Mayoryk Stephanie, O'Hara Lyndsay M, Robinson Gwen L, Lydecker Alison D, Slifka Kara Jacobs, Jones Heather, Roghmann Mary-Claire
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Am J Infect Control. 2025 Jan;53(1):126-131. doi: 10.1016/j.ajic.2024.09.014. Epub 2024 Sep 20.
Enhanced Barrier Precautions (EBPs) recommend using gowns and gloves for certain nursing home residents during specific high-contact care activities associated with multidrug-resistant organism (MDRO) transmission. Though EBP is included in published guidance as an MDRO control strategy, optimal implementation approaches remain unclear.
We implemented a quality improvement (QI) initiative using the 4E process model (engagement, education, execution, and evaluation) to optimize EBP implementation in 4 Maryland nursing homes. Semistructured interviews with health care personnel (HCP) occurred to understand EBP acceptability.
Glove use during high-contact care increased from 85% in the baseline to 97% during the intervention (P < .01). Gown use increased from 27% to 78% (P < .01). The accuracy of identifying residents eligible for EBP improved from 63% to 99% (P < .01). Of 780 residents observed, one third met EBP indications: MDRO colonization (21%), indwelling medical device (14%), and/or chronic wound (10%). The most noted facilitator to EBP implementation included HCP perception that EBP reduces MDRO transmission to other residents and staff. The most noted barrier was uncomfortable gowns.
Implementation was complex and required assessments of barriers and facilitators within each facility. HCP interviews identified barriers and facilitators of EBP that can inform future EBP implementation projects.
