Wiping away MDROs: Enhanced barrier precautions and hand hygiene

A seismic demographic shift is afoot, with older adults expected to outnumber children by the year 2034 for the first time in U.S. history. This will result in higher demand for long-term care facilities, where multidrug-resistant organism (MDROs) colonization is extremely prevalent among a concentration of high-risk patients. 

A recent study shows that a staggering 74% of resident rooms and 93% of common areas in LTC settings are contaminated with MDROs, and over half of nursing home residents are colonized with MDROs of clinical and public health significance — underscoring the urgent need for enhanced infection control measures.

Understanding enhanced barrier precautions and MDROs

To address these challenges, the CDC recently issued new guidance on the use of Enhanced Barrier Precautions (EBPs) to decrease the transmission of MDROs in LTC facilities. While contact precautions require healthcare professionals to wear gloves and gowns when entering the room of a patient infected or colonized with a novel or targeted MDRO, under EBPs, personal protective equipment (PPE) is only required during high-contact care activities, such as dressing, bathing or wound care. 

In addition, to prevent the “silent spread” of MDROs among high-risk residents, EBPs are required for both patients who are infected or colonized with an MDRO and those who have a chronic wound or indwelling medical device.

Used in conjunction with existing guidelines, EBPs are an effective means of preventing the spread of MDROs while balancing patient safety and quality of life. By limiting the need for extensive PPE and patient isolation, patients can have more quality interactions with staff and other residents — increasing patient and employee satisfaction and offering a sustainable, patient-centric solution to prolonged MDRO colonization.  

Prioritizing hand hygiene 

Hand hygiene stands as the #1 way to prevent the spread of disease, and when combined with EBPs, it plays a pivotal role in protecting LTC residents and staff from MDROs. In the coming months, as part of EBP implementation, LTC facilities will be encouraged to make PPE available outside of the rooms of high-risk patients — including hand hygiene products — for staff to use before and after entering. While this may require an up-front investment in additional hand-sanitizing products, it will ultimately reduce the spread of costly MDRO infections.

Hand sanitizing wipes offer a number of benefits for LTC facilities looking to promote effective hand hygiene practices in line with EBPs. Particularly within Alzheimer’s or psych wards, there is often a risk of patients ingesting liquid alcohol gel or foam products. The use of wipes mitigates this risk while providing an effective bedside alternative for patients who may be unable to use soap and water. Available in a variety of sizes and formats, hand sanitizing wipes can be easily placed in convenient and accessible locations throughout the LTC facility or offered during high-contact activities, like mealtimes.

Perhaps most significantly, hand sanitizing wipes are the only hand hygiene product, apart from soap and water, that can remove Clostridium difficile (C. diff) spores from the hands — a common MDRO in LTC settings. 

In fact, in one study, C. diff rates in a medical center decreased after prepackaged alcohol wipes were made available to patients unable to get to a sink. The use of hand sanitizing wipes by LTC staff and patients can, therefore, reduce the risk of harmful C. diff outbreaks among high-risk residents and reinforce EBPs to prevent the spread of MDROs.

Improving patient outcomes

Moving forward, education is vital to driving compliance with EBPs and maintaining good hand hygiene practices in LTC settings. On the patient side, ensuring that residents and visitors are well-versed in effective hand hygiene practices and the importance of PPE will encourage them to take the necessary steps to protect themselves and others from MDROs. 

On the other hand, LTC facility leaders must step up as champions of hand hygiene and infection prevention, establishing and promoting high standards of care among their staff. 

Ultimately, the establishment of EBPs is a huge step forward in preventing the spread of MDROs in LTC settings while prioritizing the needs of patients. Coupled with a robust hand hygiene program, LTC facilities have the means to effectively control the transmission of infection in a way that keeps patients happy and healthy for years to come.

Amanda Thornton, RN, MSN, CIC, VA-BC, is a clinical science liaison with PDI. She spent nine years as a direct care nurse in long-term care settings before entering the infection control and prevention space in 2005, where she found a passion for all things related to preventing avoidable HAIs. Amanda is a board-certified infection preventionist (CIC) as well as a certified infection preventionist in the LTC space (LTC-CIP).

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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