Enhanced Barrier Precautions

 

To: Nursing Home Communities    From: Janell Nichols, HAI/AR Program    Enhanced Barrier Precautions (EBP) CDC has released updated guidance for the use of personal protective equipment (PPE) in nursing homes to prevent the spread of multidrug-resistant organisms (MDROs) which are common in skilled nursing facilities, contributing to substantial resident morbidity and mortality and increased healthcare costs. Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of MDROs through gown and glove use by nursing home staff. EBP are recommended (when Contact Precautions do not otherwise apply) during high-contact care activities with residents who are at higher risk of acquiring or spreading an MDRO. Key updates include:    Expanded the use of EBP during high-contact resident care activities to include any residents of a nursing home with an indwelling medical device or wound (regardless of MDRO colonization or infection status), as well as residents with known infection or colonization with an MDRO. Examples of high-contact resident care activities requiring gown and glove use for EBP include:  Dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use (e.g., central line, urinary catheter, feeding tube, tracheostomy/ventilator), and wound care/skin care (e.g., any skin opening requiring a dressing). Expanded the list of MDRO's for which EBP applies (i.e., beyond Carbapenemase-producing organisms (CPOs)). Additions include, but are not limited to: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-producing Enterobacterales, Vancomycin-resistant Enterococci (VRE), Multidrug-resistant Pseudomonas aeruginosa, and drug-resistant Streptococcus pneumonia. Updates also include clarification that, in the majority of situations, EBP are to be continued for the duration of a resident's admission.  These updated recommendations are meant to protect nursing home residents and staff from spreading MDROs, which can cause serious and hard-to-treat infections, while avoiding restrictions on resident activities or a need for private rooms, unlike with Contact Precautions. These recommendations are not intended for use in acute care or long-term acute care hospitals and does not replace existing guidance regarding the use of Contact Precautions for other pathogens (e.g., Clostridioides difficile, norovirus) in nursing homes. Additional information can be found by visiting: https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html Email CDPHE's HAI/AR program at cdphe_hai_ar@state.co.us if you have any questions regarding EBP or have other infection prevention needs (Non-COVID).