Nursing homes are now required to employ enhanced barrier precautions to curb the extensive spread of multidrug-resistant organisms (MDROs), particularly aiming at safeguarding patients with chronic wounds and indwelling devices. This directive has been issued by the Centers for Medicare & Medicaid and will be effective starting April 1.
These new guidelines have been developed in alignment with the standards for infection prevention and control, and they supplement the current policy by extending the use of personal protective equipment (PPE) during high-contact care activities. These updates bring the CMS regulations in sync with the guidance provided by the Centers for Disease Control and Prevention in 2022.
The newly prescribed barrier precautions mandate the incorporation of gloves and the methodic donning and doffing of gowns during six high-contact activities. It’s important to note, however, that these requirements are slightly less stringent than the prevailing contact precautions.
Recognizing the reluctance of some nursing homes regarding the implementation of CDC’s barrier precaution guidance, mainly due to its potential to limit activities for residents colonized with an MDRO, CMS indicates that more than half of nursing home residents may carry an MDRO. It has been observed that several facilities have reserved the exercise of precautions exclusively for patients with an active infection.
The revised recommendations urge the application of Enhanced Barrier Precautions (EBP) during high-contact care for residents with chronic wounds or indwelling medical devices, regardless of their MDRO status. They also encourage the inclusion of residents who harbor an infection or colonization with a CDC-targeted or other epidemiologically significant MDROs when contact precautions are not applicable.
Nursing homes are given some leeway while executing EBP, with the underlying condition of maintaining a homelike environment for the residents. With EBP in place, which impose less stringent activity and room assignment constraints in comparison to contact precautions, patients are not restricted to their rooms and can partake in group activities. These precautions are expected to remain effective during the resident’s stay or until the wound heals or the indwelling device is no longer needed.
In terms of specific care and activities, EPB should be exercised during dressing, bathing, transferring, providing hygiene, changing linens, or assisting with toileting, in addition to dealing with patients who are using a central line, urinary catheter, feeding tube, tracheostomy/ventilator, or any other procedure resulting in a skin opening requiring dressing.
EBP may not be necessary in common areas like dining or activity rooms, where the contact duration can be expected to be shorter. The nursing homes also possess the discretion of whether to apply EBP for residents with no chronic wound or indwelling medical device and those carrying MDROs not specifically targeted by CDC.
Highlighting the importance of employing contact precautions with MDRO-colonized nursing home residents, Bruce Y. Lee, MD, a prominent figure in MDRO research, has emphasized that these measures aren’t only beneficial to the particular nursing home but also to other healthcare facilities that the residents may visit. Lee noted that these enforced precautions could result in significant healthcare cost savings by preventing additional infections, even though they may initially appear to increase nursing home expenditures.
Infection prevention specialist Buffy Lloyd-Krejci, DrPH, CIC, lauds the CDC guidelines as beneficial for both residents and staff. According to her, EBP is intended to quell the risk of MDRO transmission by healthcare personnel who might unwittingly spread MDROs during patient care. EBP education along with distinguishing these measures from transmission-based precautions, she contends, is the key to successful implementation and managing potential misconceptions surrounding them.
Dr. Lloyd-Krejci stresses the importance of proactive communication to the staff, residents, and their families about the implications of new measures vis-Ã -vis the prevention of a major MDRO outbreak, such as C. auris, which would necessitate community-wide screening, stricter isolation norms, and limited visitation.
Source: https://www.mcknights.com/news/cms-adds-enhanced-barrier-precautions-to-infection-control-guidance/