Implementing Enhanced Barrier Precautions to Protect Residents and Staff in Long-Term Care

Preventing the spread of multidrug-resistant organisms (MDROs) is a critical priority for skilled nursing facilities. Enhanced Barrier Precautions (EBP) provide an effective infection control strategy to reduce transmission risks while allowing residents to maintain an active and fulfilling quality of life. Implementing these precautions involves understanding their purpose, identifying high-risk scenarios, and adhering to best practices for personal protective equipment (PPE) use.

Understanding Enhanced Barrier Precautions

Enhanced Barrier Precautions focus on minimizing MDRO transmission through the strategic use of PPE, particularly gowns and gloves, during high-contact care activities. These activities often result in the transfer of harmful organisms to caregivers’ hands or clothing, making consistent precautionary measures essential. Unlike Contact Precautions, which often isolate residents, EBP balances infection control with residents’ mobility and social engagement.

Identifying When to Use Enhanced Barrier Precautions

EBP should be implemented for residents in the following scenarios:

• Colonization or infection with targeted MDROs: Residents carrying organisms like Carbapenemase-producing Enterobacterales are at higher risk of spreading infections.
• Presence of chronic wounds or indwelling devices: Conditions such as pressure ulcers, urinary catheters, or tracheostomies increase susceptibility to MDROs and necessitate heightened precautions.

Maintaining Resident Mobility

Unlike traditional Contact Precautions, EBP allows residents to participate in communal activities, provided they meet specific hygiene and containment criteria:

• Clean hands, clothes, and equipment
• Contained drainage and covered wounds

This approach supports residents’ physical and mental well-being while ensuring safety for others.

High-Contact Care Activities Requiring PPE

Staff must recognize high-contact activities where EBP is critical. Examples include:

• Providing personal care, such as bathing, dressing, or grooming
• Changing linens or handling drainage bags
• Assisting with mobility or prolonged contact with residents’ skin or equipment

In these situations, caregivers must use gloves and gowns in addition to practicing rigorous hand hygiene.

Low-Contact Activities and Standard Precautions

For low-risk activities, such as handing residents a magazine or adjusting wheelchair foot pedals, standard hand hygiene suffices. These distinctions help optimize PPE use without unnecessary barriers to resident interaction.

Educating Staff and Implementing EBP

Thorough staff education is the foundation for effective EBP implementation. Training should focus on:

1. Identifying high-risk scenarios
2. Proper use of PPE for various care activities
3. Maintaining hygiene standards to protect residents and caregivers

Providing real-life examples, such as case studies, can enhance understanding and promote consistent application. For instance:

• A resident with an indwelling urinary catheter requires PPE for personal care but not for delivering their mail.
• During an MDRO outbreak investigation, Contact Precautions may be temporarily necessary for affected units.

Collaboration and Compliance

EBP implementation requires collaboration among all staff members, including caregivers, administrators, and interdisciplinary teams. Regular audits, ongoing education, and feedback loops ensure sustained adherence to infection control practices. Additionally, consulting public health authorities and adhering to Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidelines provide a strong regulatory foundation.

Enhanced Barrier Precautions are a proactive and resident-centered approach to managing infection risks in long-term care facilities. By understanding when and how to implement these precautions, nursing home administrators and staff can create safer environments for residents while preserving their dignity and independence. Consistent education, collaboration, and commitment to best practices are key to achieving these goals and enhancing the quality of care for all.