The Center for Disease Control (CDC) recently introduced a new approach which includes Enhanced Barrier Precautions to prevent the spread of novel or targeted Multidrug-Resistant Organisms (MDROs) in nursing homes. This new approach and guidance falls between the Standard Precautions and the Contact Precautions implemented in healthcare settings.
Please reference this COMPARISON TABLE which outlines which
precautions should be used in which situations.
WHY THIS GUIDANCE IS IMPORTANT:
MDRO’s can last a long period of time and are not always plainly evident. When facilities focus only on residents with active infection systems, the risk of transmission from residents with MDRO colonization can persist and result in a silent spread of an infection. Additional controls are recommended to respond to serious antibiotic resistance threats and recognition that current contact precautions are not adequate to prevent MDRO transmission.
THE CHALLENGE FOR NURSING HOMES:
There is worry that the CDC Guideline Contact Precautions will create a challenge for nursing homes in balancing their residents’ quality of life with the suggested use of Personal Protection Equipment (PPE), dedicated equipment, and room restrictions to prevent MDRO transmission.
ENHANCE BARRIER PRECAUTIONS DEFINED:
The Enhanced Barrier Precaution guidance specifically addresses the use of PPE during certain types of resident contact and expands the use of PPE beyond situations in which exposure to blood and body fluids is anticipated. The recent guidance does not replace existing guidelines regarding Contact Precautions for other pathogens (e.g. c-diff, norovirus) in nursing homes.
Improving infection control practices in long term care requires a multifaceted approach. Organizational leadership is key in making prevention a priority and integrating infection control practices into the organization’s safety culture.
Key steps to address MDROs and implementation of Enhanced Barrier Precautions to reduce the spread of Multidrug-Resistant Organisms (MDROs) in nursing homes include:
- Identify residents with medical devices or with active symptoms of a novel or targeted MDROs.
- Establish procedures to address Standard Precautions, Enhanced Barrier Precautions, or Contact Precautions.
- Identify resident care situations where additional PPE is to be used.
- Educate and train staff on required precautions. Include training on PPE and Enhanced Barrier Precautions. Include additional recommended infection control and prevention practices and education: hand hygiene, environmental cleaning, and handling of wounds, devices and equipment.
- Reinforce that gloves and gowns are to be worn prior to high contact activity and changed before caring for another resident. Face protection is also needed if there is risk of splash or spray.
- Additional decisions regarding practices to prevent the spread of MDROs can be determined by the facility, region, and in conjunction with public health.
Contact your M3 Account Executive or Risk Manager for further discussion.
FOR MORE INFORMATION VISIT THE CDC WEBSITE:
- Article Source: https://www.cdc.gov/hai/pdfs/containment/PPE-Nursing-Homes-H.pdf
- Standard precaution table CDC source noted: https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf
- Updated July 26, 2019: https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/type-duration-precautions.html