long-term care infection prevention
long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Demystifying Enhanced Barrier Precautions in Long-Term Care Facilities
Every long-term care facility faces a challenging goal : creating a home-like environment in what is , at its core , an institutional healthcare facility . What makes this especially difficult is that , while a home-like feel is of vital importance to residents ’ happiness and comfort , safety cannot be overlooked , particularly since this is a congregate setting and the residents often have comorbidities .
To help facilities maintain resident safety in a more home-like setting related to preventing the spread of multidrug-resistant organisms ( MDROs ), the Centers for Disease Control and Prevention ( CDC ) has recommended that facilities implement enhanced barrier precautions . 1 There is a lot of misinformation around these precautions ; however , in this article , we ’ ll demystify some of the guidance and discuss how implementing this recommendation can benefit your residents , staff , and even your facility ’ s bottom line .
Enhanced barrier precautions , which require healthcare professionals to clean their hands ( including before entering and when leaving a room ), wear a clean gown , and gloves for each resident while performing high nursing activities for residents at high risk grew out of the need to protect residents against superbugs such as Candida auris and Carbapenem-resistant Enterobacterales like E . coli , while still maintaining a home-like environment . To be clear , these precautions only apply to skilled and long-term nursing homes ; they do not apply to hospitals , where patients with MDROs are placed in isolation until they ’ re discharged . The same sort of isolation isn ’ t possible in a long-term care facility , of course , where people may live for months or years .
With these precautions , high-risk residents don ’ t need to be isolated as they would be in a hospital setting ( or with more traditional transmission-based precautions ). This is a boon to residents ( who can continue to enjoy a home-like feel ), families ( who want to see their loved ones happy and safe ), and staff ( who don ’ t need to implement isolation precautions for high-risk residents ).
Enhanced barrier precautions are indicated when residents have a wound or indwelling medical device ( regardless of MDRO colonization status ) or have an infection or colonization with an MDRO . They are indicated anytime high-nursing activities are being performed ( such as peri-care , moving / transferring the resident , bathing them , and so on ). The guidelines dictate that , in these types of situations , the healthcare professional working with the resident must wear a new gown and gloves . Unlike isolation precautions , enhanced barrier precautions allow residents to come out of their rooms and move freely about the facility , even if they are classified as “ high-risk ” because they fall into one of the categories just described .
Because many MDROs are “ silent spreaders ” that can move quickly through a facility before anyone realizes as screening of MDROs is not a common practice . Therefore , these precautions are for the residents ’ protection . They are also generally less disruptive to the staff than other types of transmission-based precautions and can be implemented rather easily and may not be as burdensome as it may seem . For example , standard precautions , wearing personal protective equipment ( gown , gloves , and eye protection if indicated ), if there is a risk of coming into contact with bodily fluids or a harmful substance or chemical . If you think about it , enhanced barrier precautions aren ’ t much different . It is simply the addition of a gown and gloves when indicated .
To better increase the efficacy of enhanced barrier precautions , facilities should post the CDC signage about the need for these precautions outside any high-risk resident ’ s room . 2 The CDC offers signs that can be printed out ( ideally in color to better differentiate them from other types of precautionary requirements ). You will also want to have gowns and gloves easily available to the staff in these rooms .
Far too many facilities that my team and I support are gone waiting to implement enhanced barrier precautions . The majority state that they are waiting until the state begins citing facilities for non-compliance . I would like to encourage you not to take this approach . The high prevalence of rapidly spreading MDROs — coupled with the responsibility that facilities must keep their residents safe — makes this a terrible approach . Furthermore , we don ’ t want to implement practices based on whether a surveyor does or does not cite you ( which we all know is a very subjective practice ). Instead , we need to be proactive and protect the residents as best as we can , and this is one practice that will do so .
And think about this . When a facility implements enhanced barrier precautions , it is a clear sign to the residents and families you take infection prevention and control ( IP & C ) seriously . That you are committed to doing everything possible to keep your residents and staff safe and maintain a cozy , home-like environment . That can become a marketing tool to help facilities separate themselves from their competitors while delivering the best care possible for their residents . So , remember that enhanced barrier precautions are only indicated when residents have an infection or colonization with an MDRO , have a wound or indwelling medical device , and when high nursing activities are taking place . Perhaps most importantly , they are in place to keep residents safe and ensure they have the freedom to move about the facility and enjoy visiting from family and friends — which , after all , is what this incredible but vulnerable population deserves .
Buffy Lloyd-Krejci , DrPH , CIC , LTC-CIP , is a leading authority on infection prevention in the long-term care industry . Her firm , IPCWell , delivers in-person gap analysis , training , and support to nursing homes across the country .
References :
1 . https :// www . cdc . gov / hicpac / workgroup / EnhancedBarrierPrecautions . html
2 . https :// www . cdc . gov / hai / pdfs / containment / enhanced-barrier-precautions-sign-P . pdf
30 • www . healthcarehygienemagazine . com • january 2024