Enhanced Barrier Precautions for multi-drug-resistant organisms

29Sep 2023 by Lauren Davis

Transmission of multi-drug-resistant organisms (MDROs) has a high impact on skilled nursing residents. Infections with these pathogens are difficult to treat and limited treatments are available. Preventing the transmission of multi-drug-resistant organisms (MDROs) among skilled nursing residents is imperative. (CDC, 2021) In 2019 the CDC introduced the Enhanced barrier precautions (EBP) as a way to help prevent spread of MDRO’s. EBP are a set of infection control measures used in skilled nursing facilities to reduce the risk of spreading infections, particularly those that may be transmitted through contact with bodily fluids, respiratory secretions, or contaminated surfaces. These precautions go above and beyond the standard precautions, and are typically implemented when dealing with patients who are known or suspected to have highly contagious MDROs (CDC, 2022).

Enhanced barrier precautions expand the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for the transfer of MDRO’s to staff hands and clothing. Skilled nursing residents with wounds and indwelling medical devices are at an especially high risk of contracting an MDRO.                                

Key points:

  • Multidrug-resistant organism (MDRO) transmission is 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 resistant organisms that employs targeted gown and glove use during high contact resident care activities.
  • EBP may be indicated (when Contact Precautions do not otherwise apply) for residents with any of the following:
    •  Wounds or indwelling medical devices, regardless of MDRO colonization status
    •  Infection or colonization with an MDRO
  • Effective implementation of EBP requires staff training on the proper use of personal protective equipment (PPE) and the availability of PPE and hand hygiene supplies at the point of care.
  • Standard Precautions, which are a group of infection prevention practices, continue to apply to the care of all residents, regardless of suspected or confirmed infection or colonization status (CDC, 2022).

How can we implement enhanced barrier precautions?                                                               

  • Post clear signage on the door or wall outside of the resident’s room, with clear indication of the type of precautions required.
  • Make sure that PPE is available, and located immediately outside of the resident’s room.
  • Ensure that there is access to alcohol based-hand rub in every resident’s room.
  • Position a trash can inside the resident’s room, and near the exit, for discarding PPE after removal and before exiting the room. Always change PPE and wash hands/sanitize in-between residents, even those living in the same room.
  • Monitor hand hygiene and PPE use, to determine adherence and additional opportunities for training and education.
  • Provide education to residents and visitors to keep them safe.

What if there is no sign outside of the resident’s door? When do I know that I need to use EBP?

  • Dressing
  • Bathing/showering
  • Transferring
  • Providing hygiene
  • Changing linens
  • Changing briefs or assisting with toileting
  • Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator
  • Wound care: any skin opening requiring a dressing

This document is not intended for use in acute care or long-term acute care hospitals and does not replace existing guidance regarding use of Contact Precautions for other pathogens (e.g., Clostridioides difficile, norovirus) in nursing homes (CDC, 2022).

Reference:

Centers for Disease Control and Prevention. (2022, July 12). Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDRO). Retrieved Sept 21, 2023, from Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) | HAI | CDC

Links to include within newsletter:

Resources for Enhanced Barrier Precautions:

Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) https://www.cdc.gov/hai/containment/PPE-NursingHomes.html

Consideration for Use of Enhanced barrier Precautions in Skilled Nursing Facilities. June 2021. https://www.cdc.gov/hicpac/pdf/EnhancedBarrierPrecautions-H.pdf

Frequently Asked Questions (FAQs) about Enhanced Barrier Precautions in Nursing Homes https://www.cdc.gov/hai/containment/faqs.html

Considerations for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities https://www.cdc.gov/hicpac/workgroup/EnhancedBarrierPrecautions.html?msclkid=39038417aed311ec 8c868e1e03c50297

   Videos 

Print Resources