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● Changing briefs or assisting with toileting
● Device care or use : central line , urinary catheter , feeding tube , tracheostomy / ventilator
● Wound care : any skin opening requiring a dressing 3
Other resident care does not require these precautions unless indicated by Standard Precautions . Residents are free to come and go from their rooms . See Table 2 for a breakdown of the three precautions .
Table 2 : Summary of PPE Use and Room Restriction When Caring for Residents Colonized or Infected with Novel or Targeted MDROs in Nursing Homes 4
So , now you might be asking , how do I implement this guidance ? There are six steps to using these precautions and they also apply to Contact Precautions . The most important factor is to ensure that staff are aware of the facility ’ s expectations regarding these precautions .
➊ Signage : Be sure you have proper signs posted on the resident ’ s door or wall next to the door regarding the precaution . It should indicate the PPE required and for Enhanced Barrier Precaution it should Indicate which high contact activities require the PPE .
➋ PPE : Critical to have appropriate and adequate PPE supplies outside the room .
➌ Alcohol-based handrub ( ABHR ): Access to ABHR both inside and outside the room is preferrable .
➍ Trash can : Location of a trash can just inside the resident ’ s room door to allow for PPE removal .
➎ Monitoring and assessment : To ensure that staff are following the policies and procedures for these precautions and to determine if additional education is needed . This can be random , under cover and planned / scheduled .
➏ Education : Provide residents and family members with education and training opportunities on these precautions and why they are necessary .
To view Table 2 , click here
Prevention of MDRO transmission in nursing homes requires more than just proper use of PPE and room restriction . Education , training , and monitoring is also needed to ensure the implementation of other recommended infection prevention practices ( such as hand hygiene , environmental cleaning , proper handling of wounds , treatment of indwelling medical devices , and disinfecting of resident-care equipment ) are occurring appropriately .
Cindy Fronning , RN-BC , CDONA , FACDONA , RAC-CT , IP-BC , AS-BC , is the director of education at NADONA . She was a national consultant for more than 20 years and developed and teaches the infection prevention and control certificate of mastery and antibiotic stewardship certificate of mastery courses .
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