The Centers for Disease Control (CDC) on Tuesday July 12 released updated guidance on enhanced barrier precautions (EBP) in nursing homes related to the threat of multidrug-resistant organisms (MDRO). The guidance expands the use of gowns and gloves during high-contact resident care activities. Nursing home residents are at high risk for MDRO colonization which places them at high risk for serious illness. The use of EBP should now extend to any resident with an indwelling medical device or wound, regardless of MDRO colonization or infection status. The CDC cautioned that the new guidance does not replace existing recommendations for contact precautions. More information can be found on the CDC website at https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html.
Prevalence high in LTC
Nursing home residents have a high prevalence of MDRO colonization, putting them at risk for becoming seriously ill, according to CDC data. In fact, one large study across nursing homes found that almost 6 in 10 residents in facilities that are not ventilator capable were colonized with an MDRO. In ventilator-capable nursing homes, which care for the most complex residents, that proportion rose to 76%, or nearly 80 in 100 residents colonized with these organisms, according to Kara Jacobs Slifka, M.D., MPH.
Most of these colonizations remain undetected, Slifka, a medical officer with the CDC’s Infection Prevention and Control Response Team, said in a Wednesday nursing home stakeholder call. But transmission of these bugs, which can occur during patient care, contributes to “substantial resident morbidity and mortality” in nursing facilities, the CDC stated in an updated webpage at https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html
Apply EBP broadly
The new implementation guidance addresses this risk by expanding the range of residents for whom EBP use applies. EBP is no longer limited to outbreaks or specific MDROs and should be applied more broadly, Slifka said.
Along with residents who have an infection or colonization with an MDRO, the use of EBP should now extend to any resident with an indwelling medical device or wound, the new guidance stated. For these residents, EBP should be used no matter their MDRO colonization or infection status, and in most situations, EBP should be continued throughout the duration of the resident’s stay. The CDC also expanded the types of MDROs it includes in its EBP recommendations. Details on specific organisms can be found on the updated webpage. The new guidance does not replace existing recommendations on the use of contact precautions for other pathogens in nursing homes such as Clostridioides difficile and norovirus, the agency added.
Getting it right
Staff training and ready supplies are critical to getting these precautions right, the CDC further noted. The updated guidance includes practical suggestions for encouraging awareness of the facility’s expectations and increasing on-the-ground availability of supplies.
“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,” the CDC stated.
The new guidance can be found on the CDC’s website at https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html