HAIs and the Rise of Candida auris
- johnny3283
- Jul 1
- 14 min read
Key Takeaways
Healthcare-associated infections (HAIs) remain a major challenge in clinical environments, with Candida auris emerging as one of the most resilient threats.
Environmental surfaces and biofilms play a central role in pathogen transmission.
Current disinfection methods, including frequent cleaning with traditional chemistries, are not sufficient to prevent the spread of C. auris.
Avantamine, a novel stabilized polymer chloramine, offers a non-corrosive, skin-compatible, and long-lasting solution capable of addressing C. auris on surfaces and in biofilms.
Despite aggressive infection control protocols, Candida auris continues to defy traditional disinfection strategies—especially on high-touch hospital surfaces. But a new class of chlorine-based disinfectants may offer a long-overdue breakthrough: Avantamine, a stabilized polymer chloramine, is proving effective where others fail.
In this article, we explore why C. auris has become such a resilient and costly threat—and how a next-generation technology like Avantamine is engineered to solve it.
From HAI to C. auris
HAIs are a significant human health concern: The World Health Organization (WHO) reports that healthcare-associated infections (HAIs) affect hundreds of millions of patients worldwide each year. Estimated prevalence in hospitals ranges from 5-12% in developed countries and 5-19% in developing ones [1]. Approximately 1.7 million HAIs occur annually in U.S. hospitals, resulting in 99,000 deaths—more than prostate and breast cancer combined—and generating an estimated $35 billion in healthcare costs [2]. The reduction of HAIs is a top priority for the U.S. Department of Health and Human Services [3].
The emergence of Candida auris: C. auris is a newer pathogen primarily linked to healthcare settings, not community spread. Up to 20% of colonized patients develop invasive infections, and the 30-day mortality rate can reach 40% [4-6]. This poses a major risk to the 9 million immunocompromised individuals in the U.S.
Environmental Transmission
One third of HAIs are from the environment: Cross-contamination from healthcare workers’ hands and environmental surfaces accounts for 20–40% of HAIs [7-8]. Pathogens like vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) can persist on surfaces for days, increasing transmission risks [7, 9-11]. These pathogens are frequently transferred via contact with contaminated surfaces during patient care [12]. The risk is heightened if new patients are placed in rooms previously occupied by infected individuals [13-16].
Biofilm: A Major Contributor to Resistance
Persistent and resistant: Pathogens within biofilms are estimated to account for 75% of bacterial infections and are up to 1,000 times more resistant to disinfection than their planktonic counterparts [17-18].
Widespread contamination: A 2018 study found biofilms on over 95% of surfaces sampled in UK hospitals—including food trolleys, commodes, folders, keyboards, and sanitizer bottles [19]. Another ICU study detected biofilms in 100% of samples examined [20].
Harboring superbugs: Biofilms often contain multi-drug resistant organisms like ESBL-producing Klebsiella pneumoniae and MRSA [20]. SEM imaging confirmed that MRSA can be deeply embedded in these structures, making them even harder to eliminate.
Cleaning challenges: Outbreaks have been traced to hard-to-reach biofilm reservoirs like sinks and drains [21-24]. Despite growing awareness, few commercial disinfectants have proven effective against biofilms [25].
A Unique and Growing Challenge
C. auris is particularly dangerous because it can colonize skin, persist on surfaces, resist routine disinfectants, and trigger large outbreaks. In some facilities, colonization rates exceed 70% [26-37].
In a large multi-facility study, Sansom et.al. found C. auris on 32% of room surfaces before cleaning—and 20% as soon as 4 hours after disinfection [37]. This shows that even twice- or six-times-daily cleaning isn't enough. There’s a clear need for disinfectants with residual efficacy lasting at least 24 hours.
Transmission Prevention
The protocol: Patients with suspected or confirmed C. auris infections are isolated under Contact Precautions. This involves individual rooms, 3 feet of space between beds, PPE usage, and terminal cleaning after discharge [38-40].
The cost: Implementing Contact Precautions costs an average of $158/day or $57,670 annually per patient [41]. A single 34-patient outbreak cost one hospital over $1 million [42].
The growth: In 2023, the CDC reported 13,800 C. auris cases—a 70% increase from 2022. Cases from 2019 to 2023 increased by 32%, 166%, 48%, and 70% respectively. Excluding the COVID-period spike, average growth is 50%. At this pace, cases could exceed 100,000 by 2028, costing $5.7 billion annually for Contact Precautions alone [43].
Skin Colonization
C. auris thrives in high-salt, high-temperature environments and colonizes up to 95% of patients' skin without invading deeper tissues [6, 44-48]. It is commonly found in the axilla, groin, nares, palms, and perianal skin [44]. Multisite colonization increases the risk of invasive fungal infections, particularly for patients with catheters, wounds, or other indwelling devices [6, 47, 51].
No current decolonization protocol exists. Personal items like bedding can reintroduce the pathogen [52]. Nearly all C. auris carriers in the Sansom et al. study were also co-colonized with high-priority bacterial MDROs [37]. The CDC has labeled C. auris an urgent threat [53-55].
Current Disinfection Shortcomings
No products currently offer residual disinfection claims against C. auris. The only residual disinfectant on the market, Microban24, targets S. aureus and P. aeruginosa, not fungi. Its quaternary ammonium compound base is not considered effective against C. auris [57].
EPA guidance recommends products on List P (C. auris) and List K (C. diff), limiting choices to hydrogen peroxide, peracetic acid blends, and chlorine-based solutions like bleach [58].
High-concentration bleach is effective but corrosive and irritating, limiting use to terminal disinfection [38, 57, 59].
A New Class of Disinfectant - Avantamine
A breakthrough compound: Avantamine combines the efficacy of bleach with a non-corrosive, skin-compatible profile. It enables routine use of high-concentration disinfectants for faster and more complete kills, and residual disinfection between cleaning cycles.
Bio-inspired design: Avantamine is modeled after taurine chloramine—an antimicrobial created by human neutrophils—but stabilized for shelf life using polymer technology [60-62].
Advantages include:
Effective in both liquid and solid forms
Maintains potency without chlorine release into solution
Functions across pH ranges
Available in various formats (gel, powder, liquid)
Why Avantamine Matters
Avantamine changes the traditional tradeoff between safety and efficacy by delivering a fast-acting, broad-spectrum antimicrobial effect with negligible risk of resistance. Its large molecular size minimizes cellular uptake and reduces the risk of systemic toxicity, enhancing its safety profile. In addition, Avantamine is non-corrosive and shelf-stable for up to five years, making it a practical and durable solution for healthcare environments.
Preliminary results:
No dermal irritation at 0.6% chlorine (rabbit model)
Comparable kill rates to other chlorinated disinfectants
Effective against biofilms of C. auris, MRSA, and P. aeruginosa
Low corrosivity on stainless steel and plastics
Residual disinfection proven in EPA biofilm protocol testing
Conclusion
The growing threat of Candida auris demands new solutions—not just more frequent cleaning. Avantamine offers a promising step forward: effective, long-lasting, and safe for routine use. As C. auris continues to challenge healthcare systems worldwide, solutions like Avantamine could make all the difference.
FAQs
How long does Avantamine’s residual efficacy last?
Avantamine’s residual efficacy can last for weeks. When left undisturbed on a surface, it retains about 90% of its active chlorine after 1 week and 70% after 4 weeks. Its long-lasting performance depends on factors like surface abrasion and cleanliness, but similar to how swimming pools stay disinfected with just a few parts per million of chlorine, Avantamine continues to provide protection over time.
Is Avantamine EPA-approved for C. auris?
Avantamine is not yet EPA approved and is still undergoing the lengthy registration process.
Can Avantamine replace bleach in hospital settings?
Yes, Avantamine can replace bleach in hospital settings. It delivers comparable disinfection efficacy while avoiding the surface corrosion and material damage commonly associated with bleach.
How is Avantamine different from other disinfectants on EPA Lists P and K?
The EPA keeps lists of disinfectants depending upon which types of pathogens they can kill. Avantamine will be added to both List P and K once Avantamine gets EPA approval.
Is Avantamine effective against biofilms in healthcare environments?
Yes, Avantamine is effective against biofilms in healthcare settings and will likely be one of the very few disinfectants to make biofilm claims.
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