long-term care infection prevention
long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Reduce the Risk of C . auris and Other MDROs in Your Facility With EBP
One of the biggest problems facing long-term care facilities today is Candida auris . 1 This organism , which is often resistant to medication , can cause serious infections and even death — and to make matters worse , it ’ s becoming more prevalent , especially in nursing homes . 2 That ’ s why the Centers for Disease Control and Prevention ( CDC ) recommends long-term care facilities use enhanced barrier precautions ( EBP ) to help mitigate C . auris and other multidrug-resistant organism outbreaks .
Following this guidance is proving problematic for many facilities , though . Not only is there a great deal of confusion about how to implement EBP , but many state surveyors are targeting facilities that are trying to do so and tagging them if they , or their staff , make any mistakes in their implementation process .
Recently , my team and I worked with a long-term care facility that experienced this problem firsthand . As a result of a previous survey experience , the infection preventionist ( IP ) told us she was worried they would be targeted and cited by surveyors for implementing enhanced barrier precautions if even a single member of their staff failed to follow the guidance correctly . She also mentioned how difficult it is to implement EBP , especially because it requires constant education and follow-up with the staff to explain the differences between , for example , enhanced barrier precautions and other transmission-based precautions . The result of this all-too-common confusion can be profound . For example , one IP recently told us that a CNA walked into a COVID-19 positive isolation room with no personal protective equipment ( PPE ) because they thought they only had to as wear it as required for EBP ( during high contact activities ). This misunderstanding put her and the facility ’ s residents at risk .
Unfortunately , scenarios like this are far from isolated incidents . I could name many other instances where facilities refused to use enhanced barrier precautions because they feared doing it incorrectly would lead to being targeted and tagged by surveyors . That ’ s why my staff and I continue to educate staff in long-term care facilities and licensing divisions about EBP , its benefits , and how to properly implement it . In this article , I ’ d like to share some of the advice we give facilities with you in case you are struggling with implementing EBP in your own facility , or even questioning whether you should .
In 2019 , the CDC began recommending EBP for long-term care facilities after recognizing that staff can carry and spread MDROs on their hands and / or clothes while caring for residents . 3 Part of their aim in doing so was to reduce regional outbreaks of MDROs ( including Candida auris ) they classified as “ urgent threats .” 4
In 2022 , the CDC added additional rationale for using EBP in nursing homes . They also expanded the list of residents for whom EBP applies to include any resident with an indwelling medical device or wound , regardless of MDRO colonization or infection status . And they expanded the MDROs for which EBP applies and clarified that , in skilled nursing facilities in particular , EBP should be continued for the duration of a resident ’ s admission . 5 In March 2023 , Centers for Medicare and Medicaid Services ( CMS ) added their support for this guidance , as shown in Appendix PP of the State Operations Manual . 6
Clearly , EBP is a crucial tool in the fight against difficult-to-detect “ silent spreaders ” like C . auris . It makes sense : Because EBP
is recommended for a variety of high-risk situations — for example , for residents with an infection or colonization with an MDRO ( when contact precautions don ’ t otherwise apply ), residents with wounds and / or indwelling medical devices , and when staff are engaged in high-contact resident care activities ( such as dressing , bathing , transferring , and so on )— it can help interrupt the spread of novel or targeted MDROs , of which C . auris is one . 7
EBP guidance dictates that , when faced with any of the scenarios described above , facility staff should don gloves and gown ( and face protection if there is any risk of splash or spray ) prior to engaging in high-contact care activities . Furthermore , they should change their PPE before moving on to the next resident . 8 For ease of adherence to EBP , facilities can store gowns and gloves inside or outside each resident ’ s room .
While you may be reluctant to implement EBP when you ’ re concerned about being targeted by state surveyors , CMS regulatory requirements require facilities to follow all local and public health recommendations . To put it another way : If the CDC recommends it ( and , as we ’ ve seen , they recommend enhanced barrier precautions ), CMS says facilities should be doing it .
You can start slow and you can start small , as long as you start . Remember , not only is introducing EBP best practice for your residents but eventually , surveyors will ( some already are ) start focusing on whether facilities have implemented enhanced barrier precautions ; if you haven ’ t , you ’ ll be cited , and this is not something that can be implemented quickly .
One final thought : Our public health and medical practices should not be dictated based on what a surveyor — who often isn ’ t clinically trained — says or doesn ’ t say . They should be based on recommended , evidence-based practices . And when it comes to MDROs , that ’ s exactly what enhanced barrier precautions are : solid , evidence-based practices that can reduce the spread of dangerous organisms like C . auris among vulnerable residents in long-term care facilities throughout the country and the world .
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 Increasing Threat of Spread of Antimicrobial-resistant Fungus in Healthcare
Facilities 2 . Candida auris : A Drug-resistant Germ That Spreads in Healthcare Facilities 3 . Consideration for Use of Enhanced Barrier Precautions in Skilled Nursing
Facilities 4 . Ibid .
5 .
Implementation of Personal Protective Equipment ( PPE ) Use in Nursing Homes to Prevent Spread of Multidrug-Resistant Organisms ( MDROs )
6 .
State Operations Manual : Appendix PP - Guidance to Surveyors for Long Term Care Facilities
7 . mplementation of Personal Protective Equipment ( PPE ) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms ( MDROs )
8 . bid . march 2024 • www . healthcarehygienemagazine . com •
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