Potential Impact of CDC’s Enhanced Barrier Precautions Recommendations on Veterans’ Affairs Long-Term Care Facilities

Abstract

Background: We previously showed that ~25% of Veterans’ Affairs (VA) long-term care facility (LTCF) residents had 1 or more indwelling medical devices. Of these devices, 36% were indwelling urinary catheters, 18% were percutaneous gastrostomy tubes, 12% were peripherally inserted central catheters, 8% were suprapubic urinary catheters, and 6% were peripheral intravenous catheters. Approximately 11% of those with an indwelling device developed an LTCF-acquired infection, compared to 3.5% of those without a device. Methicillin-resistant Staphylococcus aureus (MRSA) is a targeted multidrug-resistant organism (MDRO) in all VA LTCFs nationwide. All admissions to VA LTCFs are screened for MRSA carriage upon admission and, since 2013, those that screen positive (~21%) are placed in VA enhanced barrier precautions (EBPs). VA EBPs require that all healthcare workers entering a resident’s bedroom don gowns and gloves for specific activities likely to be associated with contamination of the worker’s hands and clothes. With proper hand hygiene and clean clothing, the colonized resident is encouraged to leave their bedroom and participate fully in all LTCF activities. In July 2019, the US Centers for Disease Control and Prevention (CDC) recommended the use of EBPs for all residents in LTCFs with a wound or device regardless of their colonization status if a resident is identified within the facility with novel or targeted MDROs including panresistant organisms, carbapenemase-producing gram-negative bacteria, and Candida auris. Methods: We assessed the potential impact of this recommendation on VA LTCFs by asking our 133 LTCFs to do a 1-day point-prevalence survey. Results: In total, 63 sites (47%) responded. On the survey day, there were 4,777 residents in the participating facilities, of whom 891 (18.7%) were under EBPs or contact precautions (CPs) for MRSA or other MDROs. Moreover, 963 (20.2%) residents (not already in EBP or CP) had a wound or an indwelling device such as central venous catheter, urinary catheter, feeding tube, tracheostomy or were on a ventilator (if >1 device, resident counted only once). If newly published CDC recommendations were implemented for novel or targeted MDRO precautions in VA LTCFs nationwide, 1,854 residents (38.8%) in VA LTCFs would be placed under EBPs or CPs. Conclusions: In VA LTCFs, adopting the CDC recommendation to place all patients with wounds or indwelling devices under EBPs regardless of colonization status would increase the percentage of residents on transmission-based precautions to ~40% (nearly doubling those in an isolation precaution status).

Funding: None

Disclosures: None