02 Oct How Should PPE Be Used in Nursing Homes to Prevent MDRO Spread?
Preventing the spread of multidrug-resistant organisms (MDROs) in nursing homes is crucial for the health and safety of residents. One key strategy in combating MDRO transmission is the proper use of personal protective equipment (PPE). In this article, we will explore what PPE is, why it is important in nursing homes, and how to effectively use it to prevent the spread of MDROs.
What Is Personal Protective Equipment (PPE)?
Personal protective equipment (PPE) refers to any equipment or clothing that is worn to minimize exposure to hazards that may cause harm or injury. In the context of nursing homes, PPE includes items such as gloves, gowns, masks, and eye protection (goggles or face shield). These protective items create a barrier between the healthcare worker and potential sources of contamination, reducing the risk of infection transmission.
Understanding MDROs and Their Impact
MDROs are microorganisms, such as bacteria or fungi, that have developed resistance to multiple commonly used antibiotics. These organisms pose a significant threat to public health, as they limit treatment options and increase the risk of complications in infected individuals. In nursing homes, MDROs can spread rapidly among residents and healthcare workers if proper precautions are not taken.
Common examples of MDROs include Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), and Carbapenem-resistant Enterobacteriales (CRE). These organisms can cause infections that are difficult to treat and may result in severe illness or even death. Preventing the spread of MDROs in long-term care centers is crucial to protect the health and well-being of residents.
Guidelines for Using PPE in Nursing Homes
The Centers for Disease Control and Prevention (CDC) provides guidelines for the appropriate use of PPE in healthcare settings, including nursing homes. These guidelines outline different precautions based on the type of care being provided and the level of risk for transmission.
The three main types of precautions relevant to PPE use in nursing homes are standard precautions, contact precautions, and enhanced barrier precautions. Each of these precautions has specific requirements for the use of PPE, which we will explore in more detail in the following sections.
Standard Precautions and PPE
Standard precautions are a set of infection prevention practices that apply to the care of all residents, regardless of their infection or colonization status. These precautions are based on the principle that all bodily fluids, secretions, and excretions may contain transmissible infectious agents.
When implementing standard precautions, healthcare workers should wear gloves when there is a potential for contact with blood, bodily fluids, mucous membranes, non-intact skin, or potentially contaminated surfaces or equipment. Additionally, other PPE items, such as gowns, masks, and eye protection, should be used based on the nature of the care being provided and the risk of exposure.
Contact Precautions and PPE
Contact precautions are used when there is a risk of transmission of infectious agents, such as MDROs, through direct or indirect contact with a resident or their environment. These precautions are necessary when standard precautions alone are not sufficient to prevent transmission.
When implementing contact precautions, healthcare workers should wear gloves and gowns before entering a resident’s room. The resident should be placed in a private room, and dedicated equipment should be used to minimize the risk of transmission. Residents on contact precautions should be restricted to their rooms, except for medically necessary care, and should not participate in group activities.
Enhanced Barrier Precautions and PPE
Enhanced barrier precautions (EBP) are an additional level of precautions that expand the use of PPE during high-contact resident care activities. EBP is recommended for residents with open wounds, indwelling catheters that are not colonized or do not have an infection, or those who are colonized or have an infection with MDROs when contact precautions do not apply.
When implementing EBP, healthcare workers should wear gowns and gloves during high-contact resident care activities, such as dressing, bathing, and wound care. The use of eye protection may be necessary when there is a risk of splash or spray. Unlike contact precautions, residents on EBP are not restricted to their rooms and can participate in group activities. Since EBP permits residents to leave their rooms, participate in group activities, or eat in the dining hall, this type of precaution can help the facility to prevent transmission of infectious agents while fulfilling the requirement to use the least restrictive type of precautions as required by the Centers for Medicare and Medicaid Services (CMS).
High-Contact Resident Care Activities and PPE Use
During high-contact resident care activities, the use of PPE is crucial to prevent the transmission of MDROs. These activities include dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use (e.g., central line, urinary catheter, feeding tube, tracheostomy/ventilator), and wound care.
Healthcare workers should wear gowns and gloves during these activities to minimize the risk of contamination. It is important to note that PPE is not required for resident care activities other than those listed unless necessary for adherence to Standard Precautions.
Implementing PPE in Nursing Homes
The effective implementation of PPE in nursing homes requires a comprehensive approach that includes proper training, clear signage, availability of PPE, and ongoing monitoring and assessment. To ensure the successful implementation of PPE protocols, nursing homes should consider the following steps:
- Post clear signage on the door or wall outside resident rooms indicating the type of precautions and required PPE.
- Make PPE, including gowns and gloves, readily available outside resident rooms. Although some states may allow PPE for EBP to be stored in a resident’s room, do not place PPE in the resident’s room without checking with your state health department first.
- Ensure access to hand hygiene products, such as alcohol-based hand rub, in every resident room.
- Provide education and training to staff on the proper use of PPE and hand hygiene.
- Regularly monitor and assess adherence to PPE protocols and provide additional training and education as needed.
- Educate residents and visitors about the importance of infection prevention and the proper use of PPE.
By implementing these measures, nursing homes can create a culture of safety and infection prevention, reducing the risk of MDRO transmission.
Training and Education on PPE Use
Proper training and education on the use of PPE are essential for healthcare workers in nursing homes. Staff should receive initial training on PPE protocols and regular refresher courses to ensure ongoing competency. The training should cover topics such as the proper donning and doffing of PPE, hand hygiene, and the importance of following infection prevention practices.
Nursing homes can provide training through in-person sessions, online modules, or a combination of both. It is important to tailor the training to the specific needs of the staff and ensure that they have access to the necessary resources, such as PPE supplies and hand hygiene products, to effectively implement PPE protocols.
Protect the Well-Being of Residents With Proper PPE Use
Remember, preventing the spread of MDROs requires a collective effort and a commitment to infection prevention practices. By following the guidelines and best practices outlined in this article, nursing homes can play a crucial role in protecting the health and well-being of their residents. To learn more about proper PPE use, assistance with determining the best location to store PPE when a resident is on EBP, or to schedule an on-site infection control assessment for a nursing home or other healthcare facility, contact Infection Control Results today.