The Centers for Medicare & Medicaid Services (CMS) released a memo on March 20 to incorporate Enhanced Barrier Precautions (EBP) into infection control procedures for multidrug-resistant organisms (MDROs). Memo QSO-24-08-NH outlines the guideline, introduced by the Centers for Disease Control & Prevention (CDC) in 2019 and updated in July 2022, which will be surveyed beginning April 1.

The EBP standard recommends the use of personal protective equipment (PPE) in addition to standard precautions to reduce transmission of MDROs while providing less restriction and better quality of life than Contact Precautions. Gowns and gloves should be used during high-contact care activities for residents who:

• Are infected or colonized with a CDC-targeted MDRO when Contact Precautions do not otherwise apply, or
• Have wounds and/or indwelling medical devices, even if the resident is not known to be colonized or infected with a MDRO.

High-contact care activities include dressing, bathing, toileting, hygiene, transfers, changing bed linens, and device and wound care. CDC developed several resources when EBPs were updated in July 2022 to help nursing homes understand and implement the recommendations. See the CDC guidance for more information on CDC-targeted MDROs, and access a video presentation from December 2022 on EBP here. The slides from the presentation are available here.

Enhanced Barrier Precautions will be surveyed under F880 Infection Control based on 42 CFR 483.80(a) and (a)(1) that requires nursing homes to develop an infection control program based on accepted national standards. When CMS implemented updated surveyor guidance in Appendix PP of the State Operations Manual in October 2022, EBP were referenced under F880 as a resource for addressing MDROs in nursing homes; however, the March 20 memo now implements the standard as a requirement beginning on April 1, 2024. More information on how this standard will be surveyed will be made available in the Surveyor Resources file in the Downloads section of the CMS Nursing Homes webpage.