CDC Updates Guidance on Enhanced Barrier Precautions for Nursing Homes

Emergency Preparedness

Coinciding with a new report on antimicrobial resistance, the CDC has updated its guidance on enhanced barrier precautions​ (EBP) for all health care settings, including nursing homes. The guidance expands to residents that trigger the use of EBP and indicates it should be followed for any resident in the facility with:​​

  1. ​An open wound requiring a dressing change
  2. Has an indwelling catheter for the duration of their stay
  3. Is colonized with multi-drug resistant organisms (MDROs)​ and contact precautions do not apply 

The EBP requires 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 eye protection may be necessary when splash or spray may occur but is not necessary in other situations.

Examples of high-contact resident care activities requiring gown and glove use ​among residents that trigger EBP use 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.

The CDC provides the following considerations for use of EBP in 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.
It also clarified that, in most situations, EBP is​ to be continued for the duration of a resident’s admission.  

Facilities should consider that EBP is one of a continuum of infection prevention interventions. EBP implementation requires increased use of gown and gloves, ongoing competency with PPE use and hand hygiene, and the current nursing home and pandemic environment.  

Additional information and supplemental resources to support implementation of EBP are available at the below links.