>> Hello. This presentation is going to introduce you
to the updated guidance for the implementation
of enhanced barrier precautions in nursing homes
to prevent the spread of multidrug-resistant organisms.
First, some of the common terms used in CDC's guidance
and recommendations,
this include multidrug-resistant organism (or MDRO),
which is a germ such as bacteria or fungus that is resistant
to multiple different antibiotics.
Examples of MDROs that you might have heard
about include Candida auris, MRSA, and CRE,
which has been referred to in the media
as the nightmare bacteria.
When infections develop from these germs,
they can be very difficult to treat.
Colonization means the germ has been found on or in the body,
but it is not causing any symptoms or infection.
The presentation will describe the impact and the burden
of MDROs in nursing homes and describe the need for enhanced
to barrier precautions (or EBP),
as well as the details behind the indications
for and use of EBP.
The presentation will also discuss briefly how
to be successful with the implementation and use
of enhanced barrier precautions.
We have learned from studies and outbreak investigations
that many nursing home residents are unknowingly colonized
with an MDRO, especially residents with risk factors
for colonization,
like indwelling medical devices or wounds.
Residents who are colonized are at risk
of developing a serious infection,
like a bloodstream infection can remain colonized
for long periods of time, and these germs can spread
to other residents through the contaminated hands and clothing
of healthcare personnel.
To help visualize how common MDROs are in nursing homes,
this slide shows data from a large study that was conducted
in nursing homes, including a subset
of nursing homes called ventilator-capable nursing homes
that provide care to ventilator-dependent residents.
In the first column, these are the percentages of residents
who had documentation in their medical record of a presence
of an MDRO colonization or infection.
So about 2 out of every 10 residents
across all these nursing homes were already known
to have an MDRO.
During the study, nursing home residents were tested to see
if they were colonized with an MDRO.
The second column shows the percentages of residents
who actually had an MDRO after testing was complete.
As you can see, in the nursing homes
that did not provide ventilator care, almost 6 out of 10
of the residents were found to have an MDRO.
And in the ventilator-capable nursing homes, the number went
up to almost 8 out of every 10 residents.
So if your nursing home has at 100 residents,
this would be the same as having 80
of those residents colonized with an MDRO.
Historically, nursing homes have used contact precautions
when caring for residents who are actively infected
with an MDRO, meaning they have symptoms or might even be
on antibiotics for an infection.
Contact precautions require the use of a gown
or gloves whenever entering a room, placing the resident
in a single-person room, and restricting them
from all group activities.
However, as we just showed with the study,
the problem with MDROs is much larger, and focusing only
on interventions for residents
with an active infection is not sufficient.
Further, contact precautions are very restrictive,
especially when put in place for a significant amount of time.
We also know that contact precautions can have
negative consequences.
There is a need for an intervention
to reduce the spread of MDROs that does not recur.
isolating residents for long periods of time,
but that also considers the extended duration
that residents can remain colonized.
Enhanced barrier precautions are a method for reducing the spread
of MDROs while also reducing the isolation of residents
by using a gown and gloves to prevent contamination
of healthcare personnel hands
and clothing during the activities
that have demonstrated the highest risk for transfer
of MDROs to the hands and clothing
of healthcare personnel.
Enhanced barrier precautions are indicated
for nursing home residents who have an infection
or known colonization with an MDRO
when contact precautions do not otherwise apply.
Contact precautions should still be used for the presence
of acute diarrhea, draining wounds, or other sites
of secretions or excretions that are unable to be covered
or contained and may be used
for a limited time period during the investigation of a suspected
or confirmed MDRO outbreak in consultation with public health.
Additionally, enhanced barrier precautions are indicated
for any nursing home residents
who have wounds and/or indwelling medical devices,
as these are residents at highest risk
of becoming colonized with an MDRO.
While prior guidance focused on MDRO outbreaks,
novel and targeted MDROs, and limited areas of a nursing home
that we're experiencing an outbreak,
EBP is no longer limited to outbreaks or specific MDROs,
and should be applied broadly for any nursing home residents
that meet the criteria on this slide.
Specifically, EBP includes the use of a gown
and gloves during high-contact resident care activities,
including dressing, bathing or showering, performing transfers,
changing linens, providing hygiene,
changing a resident's brief or assisting them with toileting,
direct care of an indwelling medical device
such as a central line, urinary catheter, feeding tube,
or tracheostomy, and when performing wound care
on any skin opening that requires a dressing.
A private room is not required for the resident needing EBP,
and residents are able to participate in group activities.
They are not restricted to the room.
This recommendation is intended to be used
for the resident's entire length of stay, or for those
with devices and wounds
until the device is removed or the wound heals.
For enhanced barrier precautions to be successful,
the use of EBP must be incorporated
with several other good practices,
including hand hygiene, environmental cleaning
and disinfection, auditing of hand hygiene and appropriate use
of PPE, and communication about residents with MDROs,
both within your facility and outside of your facility.
We strongly encourage you to look
at these additional resources.
The first link will take you to the guidance document,
including printable versions of the document and the table
within the document that compares EBP to standard
and contact precautions as well as additional resources
for healthcare personnel and nursing home staff
and residents' family and visitors.
The second link will take you to a list
of frequently asked questions about EBP,
and the remaining link will take you to a more detailed document
that reviews the available literature and description
of the use of EBP that was developed
by the Healthcare Infection Control Practices
Advisory Committee.
Thank you.