer that is cleaned and disinfected daily. If a separate freezer is not available, place EBM on a dedicated freezer shelf that is cleaned and disinfected daily. ⁷¹

Pediatric recommendations: Caregivers colonized or infected with C. auris

19. (consensus) Use shared decision-making to guide breastfeeding and skin-to-skin practices for caregivers who are colonized or infected with C. auris, including decisions about cleansing the caregiver’s breasts or skin with soap and water before breastfeeding or skin-to-skin practices (expert opinion).

Remarks:

• • Identified evidence was insufficient to inform the risk of transmission of C. auris from the breast milk of caregivers colonized or infected with C. auris.

• • Breast milk does not need to be tested for C. auris before feeding the infant.

• • The immune-protective benefits of breastfeeding are well described. ^{Reference Patnode, Henrikson, Webber, Blasi, Senger and Guirguis-Blake23,Reference Davis, Castagna and Sela25,Reference Parker, Stellwagen and Miller26}

• • Identified evidence was insufficient to inform the benefits or harms of breast cleansing before breastfeeding or skin cleansing before skin-to-skin contact by caregivers who are colonized or infected with C. auris.

• • Cleansing with soap and water may remove the caregiver’s normal skin flora which could interfere with the transfer of beneficial flora to preterm infants during skin-to-skin contact. This transfer of normal flora supports immune development, reduces colonization with potential pathogens, and accelerates oral microbiome maturation. ^{Reference Hendricks-Munoz, Xu and Parikh24,Reference Dube-Zinatelli, Mayotte, Cappelletti and Ismail72–Reference Altit, Hamilton and O’Brien74}

• • If EBM is stored, double-bag EBM and place in a separate freezer that is cleaned and disinfected daily or if a separate freezer is not available, place EBM on a dedicated freezer shelf that is cleaned and disinfected daily.

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 0 disagreed and 1 abstained).

20. (consensus) Instruct a caregiver with C. auris infection involving the milk ducts or an active cutaneous lesion involving the breast to avoid breastfeeding or to discard EBM (expert opinion).

Remark:

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 0 disagreed and 2 abstained).

21. (consensus) Instruct a caregiver with C. auris infection to prevent the infant from contacting areas with active infection (expert opinion).

Remark:

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 0 disagreed and 1 abstained).

Visitation and common spaces

No general recommendations

Pediatric recommendations

22. (consensus) Consult local IPC to develop policies for pediatric patients with C. auris colonization or infection, including patients in the NICU or the newborn nursery, that address the following (expert opinion):

• • Visitation by siblings

• • Visitation by caregivers or visitors who are colonized or infected with C. auris

• • PPE use by caregivers who are rooming in

• • PPE use by visitors who are not rooming in

• • Temporary transport to shared care areas (eg, procedural areas)

• • Appropriate use of common spaces (eg, kitchens, washing machines, lounges, child life areas) by caregivers, visitors, and siblings, including any necessary restrictions or mitigation strategies.

Remarks:

• • For overnight stays or extended visits, continuous use of PPE by caregivers may be impractical. ^{Reference Munoz-Price, Banach and Bearman66} (see Recommendations 8, 10, 13).

• • Extrapolating from other guidance, crowded patient rooms, bedsides of multi-patient rooms, or NICU pods increase the risk of transmission and the number of potentially exposed individuals. ^{Reference Akinboyo, Zangwill, Berg, Cantey, Huizinga and Milstone70,Reference Andersen, Lindemann and Bergh75}

• • Consider risks to visitors with underlying medical conditions. ^{Reference Darby, Falco, McNeil, Campbell and Crews19,Reference Munoz-Price, Banach and Bearman66} (see Recommendation 6)

• • Use shared decision-making with caregivers to determine appropriate visitation.

• • In accordance with guidance from local IPC and public health partners, visitation may be temporarily restricted during C. auris outbreaks. ^{Reference Munoz-Price, Banach and Bearman66}

• • Discuss exceptions for compassionate care visitation. Compassionate care laws vary by US state.

• • Consensus achieved with 95% agreement (19 of 20 panelists agreed, 1 disagreed and 0 abstained).

Decolonization

General recommendations

• • Currently, no agent has been identified to be effective and efforts to decolonize do not prevent transmission of C. auris. ^2,14

• • Emphasize personal hygiene, especially of known colonized skin areas (such as the axillae, inguinal folds, palms) which can decrease the bioburden of C. auris and therefore reduce the likelihood of transmission. ^{Reference Ashkenazi-Hoffnung and Rosenberg Danziger16}

• • The effects of chlorhexidine on reducing skin burden or infection with C. auris have not been systematically studied. ^1,2

No additional pediatric recommendations.

Supplies, medical and non-medical equipment, and environmental cleaning and disinfection

General recommendations

• • For patients with C. auris colonization or infection ^1,2,39

  • • Use single-patient or disposable equipment whenever possible.

  • • Use single-patient supplies, such as sterile ultrasound gel packets.

  • • Use impermeable, sealed bags to handle linens and waste.

  • • Use standard healthcare laundering.

• • At least daily, clean and disinfect the rooms of patients with C. auris colonization or infection with an EPA-registered product effective against C. auris. ^{2,Reference Adams, Quinn and Tsay29,Reference Tsay, Welsh and Adams76}

• • Terminally clean (see SM Table 2) the patient’s room at hospital discharge and shared spaces (eg, occupational and physical therapy areas) that were used by patients with C. auris colonization or infection. ²

• • Clean and disinfect medical equipment after each use by patients with C. auris colonization or infection (eg, glucometers, ventilators, ultrasound machines, blood pressure cuffs). ^2,12

• • Label disinfected medical equipment and separate it from dirty equipment. ²

• • For disinfection of rooms and mobile and reusable equipment, use EPA-registered products (see SM Table 2) effective against C. auris (List P). ^2,14,77

• • Follow the MIFU for disinfectants’ contact times. ⁷⁷

• • Data on “no touch” devices such as germicidal UV irradiation and vaporized hydrogen peroxide are limited and parameters for effective disinfection are not well understood. Facilities may use these supplemental methods only after completing recommended standard cleaning and disinfection. ²

Additional pediatric recommendations

23. (consensus) Follow disinfection requirements for specialized pediatric equipment, including items with complex MIFUs, such as incubator and warmer beds, isolettes, milk warmers, X-ray plates and machines, ultrasound probes and machines, ophthalmology equipment, and audiology equipment. ^1,67

Remarks:

• • If possible, dedicate equipment for physical and occupational therapy to a single patient and perform sessions in the patient’s room.

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 1 disagreed and 1 abstained).

24. (consensus) Select non-medical equipment (eg, toys, tablets, video game consoles, and controllers) that are compatible with an EPA-registered product effective against C. auris and establish cleaning and disinfecting protocols with local IPC and child life specialists (expert opinion).

Remarks:

• • Preferentially choose non-porous toys that can be cleaned and disinfected at discharge or porous toys that remain with the patient throughout hospitalization. ^{Reference Koutlakis-Barron and Hayden78} Options for processing toys at patient discharge include:

  • • Placing toys in a plastic bag and instructing families to wash the toys at home in hot water.

  • • Cleaning and disinfecting non-porous toys for re-use.

  • • Discarding the toys if unable to effectively clean and disinfect.

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 0 disagreed and 2 abstained).

25. (consensus) If possible, dedicate toys for exclusive use by an infant or child on Contact Precautions for C. auris. ^{Reference Koutlakis-Barron and Hayden78}

Remark:

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 0 disagreed and 2 abstained).

26. (consensus) For caregivers colonized or infected with C. auris, and for infants colonized or infected with C. auris, dedicate breast pumps and accessories for exclusive use by the breastfeeding caregiver to use in the infant’s room. Clean and disinfect the pump and accessories after each use with an EPA-registered product effective against C. auris. ^77,79

• • If a single patient room is not available, use an individual lactation room. Clean and disinfect high-touch surfaces (see SM Table 2) and equipment after each use with an EPA-registered product effective against C. auris. ^{77,Reference Kenters, Kiernan and Chowdhary80,Reference Ahmad and Asadzadeh81}

• • If an individual lactation room is not available, use the communal lactation room. Clean and disinfect high-touch surfaces and equipment after each use with an EPA-registered product effective against C. auris. ^2,79

Remark:

• • Consensus achieved with 85% agreement (17 of 20 panelists agreed, 1 disagreed and 2 abstained).

27. (consensus) For pediatric patients whose caregiver is C. auris colonized or infected, clean and disinfect the patient’s room and medical and non-medical equipment (see General Recommendations, Recommendation 23, Recommendation 26) at least daily (expert opinion).

Remarks:

• • The patient’s room and equipment have likely become contaminated with C. auris from their caregiver, which poses ongoing risk to the child and other patients on the unit.

• • Consensus achieved with 90% agreement (18 of 20 panelists agreed, 1 disagreed and 1 abstained).

Communication and documentation

General recommendations

• • Place alerts in the medical record that indicate patients with C. auris colonization or infection. ²

• • Place visible signage for Contact Precautions outside the patient’s room. ²

• • Limit transport of patients with C. auris colonization or infection to medically necessary procedures. ²

• • To ensure continuity of Contact Precautions, notify receiving departments or facilities of a patient’s C. auris status. ²

No additional pediatric recommendations.