07/14/2022
CDC Updates Enhanced Barrier Precautions
On July 12, The Centers for Disease Control (CDC) updated the enhanced barrier precaution (EBP) guidance for nursing homes. During the CMS nursing home stakeholder call, CDC provided a PowerPoint presentation that referenced a nursing study that identified four out of ten nursing home residents had undiagnosed Multidrug-resistant Organism (MDRO) colonization. CDC stated that EBP was updated due to a need for intervention to reduce the spread of MDROs that does not require isolating residents for long periods of time that also considers the extended duration residents can remain colonized. Enhanced Barrier Precautions are a method for reducing the spread of MDROs, while also reducing the isolation of residents, by using a gown and gloves to prevent contamination of healthcare personnel hands and clothing during the activities that have demonstrated the highest risk for transfer of MDROs.
EBPs are indicated for nursing home residents who have an infection or known colonization with an MDRO when Contact Precautions do not otherwise apply. Contact Precautions should still be used for the presence of acute diarrhea, draining wounds, or other sites of secretions or excretions that are unable to be covered or contained. Contact Precautions may be used for a limited time period during the investigation of a suspected or confirmed MDRO outbreak in consultation with public health.
Additionally, Enhanced Barrier Precautions are indicated for any nursing home residents who have wounds and/or indwelling medical devices, as these are residents at increased risk of becoming colonized with an MDRO. While prior guidance focused on MDRO outbreaks, novel and targeted MDROs, and limited areas of a nursing home that were experiencing an outbreak – EBP is no longer limited to outbreaks or specific MDROs and should be applied broadly for any nursing home residents that meet criteria. Specifically, EBP includes the use of a gown and gloves during high-contact resident care activities, including: dressing, bathing or showering, performing transfers, changing linens, providing hygiene, and changing a resident’s brief or assisting them with toileting. Additionally, EBP can be used for direct care of an indwelling medical device, such as a central line, urinary catheter, feeding tube, or tracheostomy, and when performing wound care on any skin opening that requires a dressing. A private room is not required for the resident needing EBP and residents are able to participate in group activities; they are not restricted to their room. This recommendation is intended to be used for the resident’s entire length of stay or, for those with devices and wounds, until the device is removed or the wound heals.
CDC provides the following additional resources:
