In our post-COVID world, infection prevention and control (IPC) is more important than ever. This is especially true in long-term care facilities. 

Residents generally live in a congregate environment — which increases the risk of exposure to infectious and communicable diseases — and they frequently have multiple comorbidities that heighten the dangers associated with these illnesses. 

However, as important as safety is, creating a home-like environment is also crucial. Residents generally stay in facilities for months or even years, which makes it imperative to maintain a home-like feel for their residents. 

The challenge for facilities, then — no matter what level of care they provide — is to find a way to maintain as many home comforts as possible while simultaneously keeping residents safe and healthy. To help achieve this, the Centers for Disease Control and Prevention (CDC) created enhanced barrier precautions (EBP). 

The impact of EBP

Enhanced barrier precautions guidelines are designed to protect long-term care facility residents against the spread of deadly multidrug-resistant organisms (MDROs) while maintaining a welcoming environment that is important to the resident’s health and happiness. 

Specifically, EBP are intended to reduce the risk of MDRO transmission by healthcare personnel who may carry and spread MDROs on their hands or clothing, silent spreaders, while caring for high-risk residents. Misconceptions about EBP have contributed to resistance toward implementation. 

Furthermore, EBP requires that healthcare professionals don a fresh gown and gloves when interacting with “high-risk” residents: those with wounds or indwelling medical devices (regardless of MDRO colonization status) or who have an infection or colonization with an MDRO during high-contact nursing activities such as bathing, transferring, and hygiene care. 

The current acute care recommendation for patients who are colonized with an MDRO is to be placed on contact isolation until they are discharged. As you can see, this is not appropriate for long-term care residents. With EBP, residents can freely move about the facility and enjoy visits from family and friends. 

Implementing EBP

Common misconceptions surrounding this practice include the residents believing that staff are wearing a gown and gloves because they, the residents, have an infection. Front-line healthcare workers such as nurses also get this preventative practice confused by traditional isolation guidelines, which are the exact opposite. These measures are in place to prevent ongoing isolation while protecting the residents from the risk of obtaining an MDRO. 

Therefore, what is essential when implementing EBP is ongoing education for the residents and the staff. I have found that the teach-back method works best for front-line workers needing to hard-wire this practice. ‘

For example, I like to get a small group of certified nursing assistants (CNAs) together in front of a resident’s room that is on EBP. This room will have the appropriate signage on the door and easy access to gowns and gloves. I will then ask the CNAs to explain what the sign means and how caring for residents on EBP is different from caring for residents on transmission-based precautions. This presents the perfect opportunity to provide clarity and purpose for this new practice. The CDC provides additional teaching tools, including videos, letters to families and residents, and posters for facilities. 

Taking this further, this practice supports reducing the risk of a full-blown MDRO outbreak. In particular with Candida auris (C. auris) and Carbapenem-resistant enterobacterales (CRE). When this occurs, the entire facility, every resident, all the staff, and every family member are impacted. Uncomfortable and time-consuming screening and culturing of all of the residents take place, visitation may be limited, and stricter isolation may prevail. 

This decreases staff morale and leads to staff turnover. There is nothing good about this scenario. We have the opportunity to actively mitigate this risk by proactively implementing preventative measures such as EBP. 

Protecting your bottom line

Finally, enhanced barrier precautions are beneficial to each long-term care facility’s bottom line. When facilities embrace these precautions, it’s a clear indication to families that the facility prioritizes infection prevention practices. Unfortunately, what we commonly hear from facilities is that they are not going to implement this practice until surveyors begin handing out citations for non-compliance. 

We can do better than this, and we should. Public health recommendations are there for a reason, and implementing these practices as best as we can is critical to ensuring our residents have a safe, homelike environment to recover and reside in. 

By embracing EBP, facilities can keep their residents and staff safer and increase the facility’s respect in the eyes of prospective residents and their families. In other words, whether you are a resident, family member or facility personnel, when you take a closer look at enhanced barrier precautions, one thing becomes abundantly clear: they are a win-win-win for everyone.

Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. She and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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