Bolstering Infection Prevention: Implementing Mobile Enhanced Barrier Precautions in Nursing Homes

Taking crucial steps to prevent the transmission of multidrug-resistant organisms (MDROs) in long-term care settings, especially nursing homes, is vital to ensuring resident safety and combating antimicrobial resistance. The traditional use of contact precautions, though proven to be effective, poses hardships by confining residents to their rooms, affecting their quality of life negatively. 

Consequently, the Healthcare Infection Control Practices Advisory Committee has released a white paper suggesting the use of Enhanced Barrier Precautions (EBP) in Skilled Nursing Facilities. EBP recommendations were further revised by the Centers for Disease Control and Prevention (CDC) in 2022, highlighting the significance of Personal Protective Equipment (PPE) in impeding the spread of MDROs. High-risk residents, particularly those with indwelling medical devices or wounds, are the primary focus of these revisions, acknowledging the tendency of these residents to become sources of MDRO transmission within the facility. A spotlight on MDRO prevention in healthcare settings has been maintained by the CDC since 2006. Despite the relentless efforts, the presence and spread of MDROs continue to plague various healthcare settings. 

A significant factor contributing to this ongoing threat is the delinquent detection of such infections, often confirmed by labs well after the patients become infectious. The weight of prevention efforts, therefore, rests on limiting transmission at all stages, within individual facilities, and across the larger healthcare region. The CDC defines EBP as an infection control strategy designed to reduce the transmission of multidrug-resistant organisms through strategic use of gown and gloves during high-contact resident care activities. EBP was introduced in 2019 for reducing the spread of MDROs in the long-term care sector. 

The guidance for EBP utilization is now being incorporated into the CMS/State Survey Agency guidelines as part of the Infection Prevention and Control regulations. The birth of this provision signals a shift in long-term care standards, with expectations that all residents with wounds or indwelling devices to be on EBP for preventing MDRO infection. This protection extends to staff, who are required to wear gowns during high-contact activities with these residents, warding off the possibility of transferring germs to the residents during care. Implementing EBP is not devoid of challenges. 

Complications like PPE fatigue due to the COVID-19 pandemic, additional costs for implementation (PPE, signage, staff training, etc.), staff shortages, and lack of executive leadership support can create obstacles. On the contrary, the potential benefits of infection reduction, safer environments for residents, and preventive measures against major outbreaks warrant strong consideration for its widespread implementation. 

The CDC continues to provide substantial resources and educational tools for implementing EBP, including training webinars, planning materials, signage, and much more. It is imperative to recognize that guidance will evolve as we further explore and understand how MDROs spread. Infection preventionists should encourage any efforts towards preventing MDRO transmission to ensure resident safety and well-being.

Source: https://www.infectioncontroltoday.com/view/updated-cms-recommendations-for-infection-prevention-long-term-care