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CDC Updates Enhanced Barrier Precautions for Nursing Home Residents

Analysis  |  By Carol Davis  
   July 15, 2022

More than 50% of nursing home residents may be colonized with multidrug-resistant organisms, CDC says.

Nursing home residents are at increased risk of developing infection with multidrug-resistant organisms (MDROs), so the U.S. Centers for Disease Control and Prevention (CDC) has updated Enhanced Barrier Precautions (EBPs) for nursing facilities to protect residents.

MDRO transmission is common in skilled nursing facilities, which contributes to substantial resident morbidity and mortality and increased healthcare costs, according to the CDC.

EBPs, however, are an infection control intervention designed to reduce transmission of resistant organisms.

Introduced by the CDC in 2019 as a new approach to the use of personal protective equipment (PPE), EBP employs targeted gown and glove use during high-contact resident care activities, such as dressing, transferring, helping with hygiene, changing linens, assisting with toileting, wound care, and use of devices such as a central line, urinary catheter, feeding tube, or tracheostomy/ventilator.

A summary of the CDC’s updates this week include:

  • Added additional rationale for the use of EBP in nursing homes, including the high prevalence of MDRO colonization among residents in this setting.
  • Expanded residents for whom EBP applies to include any resident with an indwelling medical device or wound, regardless of MDRO colonization or infection status.
  • Expanded MDROs for which EBP applies.
  • Clarified that, in most situations, EBP are to be continued for the duration of a resident’s admission.

Effective implementation of EBP requires staff training on the proper use of personal protective equipment (PPE) and the availability of PPE and hand hygiene supplies at the point of care,” according to the CDC.

Standard precautions—a group of infection prevention practices—continue to apply to the care of all residents, regardless of suspected or confirmed infection or colonization status, the CDC notes.

The CDC notes that many nursing homes implement contact precautions only when residents are infected with an MDRO and on treatment. But focusing only on residents with active infection fails to address the continued risk of transmission from residents with MDRO colonization, who have no symptoms of illness. In fact, MDRO colonization may persist for long periods of time—months, even—which allows the “silent spread” of MDROs, the CDC says.

MDROs targeted by CDC include:

  • Pan-resistant organisms
  • Carbapenemase-producing carbapenem-resistant Enterobacterales
  • Carbapenemase-producing carbapenem-resistant Pseudomonas spp.
  • Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii
  • Candida auris

Additional epidemiologically important MDROs may include, but are not limited to:

  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • ESBL-producing Enterobacterales
  • Vancomycin-resistant Enterococci (VRE)
  • Multidrug-resistant Pseudomonas aeruginosa
  • Drug-resistant Streptococcus pneumoniae

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


The CDC has updated enhanced barrier precautions for nursing facilities.

The update expanded residents for whom Enhanced Barrier Precautions (EPB) applies.

Nursing home residents are at increased risk of developing infection with multidrug-resistant organisms (MDROs).

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