On March 20, 2024, CMS released QSO-24-08-NH on implementing Enhanced Barrier Precautions(EBPs) in Nursing Homes to prevent the spread of multi-drug resistant organisms (MDROs). This memo includes new guidance for State Survey Agencies (DPH) and long term care facilities on the use of enhanced barrier precautions (EBP) to align with nationally accepted standards and includes formal guidance under F880 Infection Prevention and Control to SSAs and long term care facilities on the use of EBP effective April 1. Enhanced barrier precautions are indicated for residents during high-contact activities regardless of their multidrug-resistant organism status with any of the following:
- Infection or colonization with a CDC-targeted MDRO when contact precautions do not otherwise apply.
- Wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO.
- Wounds include chronic wounds, such as pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous stasis ulcers. Shorter-lasting wounds, such as skin breaks or skin tears covered with an adhesive bandage or similar dressing, do not require EBP.
- Indwelling medical device examples include central lines, urinary catheters, feeding tubes, and tracheostomies. A peripheral intravenous line (not a peripherally inserted central catheter) is not considered an indwelling medical device for EBP.
Facilities have discretion in using EBP for residents who do not have a chronic wound or indwelling medical device and are infected or colonized with an MDRO that is not currently targeted by the CDC.
CMS notes that facilities have some discretion when implementing EBP and balancing the need to maintain a homelike environment for residents. Residents are not restricted to their rooms or limited from participation in group activities. Because EBPs do not impose the same activity and room placement restrictions as contact precautions, they are intended to be in place for the duration of a resident’s stay in the facility or until resolution of the wound or discontinuation of the indwelling medical device that placed them at higher risk.