July 13, 2022
The CDC updated guidance on enhanced barrier precautions (EBP) for all health care settings, including nursing homes. EBP are indicated for nursing home residents with any of the following:
- Infection or colonization with a multi-drug resistant organism (MDRO) and contact precautions do not apply
- Wounds and/or indwelling medical devices including catheters
The EBP require the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing. Use of face protection may be necessary when splashes or sprays may occur.
Examples of high-contact resident care activities requiring gown and glove use for EBP include:
- Dressing
- Bathing/showering
- Transferring
- Providing hygiene
- Changing linens
- 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
Gown and gloves are not required for resident care activities other than those listed above, unless otherwise necessary for adherence to standard precautions. Residents on EBP are not restricted to their rooms or limited from participation in group activities. In most situations, EBP are intended to be used for the resident's entire length of stay.
The CDC also provided the following considerations for use of EBP in skilled nursing facilities:
- MDRO transmission is common in skilled nursing facilities, contributing to significant morbidity and mortality for residents and increased costs for health care systems.
- EBP is an approach of targeted gown and glove use during high-contact resident care activities, designed to reduce transmission of S. aureus and MDROs.
- Effective implementation of EBP requires staff training on the proper use of PPE and the availability of PPE with hand hygiene products at the point of care.
