1 00:00:00,000 --> 00:00:04,400 2 00:00:04,400 --> 00:00:06,266 All right, well, welcome everyone. 3 00:00:06,266 --> 00:00:06,833 4 00:00:06,833 --> 00:00:12,000 Thank you for joining us for the May 22nd, 2024 Long Term Care 5 00:00:12,000 --> 00:00:15,800 Town Hall: Understanding Enhanced Barrier Precautions. 6 00:00:15,800 --> 00:00:16,033 7 00:00:16,033 --> 00:00:20,333 We are very thankful for the support and collaboration of the 8 00:00:20,333 --> 00:00:25,800 Centers for Disease Control and Prevention's Project First Line, 9 00:00:25,800 --> 00:00:28,966 which has enabled us to provide this webinar to you all as 10 00:00:28,966 --> 00:00:32,866 quickly as possible after learning about the recent EBP 11 00:00:32,866 --> 00:00:34,033 enforcement memo. 12 00:00:34,033 --> 00:00:34,633 13 00:00:34,633 --> 00:00:36,266 I'm Commander Kara Jacobs Slifka. 14 00:00:36,266 --> 00:00:42,733 I'm a medical officer with the 15 00:00:42,733 --> 00:00:45,433 CDCs long term care team. 16 00:00:45,433 --> 00:00:45,866 17 00:00:45,866 --> 00:00:48,833 I lead our Long term care team here within the Division of 18 00:00:48,833 --> 00:00:50,266 Healthcare Quality Promotion. 19 00:00:50,266 --> 00:00:51,666 20 00:00:51,666 --> 00:00:55,633 I'm really excited to introduce the two members of the Long term 21 00:00:55,633 --> 00:00:59,133 care team who we will be presenting this webinar, Doctors 22 00:00:59,133 --> 00:01:01,066 Bola Ogundimu and Heather Jones. 23 00:01:01,066 --> 00:01:01,766 24 00:01:01,766 --> 00:01:02,133 Dr. 25 00:01:02,133 --> 00:01:05,766 Ogundimu is a nurse infection preventionist and health 26 00:01:05,766 --> 00:01:06,400 scientist. 27 00:01:06,400 --> 00:01:06,833 28 00:01:06,833 --> 00:01:10,500 In her role, she provides consultation and technical 29 00:01:10,500 --> 00:01:13,866 assistance for implementing infection prevention and control 30 00:01:13,900 --> 00:01:16,533 strategies in post acute and long term care settings in 31 00:01:16,533 --> 00:01:20,000 collaboration with state and local health departments across 32 00:01:20,000 --> 00:01:21,033 the United States. 33 00:01:21,033 --> 00:01:21,433 34 00:01:21,433 --> 00:01:24,700 Doctor Ogundimu currently leads work focusing on the 35 00:01:24,700 --> 00:01:27,533 intersection between health disparities and infection 36 00:01:27,533 --> 00:01:28,166 prevention. 37 00:01:28,166 --> 00:01:28,833 38 00:01:28,833 --> 00:01:32,933 Doctor Heather Jones serves as a Nurse consultant, having begun 39 00:01:32,933 --> 00:01:36,000 her healthcare career as a registered nurse in acute care 40 00:01:36,000 --> 00:01:39,400 and then as a family Nurse Practitioner working alongside 41 00:01:39,400 --> 00:01:42,066 medical directors and staff in nursing homes. 42 00:01:42,066 --> 00:01:42,400 43 00:01:42,400 --> 00:01:46,233 In 2020, she received her doctorate in nursing practice 44 00:01:46,233 --> 00:01:49,566 and began her public career public health career with CDC. 45 00:01:49,566 --> 00:01:49,966 46 00:01:49,966 --> 00:01:53,333 Doctor Jones provides infection prevention and control subject 47 00:01:53,333 --> 00:01:56,866 matter expertise for post acute and long term care outbreak 48 00:01:56,866 --> 00:01:59,966 responses and has presented at many local and national 49 00:01:59,966 --> 00:02:00,633 conferences. 50 00:02:00,633 --> 00:02:00,933 51 00:02:00,933 --> 00:02:03,566 Doctor Jones is currently leading efforts for better 52 00:02:03,566 --> 00:02:06,500 understanding the role of infection preventionists in long 53 00:02:06,500 --> 00:02:07,433 term care settings. 54 00:02:07,433 --> 00:02:07,700 55 00:02:07,700 --> 00:02:08,533 right. 56 00:02:08,533 --> 00:02:11,900 And I've already shared our disclosure, so I will not repeat 57 00:02:11,900 --> 00:02:12,233 those. 58 00:02:12,233 --> 00:02:13,233 59 00:02:13,233 --> 00:02:15,933 Thank you everyone for joining us again today. 60 00:02:15,933 --> 00:02:16,533 61 00:02:16,533 --> 00:02:23,400 I'm going to now do a little bit of a presentation of the iceberg 62 00:02:23,400 --> 00:02:28,933 effect and many of you that have been in our long term care calls 63 00:02:28,933 --> 00:02:35,066 before as well as know anything about infection and colonization 64 00:02:35,066 --> 00:02:39,833 and MDROs will be quite familiar with the iceberg 65 00:02:39,833 --> 00:02:40,500 effect. 66 00:02:40,500 --> 00:02:40,933 67 00:02:40,933 --> 00:02:45,633 So to begin, when we think about the iceberg and we think about 68 00:02:45,633 --> 00:02:50,433 the tip, this is the tip of the iceberg and this is what we see. 69 00:02:50,433 --> 00:02:51,033 70 00:02:51,033 --> 00:02:55,100 And so the tip of the iceberg is clearly visible to everybody and 71 00:02:55,100 --> 00:02:58,933 it depicts what we already know or what we physically see or 72 00:02:58,933 --> 00:03:00,633 know about a patient or a resident. 73 00:03:00,633 --> 00:03:01,400 74 00:03:01,400 --> 00:03:04,633 A MDRO infection is the tip of that iceberg. 75 00:03:04,633 --> 00:03:05,000 76 00:03:05,000 --> 00:03:09,200 And when a person has an MDRO infection, they have presence of 77 00:03:09,200 --> 00:03:12,433 signs and symptoms in the resident or patients. 78 00:03:12,433 --> 00:03:12,900 79 00:03:12,900 --> 00:03:16,833 Or another way to look at this is if a person has a documented 80 00:03:16,833 --> 00:03:21,033 infection or colonization with the MDRO and it is present in 81 00:03:21,033 --> 00:03:22,100 their healthcare record. 82 00:03:22,100 --> 00:03:22,400 83 00:03:22,400 --> 00:03:24,933 So you see this and you know this. 84 00:03:24,933 --> 00:03:25,666 85 00:03:25,666 --> 00:03:32,100 It isn't a part of what we know as the larger unseen part. 86 00:03:32,100 --> 00:03:32,466 87 00:03:32,466 --> 00:03:35,033 What we don't see or we don't know. 88 00:03:35,033 --> 00:03:35,133 89 00:03:35,133 --> 00:03:38,633 And this is the large portion that's hidden below the surface. 90 00:03:38,633 --> 00:03:39,200 91 00:03:39,200 --> 00:03:43,066 This is what we often discuss when talking through a MDRO 92 00:03:43,066 --> 00:03:46,200 colonization or multi drug resistant organism. 93 00:03:46,200 --> 00:03:46,900 94 00:03:46,900 --> 00:03:51,000 A MDRO colonization is when a resident has the presence of an 95 00:03:51,000 --> 00:03:56,700 MDRO that is not causing signs and symptoms or it's not present 96 00:03:56,700 --> 00:03:58,833 in their medical record or their healthcare records. 97 00:03:58,833 --> 00:04:04,766 So you do not know that they are colonized with the MDRO and 98 00:04:04,766 --> 00:04:07,233 Here's the whole picture. 99 00:04:07,233 --> 00:04:07,666 100 00:04:07,666 --> 00:04:10,666 So when we think about the whole picture, this is where the 101 00:04:10,666 --> 00:04:12,600 prevention strategies come into play. 102 00:04:12,600 --> 00:04:13,133 103 00:04:13,133 --> 00:04:18,133 If you don't see or know the large unseen portion of MDRO 104 00:04:18,133 --> 00:04:22,133 colonization, and you're only aware of the few residents who 105 00:04:22,133 --> 00:04:26,733 have a known MDRO infection or colonization in a nursing home, 106 00:04:26,733 --> 00:04:31,233 you must have prevention strategies in place to stop the 107 00:04:31,233 --> 00:04:33,433 spread of all unknown MDRO's. 108 00:04:33,433 --> 00:04:34,200 109 00:04:34,200 --> 00:04:38,800 A recent study found that only a small portion of residents in 110 00:04:38,800 --> 00:04:43,200 the study were already known to have an MDRO, but when they 111 00:04:43,200 --> 00:04:48,400 began to actively look for MDROs in these residents of 112 00:04:48,400 --> 00:04:51,633 these nursing homes, they actually found that one out of 113 00:04:51,633 --> 00:04:54,700 every two were found to have the MDRO. 114 00:04:54,700 --> 00:04:55,266 115 00:04:55,266 --> 00:04:58,733 So we wanted to establish the basis of why there is an 116 00:04:58,733 --> 00:05:02,733 importance for having prevention strategies including enhanced 117 00:05:02,733 --> 00:05:04,000 barrier precautions. 118 00:05:04,000 --> 00:05:04,600 119 00:05:04,600 --> 00:05:07,833 And now I'm going to turn it over to Bola who is going to be 120 00:05:07,833 --> 00:05:10,000 speaking a little bit more about those. 121 00:05:10,000 --> 00:05:11,500 122 00:05:11,500 --> 00:05:13,066 Thank you so much Heather. 123 00:05:13,066 --> 00:05:13,666 124 00:05:13,666 --> 00:05:21,400 And so for exploring again like a rationale as well as a or 125 00:05:21,400 --> 00:05:26,466 exploration of enhanced barrier precautions as noted in the next 126 00:05:26,466 --> 00:05:27,100 slide. 127 00:05:27,100 --> 00:05:27,700 128 00:05:27,700 --> 00:05:33,600 So we have enhanced barrier precautions as an infection 129 00:05:33,600 --> 00:05:38,800 prevention and control strategy that is really designed to 130 00:05:38,800 --> 00:05:43,400 reduce transmission of multi drug resistant organisms 131 00:05:43,400 --> 00:05:48,333 otherwise known as MDROs in our nursing homes specifically. 132 00:05:48,333 --> 00:05:49,200 133 00:05:49,200 --> 00:05:52,700 So EBP enriches enhanced barrier precautions. 134 00:05:52,700 --> 00:05:53,300 135 00:05:53,300 --> 00:05:58,800 It involves again the use of gown and gloves that is focused on 136 00:05:58,800 --> 00:06:04,333 resident care activities most likely leading to the spread of 137 00:06:04,333 --> 00:06:07,800 MDROs in our nursing home facilities. 138 00:06:07,800 --> 00:06:08,633 139 00:06:08,633 --> 00:06:09,800 Next slide please. 140 00:06:09,800 --> 00:06:10,200 141 00:06:10,200 --> 00:06:18,633 So as a refresher, going through the different types of 142 00:06:18,633 --> 00:06:22,966 precautions that we have, starting out with the standard 143 00:06:23,000 --> 00:06:29,200 precautions, we recognize the standard precautions a pair or 144 00:06:29,200 --> 00:06:33,966 apply to the care of all residents where the use of PPE 145 00:06:34,000 --> 00:06:39,566 is really based on anticipated exposure to blood, body fluids, 146 00:06:39,566 --> 00:06:42,233 secretions as well as excretions. 147 00:06:42,233 --> 00:06:42,700 148 00:06:42,700 --> 00:06:47,700 So for instance, gloves are recommended when we someone a 149 00:06:47,700 --> 00:06:52,000 healthcare personnel will be in contact with blood or 150 00:06:52,000 --> 00:06:56,966 potentially infectious materials, mucous membranes as 151 00:06:56,966 --> 00:07:01,333 well as non intact skin or contaminated equipment. 152 00:07:01,333 --> 00:07:02,400 153 00:07:02,400 --> 00:07:09,266 If it's anticipated that that interaction will occur. Again 154 00:07:09,266 --> 00:07:11,666 going that is standard precautions. 155 00:07:11,666 --> 00:07:11,933 156 00:07:11,933 --> 00:07:19,233 And so in contrast or or sometimes in complements with 157 00:07:19,233 --> 00:07:23,866 their enhanced barrier precautions, which is the use of 158 00:07:23,866 --> 00:07:29,366 gown and gloves beyond the anticipated blood and body fluid 159 00:07:29,366 --> 00:07:30,300 exposure. 160 00:07:30,300 --> 00:07:31,300 161 00:07:31,300 --> 00:07:36,400 And again, enhanced barrier precautions focuses on gowns and 162 00:07:36,400 --> 00:07:42,466 gloves that are used during high contact resident care activities 163 00:07:42,466 --> 00:07:48,000 that have been shown to result in the to decreased transfer of 164 00:07:48,000 --> 00:07:50,833 MDROs to hands and clothing. 165 00:07:50,833 --> 00:07:51,000 166 00:07:51,000 --> 00:07:57,166 So again, to prevent transfer of MDROs to the hands and 167 00:07:57,166 --> 00:08:01,666 clothing of health care personnel, even if blood and 168 00:08:01,666 --> 00:08:07,200 body fluid exposure is not anticipated. Point to note is 169 00:08:07,200 --> 00:08:11,300 that standard precautions could still apply even when you're 170 00:08:11,300 --> 00:08:12,333 using an EBP. 171 00:08:12,333 --> 00:08:12,833 172 00:08:12,833 --> 00:08:18,433 So for instance, if it's anticipated that for a procedure 173 00:08:18,433 --> 00:08:21,833 there will be splashes or sprays or interactions with the 174 00:08:21,833 --> 00:08:26,700 residents, if splashes or sprays are anticipated during high 175 00:08:26,733 --> 00:08:30,566 contact resident care activities, face protection 176 00:08:30,566 --> 00:08:34,033 really should be used in addition to the gown and gloves. 177 00:08:34,033 --> 00:08:37,833 So essentially standard precautions plus enhanced 178 00:08:37,833 --> 00:08:41,933 barrier precautions where you anticipate that there's another 179 00:08:41,933 --> 00:08:44,733 level of body fluid exposure. 180 00:08:44,733 --> 00:08:46,133 181 00:08:46,133 --> 00:08:50,333 Next, we have contact precautions and that actually 182 00:08:50,333 --> 00:08:55,600 requires the use of gown and gloves on every single entry 183 00:08:55,600 --> 00:08:59,800 into a resident's room regardless of the level of care that is 184 00:08:59,800 --> 00:09:02,400 being provided to the resident. 185 00:09:02,400 --> 00:09:07,100 So contact precautions are generally intended to be 186 00:09:07,100 --> 00:09:12,200 time limited and when they're implemented, there should be a 187 00:09:12,233 --> 00:09:16,400 definitive plan or at least a possible plan for 188 00:09:16,400 --> 00:09:21,833 discontinuation or de-escalation of the contact precautions. 189 00:09:21,833 --> 00:09:22,466 190 00:09:22,466 --> 00:09:26,266 And then the resident is actually given a lot of times 191 00:09:26,266 --> 00:09:29,933 dedicated equipment, the stethoscope, blood pressure 192 00:09:29,933 --> 00:09:34,500 cuff, sometimes dynamaps and is placed in the private room 193 00:09:34,500 --> 00:09:37,233 setting specifically for contact precautions. 194 00:09:37,233 --> 00:09:37,500 195 00:09:37,500 --> 00:09:41,866 And then we also say when private rooms are not available, 196 00:09:41,866 --> 00:09:46,533 some residents typically we say grouped like residents together. 197 00:09:46,533 --> 00:09:51,466 so some residents may be cohorted or grouped together 198 00:09:51,466 --> 00:09:56,800 and then also residents of contact precautions should be 199 00:09:56,800 --> 00:10:01,066 restricted to their rooms except for medically necessary 200 00:10:01,066 --> 00:10:05,733 care and they also restricted some participation of group 201 00:10:05,733 --> 00:10:06,633 activities. 202 00:10:06,633 --> 00:10:12,100 So again, those are the contrast between standard precautions, 203 00:10:12,100 --> 00:10:15,500 enhanced barrier precautions and contact precautions. 204 00:10:15,500 --> 00:10:19,300 And just reiterating again, enhanced barrier precautions 205 00:10:19,300 --> 00:10:23,566 will be gown and gloves used, but if you anticipate there's 206 00:10:23,600 --> 00:10:27,733 additional like body fluid exposure, then standard 207 00:10:27,733 --> 00:10:32,300 precautions would also be used in addition to enhanced barrier 208 00:10:32,300 --> 00:10:34,400 precautions. Next slide. 209 00:10:34,400 --> 00:10:35,633 210 00:10:35,633 --> 00:10:40,833 So at a minimum, enhanced barrier precautions are intended to be 211 00:10:40,833 --> 00:10:46,966 used for residents colonized or infected with MDROs targeted 212 00:10:46,966 --> 00:10:47,933 by the CDC. 213 00:10:47,933 --> 00:10:49,066 214 00:10:49,066 --> 00:10:53,300 We've often gotten questions about what do we mean by CDC 215 00:10:53,300 --> 00:10:55,133 targeted MDROs. 216 00:10:55,133 --> 00:10:55,433 217 00:10:55,433 --> 00:10:58,200 So I'll be going over that the next couple of seconds. 218 00:10:58,200 --> 00:10:58,300 219 00:10:58,300 --> 00:11:04,700 So for the next slide, So what do we mean by a targeted MDRO? 220 00:11:04,700 --> 00:11:05,400 221 00:11:05,400 --> 00:11:10,600 So essentially targeted MDRO's are germs that are resist 222 00:11:10,600 --> 00:11:17,033 resistant to most or all available antimicrobial agents 223 00:11:17,033 --> 00:11:22,500 and have the potential to spread widely and intensive public 224 00:11:22,500 --> 00:11:27,133 health actions are typically required to slow the spread of 225 00:11:27,133 --> 00:11:28,433 targeted MDROs. 226 00:11:28,433 --> 00:11:29,533 227 00:11:29,533 --> 00:11:32,633 And next slide we have a couple of examples. 228 00:11:32,633 --> 00:11:38,166 So just off this list on the slide we have 229 00:11:38,166 --> 00:11:44,033 Pan-resistant organisms which I mentioned earlier as well as carbapenemase 230 00:11:44,033 --> 00:11:50,300 producing carbapenem-resistant Enterobacterales and then also 231 00:11:50,300 --> 00:11:54,533 carbapenemase-producing carbapenem-resistant 232 00:11:54,533 --> 00:11:59,600 Pseudomonas species and also Carbapenemase-producing 233 00:11:59,600 --> 00:12:05,300 carbapenem-resistant is the Acinetobacter baumannii which 234 00:12:05,300 --> 00:12:11,300 also some is known as crab and then Candida auris is another 235 00:12:11,300 --> 00:12:12,066 example. 236 00:12:12,066 --> 00:12:12,866 237 00:12:12,866 --> 00:12:21,300 So next slide, it is important to note that in addition, 238 00:12:21,300 --> 00:12:27,200 residents should have MDRO prevention strategies in place 239 00:12:27,200 --> 00:12:31,300 for residents at high at an increased or higher risk of 240 00:12:31,300 --> 00:12:35,400 being colonized or already colonized or infected. 241 00:12:35,400 --> 00:12:36,466 242 00:12:36,466 --> 00:12:41,033 And we would be using EBP for residents with indwelling 243 00:12:41,033 --> 00:12:47,000 medical devices essentially as an MDRO prevention strategy 244 00:12:47,000 --> 00:12:51,533 that could be used or that may be used for this group of 245 00:12:51,533 --> 00:12:53,100 residents with increased risk. 246 00:12:53,100 --> 00:12:57,733 So the first increased risk would be residents with 247 00:12:57,733 --> 00:13:03,200 indwelling medical devices such as indwelling foley catheters or 248 00:13:03,200 --> 00:13:08,033 indwelling urinary catheters, tracheostomies, ventilators as 249 00:13:08,033 --> 00:13:13,333 well as central venous catheter like PICCs or ports. 250 00:13:13,333 --> 00:13:13,700 251 00:13:13,700 --> 00:13:18,866 And then for the purposes of EBP, we had also added midline 252 00:13:18,866 --> 00:13:21,466 catheters in addition to that. 253 00:13:21,466 --> 00:13:22,300 254 00:13:22,300 --> 00:13:29,533 So next slide, we have also EBP may be used for residents that 255 00:13:29,533 --> 00:13:31,033 have a wound. 256 00:13:31,033 --> 00:13:31,333 257 00:13:31,333 --> 00:13:33,800 So we got a lot of questions about wounds. 258 00:13:33,800 --> 00:13:34,533 Like what? 259 00:13:34,533 --> 00:13:35,400 260 00:13:35,400 --> 00:13:37,066 What do we mean by wounds? 261 00:13:37,066 --> 00:13:37,400 262 00:13:37,400 --> 00:13:43,466 So we're not talking short term wounds that you can apply 263 00:13:43,466 --> 00:13:46,400 band-aid kind of dressing on. 264 00:13:46,400 --> 00:13:46,600 265 00:13:46,600 --> 00:13:50,233 We're talking more chronic wounds like pressure ulcers or 266 00:13:50,233 --> 00:13:56,100 diabetic foot ulcers as well as chronic venous stasis 267 00:13:56,100 --> 00:14:00,966 ulcers as we recognize that chronic wounds are risk factors 268 00:14:00,966 --> 00:14:02,400 for MDROs. 269 00:14:02,400 --> 00:14:03,233 270 00:14:03,233 --> 00:14:11,700 And so the other next slide we have is just thinking through 271 00:14:11,700 --> 00:14:15,333 our EBP versus contact precautions. 272 00:14:15,333 --> 00:14:19,600 So we've often gotten questions about, well who needs contact 273 00:14:19,600 --> 00:14:23,266 precautions instead of enhanced barrier precautions. 274 00:14:23,266 --> 00:14:30,333 Still to answer that question again, recognize that EBP is 275 00:14:30,333 --> 00:14:36,166 specific for MDROs prevention specifically in nursing homes 276 00:14:36,166 --> 00:14:41,433 and so Appendix A of the isolation guidelines would still 277 00:14:41,433 --> 00:14:43,400 apply for other pathogens. 278 00:14:43,400 --> 00:14:43,833 279 00:14:43,833 --> 00:14:50,133 So in your facility or in any facility, specifically nursing 280 00:14:50,133 --> 00:14:56,400 homes, if a resident, for instance, has certain conditions 281 00:14:56,433 --> 00:15:01,200 where there might be possible transmission if not contained, 282 00:15:01,200 --> 00:15:04,833 then contact precautions should be implemented. 283 00:15:04,833 --> 00:15:05,466 284 00:15:05,466 --> 00:15:11,900 So those examples would include for a facility that has 285 00:15:11,900 --> 00:15:14,733 residents, for instance, with acute diarrhea. 286 00:15:14,733 --> 00:15:15,000 287 00:15:15,000 --> 00:15:19,766 For those residents, contact precautions will be in place as 288 00:15:19,766 --> 00:15:24,933 well as residents that have draining wounds that can't be 289 00:15:24,933 --> 00:15:30,133 contained or covered like they'd have weeping wounds, contact 290 00:15:30,133 --> 00:15:31,833 precautions would be implemented. 291 00:15:31,833 --> 00:15:32,100 292 00:15:32,100 --> 00:15:40,433 And then also if there are conditions where the 293 00:15:40,433 --> 00:15:44,900 resident is unable to contain their excretions, for instance, 294 00:15:44,900 --> 00:15:49,100 for cases like C diff where or even norovirus where they might 295 00:15:49,100 --> 00:15:54,733 have explosive diarrhea, then contact precautions would be 296 00:15:54,733 --> 00:15:55,866 implemented. 297 00:15:55,866 --> 00:15:56,133 298 00:15:56,133 --> 00:16:01,500 And again, it's just secretions or excretions that can't be 299 00:16:01,500 --> 00:16:04,833 covered or contained. Next slide. 300 00:16:04,833 --> 00:16:06,100 301 00:16:06,100 --> 00:16:14,000 So we also have situations where as I indicated earlier, other 302 00:16:14,000 --> 00:16:19,100 situations outside of not being able to contain or cover whether 303 00:16:19,100 --> 00:16:23,666 it's a wound, weeping wound or on excretion. 304 00:16:23,666 --> 00:16:24,133 305 00:16:24,133 --> 00:16:30,300 Also have situations where if a facility has a suspected or 306 00:16:30,300 --> 00:16:34,433 confirmed MDRO outbreak in working together with the public 307 00:16:34,433 --> 00:16:40,800 health department and often times it is directed by the 308 00:16:40,800 --> 00:16:43,933 public health department or public health authorities 309 00:16:43,933 --> 00:16:44,000 310 00:16:44,000 --> 00:16:49,000 investigations, that contact precautions is in place again 311 00:16:49,000 --> 00:16:51,333 for a time limiting period. 312 00:16:51,333 --> 00:16:52,266 313 00:16:52,266 --> 00:16:57,200 And this is generally intended again to be time limited. 314 00:16:57,200 --> 00:16:57,266 315 00:16:57,266 --> 00:17:00,633 And when implemented there should be a plan for 316 00:17:00,633 --> 00:17:03,700 discontinuation or de-escalation. 317 00:17:03,700 --> 00:17:04,500 318 00:17:04,500 --> 00:17:10,500 And also not all MDRO outbreaks may need the use of contact 319 00:17:10,500 --> 00:17:10,833 precautions. 320 00:17:10,833 --> 00:17:14,866 Again, we encourage you to work with your public health 321 00:17:14,866 --> 00:17:20,000 department to really go through with different steps of your 322 00:17:20,000 --> 00:17:22,933 outbreak investigation in collaboration with them. 323 00:17:22,933 --> 00:17:23,700 324 00:17:23,700 --> 00:17:24,500 Next slide. 325 00:17:24,500 --> 00:17:25,900 326 00:17:25,900 --> 00:17:33,300 So we've often gotten these questions regarding what the CDC 327 00:17:33,300 --> 00:17:39,000 defines or you know it gives examples of high contact 328 00:17:39,000 --> 00:17:40,700 resident care activities. 329 00:17:40,700 --> 00:17:48,200 So those activities include, first off, things like dressing, 330 00:17:48,200 --> 00:17:55,566 bathing or showering, as well as transferring the residents one 331 00:17:55,566 --> 00:18:01,533 spot to the other from bed to chair and vice versa. 332 00:18:01,533 --> 00:18:01,800 333 00:18:01,800 --> 00:18:07,000 And also providing hygiene and changing bed linens as well as 334 00:18:07,000 --> 00:18:12,066 changing sheets or assisting a resident with toileting as 335 00:18:12,066 --> 00:18:16,266 well as handling their indwelling medical device. 336 00:18:16,266 --> 00:18:18,066 337 00:18:18,066 --> 00:18:22,833 And also if we're gonna be assisting with maintaining their 338 00:18:22,833 --> 00:18:27,066 indwelling medical devices, that gowns and gloves would be needed 339 00:18:27,066 --> 00:18:28,800 for those circumstances. 340 00:18:28,800 --> 00:18:29,133 341 00:18:29,133 --> 00:18:33,000 And again, when we talk about wound care, as I illustrated 342 00:18:33,000 --> 00:18:37,433 earlier, we don't necessarily need the shorter lasting 343 00:18:37,433 --> 00:18:38,700 Band-Aid wounds. 344 00:18:38,700 --> 00:18:39,333 345 00:18:39,333 --> 00:18:43,833 We're talking more chronic wounds and a lot of times we 346 00:18:43,833 --> 00:18:48,033 often say that those resident care activities that are shown 347 00:18:48,033 --> 00:18:52,766 on this slide, the high contact resident care activities should 348 00:18:52,766 --> 00:18:55,066 be bundled as much as possible. 349 00:18:55,066 --> 00:18:59,166 So if you're doing AM care, it is important to consider what 350 00:18:59,166 --> 00:19:05,433 else you can have in place as maybe being able to group 351 00:19:05,433 --> 00:19:08,033 together the different activities that can be done. 352 00:19:08,033 --> 00:19:08,133 353 00:19:08,133 --> 00:19:12,800 And the next couple of slides will show certain examples of 354 00:19:12,800 --> 00:19:17,833 what can be done for facilities while they're bundling different 355 00:19:17,833 --> 00:19:19,800 resident care activities. 356 00:19:19,800 --> 00:19:20,466 357 00:19:20,466 --> 00:19:21,100 Next slide. 358 00:19:21,100 --> 00:19:22,200 359 00:19:22,200 --> 00:19:22,600 OK. 360 00:19:22,600 --> 00:19:23,333 361 00:19:23,333 --> 00:19:28,966 So again, many of the high contact resident care activities 362 00:19:28,966 --> 00:19:35,133 are typically bundled inside the room as part of AM or PM care as 363 00:19:35,133 --> 00:19:36,633 I noted earlier. 364 00:19:36,633 --> 00:19:37,666 365 00:19:37,666 --> 00:19:41,800 So for instance, on the left side of the slide that is 366 00:19:41,800 --> 00:19:47,233 circled in in red, activities such as helping the resident use 367 00:19:47,233 --> 00:19:52,266 the toilet or toileting, helping them getting freshened up as 368 00:19:52,266 --> 00:19:56,966 well as helping them get dressed or change bed linens and 369 00:19:56,966 --> 00:20:00,933 transferring the resident from bed to chair. 370 00:20:00,933 --> 00:20:01,000 371 00:20:01,000 --> 00:20:05,666 Vice versa can be bundled together during one interaction 372 00:20:05,666 --> 00:20:07,100 with the resident. 373 00:20:07,100 --> 00:20:07,400 374 00:20:07,400 --> 00:20:11,233 So otherwise we call it AM care in some instances. 375 00:20:11,233 --> 00:20:11,800 376 00:20:11,800 --> 00:20:16,466 In another instance on the right activities such as assessing 377 00:20:16,466 --> 00:20:22,000 wound care, dressing or changing wound dressings as well as 378 00:20:22,000 --> 00:20:28,366 performing skin assessment and also assessing 379 00:20:28,366 --> 00:20:31,666 their feeding tubes or giving medications through their 380 00:20:31,666 --> 00:20:36,100 feeding tubes also can be bundled together or can be 381 00:20:36,100 --> 00:20:41,833 provided at certain intervals rather than just using a single 382 00:20:41,833 --> 00:20:43,900 entry into that resident’s room. 383 00:20:43,900 --> 00:20:45,333 384 00:20:45,333 --> 00:20:53,833 So next slide we have again EBP is generally not necessary for 385 00:20:53,833 --> 00:20:58,233 brief minimal touch interactions with the residents. 386 00:20:58,233 --> 00:20:58,600 387 00:20:58,600 --> 00:21:02,600 And also if the healthcare personnel is not 388 00:21:02,600 --> 00:21:06,433 necessarily touching the resident or environment inside 389 00:21:06,433 --> 00:21:10,333 the room, then EBP is not needed. 390 00:21:10,333 --> 00:21:10,833 391 00:21:10,833 --> 00:21:16,066 So for instance, if there is anticipated isolated foaming of 392 00:21:16,066 --> 00:21:21,533 the residents pair that is not otherwise bundled with other 393 00:21:21,533 --> 00:21:25,600 high contact resident care activities, then that 394 00:21:25,600 --> 00:21:30,433 interaction would not necessarily mean gown and gloves, 395 00:21:30,433 --> 00:21:34,900 essentially no EBP for that only isolated instance. 396 00:21:34,900 --> 00:21:35,700 397 00:21:35,700 --> 00:21:36,500 Next slide. 398 00:21:36,500 --> 00:21:37,866 399 00:21:37,866 --> 00:21:45,466 So again as to why we have EBP being recommended, we've looked 400 00:21:45,466 --> 00:21:49,633 at multiple studies over the years and over the next couple 401 00:21:49,633 --> 00:21:53,466 of slides we wanted to share different studies that have 402 00:21:53,466 --> 00:21:58,666 looked at high contact resident care activities that have 403 00:21:58,666 --> 00:22:02,300 resulted in the highest spread of MDROs. 404 00:22:02,300 --> 00:22:02,733 405 00:22:02,733 --> 00:22:08,066 So as you can see on this slide with the bars, the highest risk 406 00:22:08,066 --> 00:22:13,466 activities included those where we recommend gown and gloves to 407 00:22:13,466 --> 00:22:17,200 be used in the current EBP recommendations. 408 00:22:17,200 --> 00:22:18,033 409 00:22:18,033 --> 00:22:22,100 Again, these slides will be available to everybody after the 410 00:22:22,100 --> 00:22:24,833 town hall. Next slide. 411 00:22:24,833 --> 00:22:25,500 412 00:22:25,500 --> 00:22:30,700 We also showed similar results with other studies that others 413 00:22:30,700 --> 00:22:37,333 have done, really indicating the highest risk activities that 414 00:22:37,333 --> 00:22:40,400 that force the most MDRO spread. 415 00:22:40,400 --> 00:22:40,933 416 00:22:40,933 --> 00:22:45,333 Again, the importance of having data from these nursing homes 417 00:22:45,333 --> 00:22:46,833 cannot be overstated. 418 00:22:46,833 --> 00:22:47,333 419 00:22:47,333 --> 00:22:51,700 So observations of the types of care activities that are 420 00:22:51,700 --> 00:22:56,066 performed in nursing home residents and which activities 421 00:22:56,066 --> 00:23:00,333 are found to be the highest risk of spreading MDROs to 422 00:23:00,333 --> 00:23:04,266 healthcare personnel, which could then spread to other 423 00:23:04,266 --> 00:23:09,100 residents and even themselves really directly influenced by 424 00:23:09,100 --> 00:23:10,100 EBP guidance. 425 00:23:10,100 --> 00:23:12,500 426 00:23:12,500 --> 00:23:14,433 And then we have the next slide, 427 00:23:14,433 --> 00:23:15,100 428 00:23:15,100 --> 00:23:19,900 So with the previous studies that I had noted earlier, again 429 00:23:19,900 --> 00:23:24,500 really these high contact activities have the most spread. 430 00:23:24,500 --> 00:23:25,266 431 00:23:25,266 --> 00:23:30,233 But this particular slide that, this particular slide 432 00:23:30,233 --> 00:23:36,200 denotes like how targeted gown and glove use also known as EBP 433 00:23:36,200 --> 00:23:39,933 or enhanced barrier precautions successfully reduced the 434 00:23:39,933 --> 00:23:41,666 transmission of MDRO. 435 00:23:41,666 --> 00:23:42,133 436 00:23:42,133 --> 00:23:47,100 So this study in particular demonstrated that nursing homes 437 00:23:47,100 --> 00:23:51,200 were able to successfully identify residents with risk 438 00:23:51,200 --> 00:23:55,833 factors for MDROs as I indicated earlier and also 439 00:23:55,833 --> 00:24:01,100 obtained an excellent adherence to the focus use of gown and gloves 440 00:24:01,100 --> 00:24:05,733 meaning EBP by healthcare personnel during these 441 00:24:05,733 --> 00:24:08,933 high contact resident care activities. 442 00:24:08,933 --> 00:24:10,033 443 00:24:10,033 --> 00:24:15,033 And again these results that we have on the slide showing on the 444 00:24:15,033 --> 00:24:20,333 bar indicate that EBP was an evidence based approach for 445 00:24:20,333 --> 00:24:25,500 preventing the transmission of MDROs and additional related 446 00:24:25,500 --> 00:24:31,000 studies are ongoing right now to continue to support our ongoing 447 00:24:31,000 --> 00:24:36,233 understanding of the most of the most effective approaches to 448 00:24:36,233 --> 00:24:40,233 preventing MDRO transmission in nursing homes. 449 00:24:40,233 --> 00:24:40,700 450 00:24:40,700 --> 00:24:46,600 So again, nursing homes have successfully identified who met 451 00:24:46,600 --> 00:24:53,666 EBP, as well as, successfully been able to have adherence to gown 452 00:24:53,666 --> 00:24:57,466 and glove use within their different facilities. 453 00:24:57,466 --> 00:24:59,233 454 00:24:59,233 --> 00:25:05,666 And so we have had our partners share the possibility of having 455 00:25:05,666 --> 00:25:09,200 EBP implemented and the successes that our partners have 456 00:25:09,200 --> 00:25:14,466 found as well as challenges that our partners have been able to 457 00:25:14,466 --> 00:25:18,733 identify with implemented EBP at our nursing homes. 458 00:25:18,733 --> 00:25:19,233 459 00:25:19,233 --> 00:25:23,833 So with that said, I will hand over to Heather to talk about 460 00:25:23,833 --> 00:25:29,500 why we need EBP as part of the MDRO prevention strategy. 461 00:25:29,500 --> 00:25:30,033 462 00:25:30,033 --> 00:25:30,733 Thank you, Heather. 463 00:25:30,733 --> 00:25:32,466 464 00:25:32,466 --> 00:25:34,133 Thank you so much, Bola. 465 00:25:34,133 --> 00:25:34,600 466 00:25:34,600 --> 00:25:37,066 I'm now going to discuss why it is needed. 467 00:25:37,066 --> 00:25:41,033 Why do we need enhanced barrier precautions as part of an MDRO 468 00:25:41,033 --> 00:25:42,300 prevention strategy? 469 00:25:42,300 --> 00:25:44,066 470 00:25:44,066 --> 00:25:48,433 First, nursing home residents are at the highest risk and 471 00:25:48,433 --> 00:25:53,433 higher risks for not only having but getting MDRO colonization or 472 00:25:53,433 --> 00:25:54,200 infection. 473 00:25:54,200 --> 00:25:54,833 474 00:25:54,833 --> 00:25:59,066 A majority of people who live in nursing homes are older, and as 475 00:25:59,066 --> 00:26:03,266 a person ages, the body is less able to fight infection as they 476 00:26:03,266 --> 00:26:05,866 would have been when they were younger. 477 00:26:05,866 --> 00:26:06,666 478 00:26:06,666 --> 00:26:11,466 Most have multiple comorbid conditions such as high blood 479 00:26:11,466 --> 00:26:16,166 pressure, chronic kidney disease, or chronic respiratory 480 00:26:16,166 --> 00:26:17,066 conditions. 481 00:26:17,066 --> 00:26:17,800 482 00:26:17,800 --> 00:26:21,733 Nursing home residents also depends on many of the staff 483 00:26:21,733 --> 00:26:26,133 members to help them with caring for themselves, whether through 484 00:26:26,133 --> 00:26:28,666 physical or cognitive limitations. 485 00:26:28,666 --> 00:26:29,300 486 00:26:29,300 --> 00:26:34,333 There is also a high social context within nursing homes and 487 00:26:34,333 --> 00:26:38,866 multiple interactions occur between both residents and 488 00:26:38,866 --> 00:26:39,333 staff. 489 00:26:39,333 --> 00:26:42,266 490 00:26:42,266 --> 00:26:46,300 Other higher risk factors that affect the likelihood of MDRO 491 00:26:46,300 --> 00:26:50,166 spread is that a lot of the residents have had a recent or a 492 00:26:50,166 --> 00:26:54,400 long hospital stay, they have wounds and in dwelling medical 493 00:26:54,400 --> 00:26:54,933 devices. 494 00:26:54,933 --> 00:26:55,700 495 00:26:55,700 --> 00:26:59,766 A majority of nursing homes in the United States continue to 496 00:26:59,766 --> 00:27:03,933 have multi resident rooms with up to four residents together in 497 00:27:03,933 --> 00:27:04,633 one room. 498 00:27:04,633 --> 00:27:05,300 499 00:27:05,300 --> 00:27:09,233 There is also a continued overuse of antibiotics in our 500 00:27:09,233 --> 00:27:13,566 nursing home residents which all can place them at a higher risk 501 00:27:13,566 --> 00:27:15,233 of acquiring a MDRO. 502 00:27:15,233 --> 00:27:17,833 503 00:27:17,833 --> 00:27:22,033 So how can you be successful in implementing enhanced barrier 504 00:27:22,033 --> 00:27:22,866 precautions? 505 00:27:22,866 --> 00:27:25,466 506 00:27:25,466 --> 00:27:28,933 It starts with robust and foundational prevention 507 00:27:28,933 --> 00:27:33,800 strategies along with enhanced barrier precautions from cleaning 508 00:27:33,800 --> 00:27:37,366 your hands to environmental cleaning and disinfection, 509 00:27:37,366 --> 00:27:41,100 auditing practices and good communication. 510 00:27:41,100 --> 00:27:43,533 511 00:27:43,533 --> 00:27:47,500 First, very foundational information, but also very 512 00:27:47,500 --> 00:27:51,900 important is to emphasize cleaning your hands, especially 513 00:27:51,900 --> 00:27:56,633 before and after any care with a resident or patient or after 514 00:27:56,633 --> 00:28:00,500 using or touching equipment in their environments. 515 00:28:00,500 --> 00:28:01,333 516 00:28:01,333 --> 00:28:05,333 Alcohol based hand sanitizers continue to be the preferred 517 00:28:05,333 --> 00:28:10,000 method for cleaning your hands when they are not visibly dirty 518 00:28:10,000 --> 00:28:12,800 and when your hands are visibly dirty, 519 00:28:12,800 --> 00:28:13,033 520 00:28:13,033 --> 00:28:17,266 clean your hands with soap and water and make sure that staff 521 00:28:17,266 --> 00:28:21,233 has easy accessibility to the products they need to clean 522 00:28:21,233 --> 00:28:23,033 their hands appropriately. 523 00:28:23,033 --> 00:28:25,733 524 00:28:25,733 --> 00:28:28,033 Next up is cleaning and disinfection. 525 00:28:28,033 --> 00:28:28,666 526 00:28:28,666 --> 00:28:32,400 Although many times seen as a primary duty of Environmental 527 00:28:32,400 --> 00:28:36,766 Services staff members, cleaning and disinfection is important 528 00:28:36,766 --> 00:28:38,666 for everyone to take part in. 529 00:28:38,666 --> 00:28:39,300 530 00:28:39,300 --> 00:28:43,700 Make sure high touch surfaces are cleaned and disinfected at 531 00:28:43,700 --> 00:28:48,066 least daily and reusable equipment must be cleaned and 532 00:28:48,066 --> 00:28:51,266 disinfected after each and every use. 533 00:28:51,266 --> 00:28:52,066 534 00:28:52,066 --> 00:28:55,700 Work with others in your community or facility to reduce 535 00:28:55,700 --> 00:28:58,466 the number of cleaning and disinfection products you were 536 00:28:58,466 --> 00:29:02,900 using while also ensuring the most appropriate hospital grade 537 00:29:02,900 --> 00:29:08,866 products are being used and develop, maintain and use a who 538 00:29:08,866 --> 00:29:13,266 cleans what list so that everyone on the team knows who 539 00:29:13,266 --> 00:29:15,500 is responsible for which items. 540 00:29:15,500 --> 00:29:18,233 541 00:29:18,233 --> 00:29:20,600 Next is a brief discussion about auditing. 542 00:29:20,600 --> 00:29:21,266 543 00:29:21,266 --> 00:29:24,366 Auditing is your way of knowing if the education you have 544 00:29:24,366 --> 00:29:27,800 provided to staff is being implemented and done 545 00:29:27,800 --> 00:29:28,666 appropriately. 546 00:29:28,666 --> 00:29:29,233 547 00:29:29,233 --> 00:29:32,733 This should happen with all aspects of infection prevention 548 00:29:32,733 --> 00:29:36,700 and control and include hand hygiene audits. 549 00:29:36,700 --> 00:29:37,233 550 00:29:37,233 --> 00:29:41,533 How well are PPE being taken off and put on? 551 00:29:41,533 --> 00:29:42,066 552 00:29:42,066 --> 00:29:46,200 Also looking at the cleaning and disinfection practices and not 553 00:29:46,200 --> 00:29:50,666 only at those high touch locations but also daily and 554 00:29:50,666 --> 00:29:52,200 terminal room cleans. 555 00:29:52,200 --> 00:29:52,800 556 00:29:52,800 --> 00:29:56,900 And audit your communication practices of the staff members 557 00:29:56,900 --> 00:30:01,433 and as important is to share the feedback with your staff so they 558 00:30:01,433 --> 00:30:05,000 know if there are opportunities for improvement and 559 00:30:05,000 --> 00:30:08,433 acknowledging when challenges have been overcome. 560 00:30:08,433 --> 00:30:11,633 561 00:30:11,633 --> 00:30:15,566 Communication is the final piece of the prevention strategies I 562 00:30:15,566 --> 00:30:16,666 wanted to discuss. 563 00:30:16,666 --> 00:30:17,233 564 00:30:17,233 --> 00:30:21,933 Communication should not only occur within the units of your 565 00:30:21,933 --> 00:30:25,833 facility but also with outside partners. 566 00:30:25,833 --> 00:30:26,333 567 00:30:26,333 --> 00:30:30,433 Find and use a communication tool that works for everyone 568 00:30:30,433 --> 00:30:34,233 across the community and make sure pertinent information is 569 00:30:34,233 --> 00:30:36,833 shared as we are all connected. 570 00:30:36,833 --> 00:30:41,133 571 00:30:41,133 --> 00:30:44,566 Here are a few more tips to help you with the initial 572 00:30:44,566 --> 00:30:49,000 implementation of EBP in your facility or facilities. 573 00:30:49,000 --> 00:30:49,900 574 00:30:49,900 --> 00:30:54,033 Provide initial and ongoing education to everyone who comes 575 00:30:54,033 --> 00:30:58,466 into, works in, or lives in your community or facility. 576 00:30:58,466 --> 00:30:58,933 577 00:30:58,933 --> 00:31:02,000 Include all staff and all shifts. 578 00:31:02,000 --> 00:31:02,533 579 00:31:02,533 --> 00:31:05,400 Don't forget to provide education to the overnight 580 00:31:05,400 --> 00:31:07,400 shifts and the weekend staff. 581 00:31:07,400 --> 00:31:08,400 582 00:31:08,400 --> 00:31:12,066 Create a robust rollout plan and use the tools that have been 583 00:31:12,066 --> 00:31:12,833 developed. 584 00:31:12,833 --> 00:31:13,200 585 00:31:13,200 --> 00:31:14,800 Don't reinvent the wheel. 586 00:31:14,800 --> 00:31:15,466 587 00:31:15,466 --> 00:31:18,400 Many of the tools can be customized so you can tailor 588 00:31:18,400 --> 00:31:20,433 them to your unique community. 589 00:31:20,433 --> 00:31:21,133 590 00:31:21,133 --> 00:31:25,766 Start by using the CDC Pre Implementation tool and make 591 00:31:25,766 --> 00:31:31,000 sure to 1st identify a method which residents need EBP 592 00:31:31,000 --> 00:31:35,700 initiated and then how best to maintain this record. 593 00:31:35,700 --> 00:31:40,466 594 00:31:40,466 --> 00:31:44,733 Now I want to show you just one example of what can happen when 595 00:31:44,733 --> 00:31:48,133 any one of these prevention strategies are missed. 596 00:31:48,133 --> 00:31:50,000 597 00:31:50,000 --> 00:31:56,600 You have an acute care hospital which has a known MDRO outbreak 598 00:31:56,600 --> 00:32:01,266 and patient A and patient B arrive for care. 599 00:32:01,266 --> 00:32:04,600 600 00:32:04,600 --> 00:32:12,700 During patient A stay, they acquire a MDRO, then patient A 601 00:32:12,700 --> 00:32:16,733 and patient B transfer out to a long term acute care hospital 602 00:32:16,733 --> 00:32:18,466 for further care. 603 00:32:18,466 --> 00:32:19,233 604 00:32:19,233 --> 00:32:24,500 Patient A brings that MDRO along with them. Well through poor 605 00:32:24,500 --> 00:32:26,300 preventive practices. 606 00:32:26,300 --> 00:32:26,400 607 00:32:26,400 --> 00:32:32,600 Patient B now also acquires or gets the MDRO. Well, 608 00:32:32,600 --> 00:32:37,833 after a little bit of time they part ways and patient A goes to 609 00:32:37,833 --> 00:32:43,200 a skilled nursing facility or SNF 1 and takes the MDRO 610 00:32:43,200 --> 00:32:44,000 along with them. 611 00:32:44,000 --> 00:32:45,900 612 00:32:45,900 --> 00:32:50,433 Patient A or resident now Resident A meets Resident C and 613 00:32:50,433 --> 00:32:56,966 Resident D through bad practices and not following appropriate 614 00:32:56,966 --> 00:32:59,233 and adequate prevention practices, 615 00:32:59,233 --> 00:32:59,533 616 00:32:59,533 --> 00:33:05,333 now Resident C and Resident D also have acquired or gotten the 617 00:33:05,333 --> 00:33:06,266 MDRO. 618 00:33:06,266 --> 00:33:08,400 619 00:33:08,400 --> 00:33:16,433 And let's not forget Resident B. Resident B went to SNF 2 and 620 00:33:16,433 --> 00:33:20,533 took the MDRO with them as well. 621 00:33:20,533 --> 00:33:21,233 622 00:33:21,233 --> 00:33:25,766 So then Resident B meets Resident E and Resident F in 623 00:33:25,766 --> 00:33:29,866 that SNF 2. Through poor prevention practices, 624 00:33:29,866 --> 00:33:35,066 once again, Resident E and Resident F acquire or get the 625 00:33:35,066 --> 00:33:36,633 MDRO as well. 626 00:33:36,633 --> 00:33:37,600 627 00:33:37,600 --> 00:33:41,633 So due to prevention practices not being followed, such as a 628 00:33:41,633 --> 00:33:46,733 lapse and communicating MDRO status, perhaps staff weren't 629 00:33:46,733 --> 00:33:49,966 cleaning their hands after providing care to the patient or 630 00:33:49,966 --> 00:33:53,233 residents once they got to the SNF. 631 00:33:53,233 --> 00:33:57,266 Maybe they didn't put them on enhanced barrier precautions and 632 00:33:57,266 --> 00:34:02,133 they had an indwelling medical device that necessitated them 633 00:34:02,133 --> 00:34:03,033 being on it. 634 00:34:03,033 --> 00:34:04,000 635 00:34:04,000 --> 00:34:08,766 Someone didn't clean and disinfect as was required or 636 00:34:08,766 --> 00:34:12,733 there's an absence of auditing in any one of these locations. 637 00:34:12,733 --> 00:34:13,800 638 00:34:13,800 --> 00:34:18,333 So what happened was that what was only one MDRO colonization 639 00:34:18,333 --> 00:34:24,000 or infection at the acute care hospital has now become six MDRO 640 00:34:24,000 --> 00:34:28,733 colonizations or infections across two separate long term 641 00:34:28,733 --> 00:34:30,033 care facilities. 642 00:34:30,033 --> 00:34:30,733 643 00:34:30,733 --> 00:34:35,733 And as I shared, this is only one brief example of how MDROs 644 00:34:35,733 --> 00:34:42,400 can spread across healthcare communities. Which brings me to 645 00:34:42,400 --> 00:34:47,300 my final slide and that is to emphasize enhanced barrier 646 00:34:47,300 --> 00:34:51,533 precautions being a method to balance safety of the residents 647 00:34:51,533 --> 00:34:54,133 with maintaining the residents quality of life. 648 00:34:54,133 --> 00:34:54,733 649 00:34:54,733 --> 00:34:59,066 We know MDROs are common in nursing homes and the MDRO 650 00:34:59,066 --> 00:35:04,266 colonization can lead to serious infections and even death in our 651 00:35:04,266 --> 00:35:05,066 residents. 652 00:35:05,066 --> 00:35:05,933 653 00:35:05,933 --> 00:35:10,700 Implementing strategies such as enhanced barrier precautions can 654 00:35:10,700 --> 00:35:15,000 prevent the spread of MDROs while considering the unique 655 00:35:15,000 --> 00:35:18,500 aspects of nursing home care and socialization. 656 00:35:18,500 --> 00:35:19,233 657 00:35:19,233 --> 00:35:23,066 While in other healthcare settings, the answer is to use 658 00:35:23,066 --> 00:35:26,933 contact precautions for MDRO infection or colonization. 659 00:35:26,933 --> 00:35:27,466 660 00:35:27,466 --> 00:35:31,000 A nursing home is not an appropriate setting for long 661 00:35:31,000 --> 00:35:35,733 term prevention of MDROs with contact precautions as it would 662 00:35:35,733 --> 00:35:39,333 see residents not being able to maintain a good quality of life 663 00:35:39,333 --> 00:35:43,033 because they would be restricted to the rooms except for 664 00:35:43,033 --> 00:35:46,866 medically necessary care, as well as being restricted from 665 00:35:46,866 --> 00:35:49,933 being able to participate in group activities. 666 00:35:49,933 --> 00:35:50,833 667 00:35:50,833 --> 00:35:54,833 Enhanced Barrier precautions is a prevention strategy that 668 00:35:54,833 --> 00:35:57,000 balances each of these together. 669 00:35:57,000 --> 00:35:57,300 670 00:35:57,300 --> 00:36:01,766 Prevention of MDRO spread, maintaining resident safety and 671 00:36:01,766 --> 00:36:04,800 improving a resident's quality of life. 672 00:36:04,800 --> 00:36:06,800 673 00:36:06,800 --> 00:36:11,233 As we shared previously, the slides will be made available 674 00:36:11,233 --> 00:36:13,666 after our webinar and town hall. 675 00:36:13,666 --> 00:36:14,033 676 00:36:14,033 --> 00:36:18,066 And these are a few of the links updated since our recent 677 00:36:18,066 --> 00:36:20,900 Clean Slate CDC.gov updates. 678 00:36:20,900 --> 00:36:21,266 679 00:36:21,266 --> 00:36:24,700 And these provide some of our educational videos that are 680 00:36:24,700 --> 00:36:26,100 available on this slide. 681 00:36:26,100 --> 00:36:26,866 682 00:36:26,866 --> 00:36:30,000 And then these are enhanced barrier precaution tools that 683 00:36:30,000 --> 00:36:35,266 can help you with implementation as well as letters that you are 684 00:36:35,266 --> 00:36:39,766 able to customize for residents, families, staff and nursing home 685 00:36:39,766 --> 00:36:40,500 leadership. 686 00:36:40,500 --> 00:36:41,933 687 00:36:41,933 --> 00:36:46,600 We've also developed posters and a pocket guide that can help you 688 00:36:46,600 --> 00:36:50,133 with the staff development and ongoing education. 689 00:36:50,133 --> 00:36:52,700 690 00:36:52,700 --> 00:36:56,300 I will now turn it back to Kara who will moderate for any 691 00:36:56,300 --> 00:36:56,900 questions. 692 00:36:56,900 --> 00:36:57,133 693 00:36:57,133 --> 00:36:57,700 Thank you. 694 00:36:57,700 --> 00:37:00,133 695 00:37:00,133 --> 00:37:01,200 Thank you so much. 696 00:37:01,200 --> 00:37:04,600 I want to, I want to give a special thank you to Doctor 697 00:37:04,600 --> 00:37:08,900 Ogundimu and Doctor Jones for walking us through this webinar. 698 00:37:08,900 --> 00:37:09,266 699 00:37:09,266 --> 00:37:13,000 I have been taking note of the questions that are coming in. 700 00:37:13,000 --> 00:37:13,233 701 00:37:13,233 --> 00:37:16,633 We will do our best to try to get to as many of those as 702 00:37:16,633 --> 00:37:17,200 possible. 703 00:37:17,200 --> 00:37:17,700 704 00:37:17,700 --> 00:37:22,333 I may combine some of them and try to give an answer that will 705 00:37:22,333 --> 00:37:26,800 hopefully help with the related questions that we are seeing 706 00:37:26,800 --> 00:37:27,533 coming in. 707 00:37:27,533 --> 00:37:28,600 708 00:37:28,600 --> 00:37:36,366 So to start, I think we have had a couple of questions that have 709 00:37:36,366 --> 00:37:39,233 been specific to wounds. 710 00:37:39,233 --> 00:37:43,300 So I think let's go ahead and start with clarifying what 711 00:37:43,300 --> 00:37:46,966 wounds would be an indication for enhanced barrier 712 00:37:46,966 --> 00:37:47,833 precautions. 713 00:37:47,833 --> 00:37:49,733 714 00:37:49,733 --> 00:37:50,666 Thanks, Kara. 715 00:37:50,666 --> 00:37:53,000 And that's a pretty great question. 716 00:37:53,000 --> 00:37:53,866 717 00:37:53,866 --> 00:37:59,400 So the guide, our EBP guidance describes that all 718 00:37:59,400 --> 00:38:05,766 residents with rooms would meet the enhanced barrier precautions 719 00:38:05,766 --> 00:38:06,700 guidance. 720 00:38:06,700 --> 00:38:08,133 721 00:38:08,133 --> 00:38:14,566 However, the intent again of our EBP guidance is to focus on 722 00:38:14,566 --> 00:38:20,766 residents that have a higher risk of acquiring MDRO over a 723 00:38:20,766 --> 00:38:25,700 long period of time, so not just hours, right. 724 00:38:25,700 --> 00:38:26,100 725 00:38:26,100 --> 00:38:31,066 And so within the enhanced barrier precautions, frequently asked 726 00:38:31,066 --> 00:38:37,766 questions or FAQs, we actually expand more on describing the 727 00:38:37,766 --> 00:38:42,133 focus on residents with chronic wounds and not the short term 728 00:38:42,133 --> 00:38:47,266 wounds like the band-aids, quote and quote ones, as I noted 729 00:38:47,266 --> 00:38:47,933 earlier. 730 00:38:47,933 --> 00:38:48,133 731 00:38:48,133 --> 00:38:52,900 So it's more chronic wounds that include your pressure ulcers as 732 00:38:52,900 --> 00:38:57,933 well as diabetic foot ulcers and chronic venous stasis ulcers. 733 00:38:57,933 --> 00:38:59,200 734 00:38:59,200 --> 00:38:59,666 Thank you. 735 00:38:59,666 --> 00:38:59,833 736 00:38:59,833 --> 00:39:01,433 So thank you. 737 00:39:01,433 --> 00:39:05,066 So the focus being on chronic longer lasting wounds and then 738 00:39:05,066 --> 00:39:08,900 you started to mention are there wounds that are not considered 739 00:39:08,900 --> 00:39:10,600 to be an indication for EBP? 740 00:39:10,600 --> 00:39:11,466 741 00:39:11,466 --> 00:39:12,600 Yeah, thanks, Kara. 742 00:39:12,600 --> 00:39:17,633 So yeah, your shorter lasting wounds as I indicated earlier, 743 00:39:17,633 --> 00:39:22,766 the band-aid wounds or the skin grades or skin tears that are 744 00:39:22,766 --> 00:39:27,433 again like cover like with the small dressing or shorter period 745 00:39:27,433 --> 00:39:33,233 of time or anything similar in terms of the dressing would 746 00:39:33,233 --> 00:39:35,633 not be an indication for EBP. 747 00:39:35,633 --> 00:39:38,466 Again, it's a shorter time kind of route. 748 00:39:38,466 --> 00:39:39,800 749 00:39:39,800 --> 00:39:45,966 And so for we did actually have fielded questions from different 750 00:39:45,966 --> 00:39:51,466 facilities as well as HAI programs about healing post op 751 00:39:51,466 --> 00:39:57,633 surgical wounds and that specifically healing post op 752 00:39:57,633 --> 00:40:01,500 surgical wounds would not be an indication for EBP. 753 00:40:01,500 --> 00:40:02,466 754 00:40:02,466 --> 00:40:02,900 Thank you. 755 00:40:02,900 --> 00:40:06,133 And that came up that has come up a few times in the, the 756 00:40:06,133 --> 00:40:08,266 Q&A on the webinar today. 757 00:40:08,266 --> 00:40:08,600 758 00:40:08,600 --> 00:40:12,233 So, you know, while there isn't a definition for the exact 759 00:40:12,233 --> 00:40:16,266 amount of time that a wound must be present to become colonized, 760 00:40:16,266 --> 00:40:19,866 we recognize that the longer a wound is present, the more 761 00:40:19,866 --> 00:40:23,233 concern we have that these wounds may become colonized with 762 00:40:23,233 --> 00:40:24,066 an MDRO. 763 00:40:24,066 --> 00:40:24,433 764 00:40:24,433 --> 00:40:28,100 And so in situations where underlying medical conditions 765 00:40:28,100 --> 00:40:31,800 lead to chronic poorly healing wounds, our concern level 766 00:40:31,800 --> 00:40:35,433 increases that those may become colonized with an MDRO. 767 00:40:35,433 --> 00:40:36,233 768 00:40:36,233 --> 00:40:39,300 So I do also because again, a few questions have come up. 769 00:40:39,300 --> 00:40:39,433 770 00:40:39,433 --> 00:40:41,433 I think this is related to wounds. 771 00:40:41,433 --> 00:40:41,666 772 00:40:41,666 --> 00:40:45,800 There are a few questions about ostomies specifically. Do we 773 00:40:45,800 --> 00:40:48,066 are those considered to be wounds? 774 00:40:48,066 --> 00:40:50,000 775 00:40:50,000 --> 00:40:52,466 Thanks for that excellent question, Kara. 776 00:40:52,466 --> 00:40:52,700 777 00:40:52,700 --> 00:40:54,500 No ostomies. 778 00:40:54,500 --> 00:40:54,700 779 00:40:54,700 --> 00:40:57,733 And when I talk about ostomies, I'm referring to like 780 00:40:57,733 --> 00:41:00,200 colostomies and ileostomies. 781 00:41:00,200 --> 00:41:03,566 These are not considered to be wounds for enhanced barrier 782 00:41:03,566 --> 00:41:04,266 precautions. 783 00:41:04,266 --> 00:41:04,733 784 00:41:04,733 --> 00:41:08,133 And to help clarify this commonly asked question, we have 785 00:41:08,133 --> 00:41:12,200 also updated our enhanced barrier precautions frequently 786 00:41:12,200 --> 00:41:15,866 asked questions page to specifically address ostomies so 787 00:41:15,866 --> 00:41:20,000 that you'll have a way to refer back in case you have questions 788 00:41:20,000 --> 00:41:21,300 that are brought up. 789 00:41:21,300 --> 00:41:24,533 790 00:41:24,533 --> 00:41:31,600 Now, ostomies are not considered to be wounds, but for EBP 791 00:41:31,600 --> 00:41:35,800 purposes, but if they have an indwelling medical device, so 792 00:41:35,800 --> 00:41:39,833 like if you're thinking about a tracheostomy tube or a 793 00:41:39,833 --> 00:41:44,433 percutaneous nephrostomy tube, those would be an indication for 794 00:41:44,433 --> 00:41:48,866 EBP because there's now a component that's communicating 795 00:41:48,866 --> 00:41:52,900 internally and externally, which places them at a higher risk of 796 00:41:52,900 --> 00:41:56,233 getting an MDRO or even acquiring one. 797 00:41:56,233 --> 00:41:58,033 798 00:41:58,033 --> 00:41:58,833 Thank you, Heather. 799 00:41:58,833 --> 00:42:00,400 800 00:42:00,400 --> 00:42:04,633 One of the other common, one of the other common questions I've 801 00:42:04,633 --> 00:42:09,366 seen about throughout the chat has been asking about physical 802 00:42:09,366 --> 00:42:15,166 therapy, asking about therapy, you know, in a therapy gym there 803 00:42:15,166 --> 00:42:18,100 there have been numerous questions that have brought up 804 00:42:18,100 --> 00:42:20,600 therapy and wanting us to clarify a little bit more here. 805 00:42:20,600 --> 00:42:21,233 806 00:42:21,233 --> 00:42:24,500 And we definitely recognize that physical therapy encompasses a 807 00:42:24,500 --> 00:42:28,166 wide range and not just physical therapy, occupational therapy, 808 00:42:28,166 --> 00:42:29,200 therapy activities. 809 00:42:29,200 --> 00:42:33,000 They there are a wide range of activities and they are not 810 00:42:33,000 --> 00:42:37,100 specifically called out as high contact resident care activity. 811 00:42:37,100 --> 00:42:37,333 812 00:42:37,333 --> 00:42:42,066 So can you can, can you talk a little bit about whether 813 00:42:42,066 --> 00:42:45,400 physical therapy or therapy is considered to be high contact? 814 00:42:45,400 --> 00:42:47,833 Should therapists be using PPE? 815 00:42:47,833 --> 00:42:49,800 816 00:42:49,800 --> 00:42:50,100 Yeah. 817 00:42:50,100 --> 00:42:50,200 818 00:42:50,200 --> 00:42:52,066 Thank you so much, Kara. 819 00:42:52,066 --> 00:42:57,900 So depending on the activity, therapy may be considered a high 820 00:42:57,900 --> 00:43:00,800 contact resident care activity. 821 00:43:00,800 --> 00:43:02,033 822 00:43:02,033 --> 00:43:07,866 And again, we see therapists should use gown and gloves when 823 00:43:07,866 --> 00:43:13,900 when working with residents on EBP and the therapy gym that's 824 00:43:13,900 --> 00:43:20,466 ideal or in the resident’s room if they anticipate having that 825 00:43:20,466 --> 00:43:25,766 prolonged to those body contacts where transmission of MDROs 826 00:43:25,766 --> 00:43:30,200 to the therapist clothes is certainly possible. 827 00:43:30,200 --> 00:43:36,166 And so as a follow up to that, what if the therapy can't be 828 00:43:36,166 --> 00:43:40,233 performed in the therapy gym or in the resident’s room? 829 00:43:40,233 --> 00:43:40,433 830 00:43:40,433 --> 00:43:44,000 Or as some examples in the chat have shared, what if the 831 00:43:44,000 --> 00:43:47,566 resident needs assistance walking from their room to the 832 00:43:47,566 --> 00:43:49,500 therapy gym or in the hallways? 833 00:43:49,500 --> 00:43:50,266 834 00:43:50,266 --> 00:43:52,666 Is it OK to use PPE in the hallways? 835 00:43:52,666 --> 00:43:53,933 836 00:43:53,933 --> 00:43:56,000 Yeah, that's a great follow up question. 837 00:43:56,000 --> 00:44:01,666 So EBP is it really should not limit a resident's ability to 838 00:44:01,666 --> 00:44:06,900 continue their medical therapy that is critical, right? 839 00:44:06,900 --> 00:44:07,500 840 00:44:07,500 --> 00:44:12,633 And so while the use of gowns and gloves is generally 841 00:44:12,633 --> 00:44:18,566 discouraged in the hallways and other common areas, there may be 842 00:44:18,566 --> 00:44:23,666 individual circumstances like therapy that has to occur 843 00:44:23,666 --> 00:44:29,066 outside the resident’s room or outside the therapy gym that 844 00:44:29,066 --> 00:44:34,733 would prompt an evaluation for the need of PPE outside of the 845 00:44:34,733 --> 00:44:36,200 room or the gym. 846 00:44:36,200 --> 00:44:36,700 847 00:44:36,700 --> 00:44:41,100 Really depending on the level of assistance or close contacts 848 00:44:41,100 --> 00:44:45,533 that the therapist or anybody helping out with therapy will be 849 00:44:45,533 --> 00:44:47,300 happening with the residents. 850 00:44:47,300 --> 00:44:51,133 851 00:44:51,133 --> 00:44:55,133 And I also wanted to add a comment here that we understand 852 00:44:55,133 --> 00:44:59,466 and we know that there is a lot of gray area when we talk about 853 00:44:59,466 --> 00:45:03,633 these situations and when it comes to infection prevention in 854 00:45:03,633 --> 00:45:07,700 general and not just with the practices of enhanced barrier 855 00:45:07,700 --> 00:45:08,500 precautions. 856 00:45:08,500 --> 00:45:09,066 857 00:45:09,066 --> 00:45:12,600 Because we understand that even the most seasoned infection 858 00:45:12,600 --> 00:45:15,966 preventionists are going to be faced with new different 859 00:45:15,966 --> 00:45:20,133 situations and you will need to evaluate those situations based 860 00:45:20,133 --> 00:45:24,300 on your expertise as they arise and then make the best 861 00:45:24,300 --> 00:45:28,333 determinations based on best practices for both the residents 862 00:45:28,333 --> 00:45:30,533 and the healthcare worker safety. 863 00:45:30,533 --> 00:45:31,900 864 00:45:31,900 --> 00:45:32,700 Thank you both. 865 00:45:32,700 --> 00:45:33,600 866 00:45:33,600 --> 00:45:36,733 I want to shift the topic a little bit to talk about 867 00:45:36,733 --> 00:45:40,966 midlines because there are multiple questions that have 868 00:45:40,966 --> 00:45:45,533 come in during the webinar specific to midlines or midline 869 00:45:45,533 --> 00:45:50,966 catheters and asking for more explanation in terms of are 870 00:45:50,966 --> 00:45:53,466 these considered to be indwelling medical devices for 871 00:45:53,466 --> 00:45:56,733 the purposes of enhanced barrier precautions? 872 00:45:56,733 --> 00:46:00,133 873 00:46:00,133 --> 00:46:02,633 Yeah, thank you so much for another great question. 874 00:46:02,633 --> 00:46:09,366 So yes, midlines in addition to central venus catheters, so your 875 00:46:09,366 --> 00:46:16,966 CVCs that includes your ports or PICC lines are considered 876 00:46:16,966 --> 00:46:21,100 indwelling medical devices for the purposes of EBP. 877 00:46:21,100 --> 00:46:21,733 878 00:46:21,733 --> 00:46:26,233 Yes. And thank you, Bola, can you expand upon that a little bit? 879 00:46:26,233 --> 00:46:26,400 880 00:46:26,400 --> 00:46:31,000 Some of the questions have asked since peripheral IVs are not 881 00:46:31,000 --> 00:46:37,200 included as indwelling medical devices for EBP and you know, 882 00:46:37,200 --> 00:46:39,966 can you share a little bit more about why midlines are 883 00:46:39,966 --> 00:46:42,333 considered an indwelling device? 884 00:46:42,333 --> 00:46:43,133 885 00:46:43,133 --> 00:46:44,333 Yeah, great follow up. 886 00:46:44,333 --> 00:46:50,166 So more importantly, residents who have midline catheters as 887 00:46:50,166 --> 00:46:54,566 part of their medical therapy, often complex, right, tend to be 888 00:46:54,566 --> 00:46:58,833 residents with additional risk factors for MDRO 889 00:46:58,833 --> 00:46:59,900 colonization. 890 00:46:59,900 --> 00:47:00,300 891 00:47:00,300 --> 00:47:06,700 So similar to central venous catheters, PICC supports these 892 00:47:06,700 --> 00:47:11,366 midlines may remain in place for an extended period of time, 893 00:47:11,366 --> 00:47:16,866 again longer period of time, often up to four weeks or more 894 00:47:16,866 --> 00:47:22,666 and thereby increasing the risk of an infection or MDRO 895 00:47:22,666 --> 00:47:23,800 acquisition. 896 00:47:23,800 --> 00:47:25,466 897 00:47:25,466 --> 00:47:26,033 Thank you. 898 00:47:26,033 --> 00:47:26,233 899 00:47:26,233 --> 00:47:26,866 Thank you, Bola. 900 00:47:26,866 --> 00:47:28,066 901 00:47:28,066 --> 00:47:32,800 I'm seeing numerous questions asking for us to expand a little 902 00:47:32,800 --> 00:47:36,800 bit more on the brief contact that was mentioned 903 00:47:36,800 --> 00:47:38,233 during the webinar. 904 00:47:38,233 --> 00:47:39,200 905 00:47:39,200 --> 00:47:43,733 So are can you expand or one of you able to expand a little bit 906 00:47:43,733 --> 00:47:48,233 more on what those situations might be, you know, particularly 907 00:47:48,233 --> 00:47:53,466 inside of a resident’s room who's on EBP where limited enough 908 00:47:53,466 --> 00:47:56,800 contact occurs between the resident and nursing home staff 909 00:47:56,800 --> 00:47:59,066 that PPE might not be indicated? 910 00:47:59,066 --> 00:48:02,133 911 00:48:02,133 --> 00:48:03,700 Absolutely, Kara, thank you. 912 00:48:03,700 --> 00:48:04,866 913 00:48:04,866 --> 00:48:06,933 So we've been asked about situations. 914 00:48:06,933 --> 00:48:08,133 915 00:48:08,133 --> 00:48:12,466 One example is like going into the resident’s room and helping 916 00:48:12,466 --> 00:48:18,733 them put on a sweater or going in to just do a minimal transfer 917 00:48:18,733 --> 00:48:21,733 and it's brief contact that occurs. 918 00:48:21,733 --> 00:48:26,833 Or even if you're individually going in to brush someone's 919 00:48:26,833 --> 00:48:27,266 hair. 920 00:48:27,266 --> 00:48:27,933 921 00:48:27,933 --> 00:48:31,466 These are examples of activities that Bola shared previously. 922 00:48:31,466 --> 00:48:35,533 They're constantly bundled together as part of 923 00:48:35,533 --> 00:48:40,266 morning or evening care rather than occurring as those multiple 924 00:48:40,266 --> 00:48:43,400 isolated interactions throughout the day. 925 00:48:43,400 --> 00:48:44,100 926 00:48:44,100 --> 00:48:48,500 When bundled together, it would be an indication to wear a gown 927 00:48:48,500 --> 00:48:52,233 and gloves because you're having that prolonged contact care with 928 00:48:52,233 --> 00:48:55,300 the residents while you're bundling it together. 929 00:48:55,300 --> 00:48:56,633 930 00:48:56,633 --> 00:49:01,533 But if you're in there for an isolated activity, you're having 931 00:49:01,533 --> 00:49:06,200 a short brief interaction contact with the resident, 932 00:49:06,200 --> 00:49:06,666 933 00:49:06,666 --> 00:49:10,233 this would not generally necessitate the need for using 934 00:49:10,233 --> 00:49:11,266 gown and gloves. 935 00:49:11,266 --> 00:49:12,533 936 00:49:12,533 --> 00:49:13,033 Thank you. 937 00:49:13,033 --> 00:49:13,800 938 00:49:13,800 --> 00:49:20,733 So similarly, while the presence of so similarly, I want to ask a 939 00:49:20,733 --> 00:49:27,433 little bit about this question related to an indwelling medical 940 00:49:27,433 --> 00:49:28,200 device. 941 00:49:28,200 --> 00:49:31,566 So we know that indwelling medical devices are a major risk 942 00:49:31,566 --> 00:49:35,866 factor for being colonized with or being at risk for becoming 943 00:49:35,866 --> 00:49:38,033 colonized with an MDRO. 944 00:49:38,033 --> 00:49:40,266 945 00:49:40,266 --> 00:49:45,333 Can you talk a little bit more about use of medical devices 946 00:49:45,333 --> 00:49:48,633 that might only involve limited physical contact between a 947 00:49:48,633 --> 00:49:52,966 healthcare worker and a resident and the use of gloves and 948 00:49:52,966 --> 00:49:55,500 gowns in in that type of situation? 949 00:49:55,500 --> 00:49:56,666 950 00:49:56,666 --> 00:49:57,800 Yeah, thanks, Kara. 951 00:49:57,800 --> 00:49:59,900 I am happy to expand on that a little bit. 952 00:49:59,900 --> 00:50:00,500 953 00:50:00,500 --> 00:50:05,500 One example that I like to give is that say you have a staff 954 00:50:05,500 --> 00:50:08,666 member that's going to pass medications through a feeding 955 00:50:08,666 --> 00:50:09,033 tube. 956 00:50:09,033 --> 00:50:09,700 957 00:50:09,700 --> 00:50:14,000 And although this is only appropriate if the activity is 958 00:50:14,000 --> 00:50:18,500 not bundled together with other high contact prolonged care 959 00:50:18,500 --> 00:50:22,800 activities and there's no evidence of ongoing MDRO 960 00:50:22,800 --> 00:50:27,000 transmission in the facility, the safest practice would be to 961 00:50:27,000 --> 00:50:31,500 wear a gown and gloves for any care or use of an indwelling 962 00:50:31,500 --> 00:50:32,633 medical device. 963 00:50:32,633 --> 00:50:33,200 964 00:50:33,200 --> 00:50:37,233 But facilities can define these limited contact activities in 965 00:50:37,233 --> 00:50:42,400 their policies and procedures and educate healthcare personnel 966 00:50:42,400 --> 00:50:45,366 so they can ensure consistent application of enhanced barrier 967 00:50:45,366 --> 00:50:49,200 precautions when it comes to these brief interactions that 968 00:50:49,200 --> 00:50:49,600 occur. 969 00:50:49,600 --> 00:50:51,600 970 00:50:51,600 --> 00:50:52,066 Thank you. 971 00:50:52,066 --> 00:50:53,866 972 00:50:53,866 --> 00:50:59,400 I want to comment or I want to ask you to comment also on PPE 973 00:50:59,400 --> 00:51:00,100 storage. 974 00:51:00,100 --> 00:51:00,833 975 00:51:00,833 --> 00:51:04,933 So, so speaking about PPE, where, where should PPE be 976 00:51:04,933 --> 00:51:06,733 storage stored with EBP? 977 00:51:06,733 --> 00:51:07,933 978 00:51:07,933 --> 00:51:09,200 Yeah, Thanks, Kara. 979 00:51:09,200 --> 00:51:11,400 This question has come up often. 980 00:51:11,400 --> 00:51:12,500 981 00:51:12,500 --> 00:51:16,400 CDC continues to recommend that PPE is located immediately 982 00:51:16,400 --> 00:51:20,566 outside of the resident’s room or at the entry to the resident’s 983 00:51:20,566 --> 00:51:20,900 room. 984 00:51:20,900 --> 00:51:21,700 985 00:51:21,700 --> 00:51:24,833 And we've discouraged the practice of storing the PPE in 986 00:51:24,833 --> 00:51:29,133 the room primarily because there is a risk of contamination. 987 00:51:29,133 --> 00:51:29,933 988 00:51:29,933 --> 00:51:33,833 This is one specific question where many of you have pointed 989 00:51:33,833 --> 00:51:37,433 out previously that CDC and CMS have responded slightly 990 00:51:37,433 --> 00:51:38,200 differently. 991 00:51:38,200 --> 00:51:38,900 992 00:51:38,900 --> 00:51:45,333 However, our key message aligns, PPE should be readily available 993 00:51:45,333 --> 00:51:48,533 for a staff member to use when they are planning to provide 994 00:51:48,533 --> 00:51:52,866 high contact resident care and whether stored inside or 995 00:51:52,866 --> 00:51:55,800 immediately outside of the resident’s room, the facility 996 00:51:55,800 --> 00:52:00,133 should make every effort to avoid contamination of that PPE. 997 00:52:00,133 --> 00:52:02,266 998 00:52:02,266 --> 00:52:06,333 Thank you, Heather. Now I know we are, we are nearing the end of our 999 00:52:06,333 --> 00:52:10,100 time, but I did see that there were a couple of questions 1000 00:52:10,100 --> 00:52:13,700 specifically asking about the studies that were shared. 1001 00:52:13,700 --> 00:52:17,233 And these are available in the the there or resources that we 1002 00:52:17,233 --> 00:52:19,000 will include with these slides. 1003 00:52:19,000 --> 00:52:23,233 And they are also available on the CDC EBP web page. 1004 00:52:23,233 --> 00:52:23,800 1005 00:52:23,800 --> 00:52:26,133 So you can take a look and review in more detail. 1006 00:52:26,133 --> 00:52:26,333 1007 00:52:26,333 --> 00:52:30,866 I did want to ask the Washington State Department of Health had 1008 00:52:30,866 --> 00:52:35,266 shared with us an analysis done looking at cost effectiveness of 1009 00:52:35,266 --> 00:52:38,433 EBP Bola very quickly in the last minute. 1010 00:52:38,433 --> 00:52:41,600 Are you able to share briefly what they've learned? 1011 00:52:41,600 --> 00:52:45,066 1012 00:52:45,066 --> 00:52:46,033 Sorry, yeah. 1013 00:52:46,033 --> 00:52:50,733 So with Washington State HAI program and I don't see them on 1014 00:52:50,733 --> 00:52:52,600 the call, but that's OK. 1015 00:52:52,600 --> 00:52:53,000 1016 00:52:53,000 --> 00:52:58,066 So they had done a cost analysis of skilled nursing facilities 1017 00:52:58,066 --> 00:53:03,300 using enhanced barrier precautions, looking at their implementation 1018 00:53:03,300 --> 00:53:09,166 like how much it costs versus the cost of contact precautions, 1019 00:53:09,166 --> 00:53:12,633 implemented contact precautions and the C. auris outbreak 1020 00:53:12,633 --> 00:53:13,733 investigation. 1021 00:53:13,733 --> 00:53:14,233 1022 00:53:14,233 --> 00:53:17,866 And the specific nursing home that they looked at was 100 1023 00:53:17,866 --> 00:53:18,333 beds. 1024 00:53:18,333 --> 00:53:19,466 1025 00:53:19,466 --> 00:53:23,766 And they had ten different residents essentially that have 1026 00:53:23,766 --> 00:53:27,600 foley catheters that would have met the enhanced barrier 1027 00:53:27,600 --> 00:53:32,633 precautions implementation criteria. 1028 00:53:32,633 --> 00:53:33,000 1029 00:53:33,000 --> 00:53:39,433 And they also learned that if they looked at residents needing 1030 00:53:39,433 --> 00:53:43,500 the indication for contact precautions. 1031 00:53:43,500 --> 00:53:44,000 1032 00:53:44,000 --> 00:53:48,800 That again, looking at the cost, the aggregate costs, they 1033 00:53:48,800 --> 00:53:53,766 determined that they would need an RN to provide six contact 1034 00:53:53,766 --> 00:53:58,833 care activities per resident per day with the CNA providing 4 1035 00:53:58,833 --> 00:54:04,000 contact activities per resident per day and cleaning products, 1036 00:54:04,000 --> 00:54:10,533 also for C. auris that have to be specifically noted with the kill 1037 00:54:10,533 --> 00:54:16,900 claim as well as the germicidal bleach wipes for C. auris, 1038 00:54:16,900 --> 00:54:22,633 and also screening time for staff or resident depending in 1039 00:54:22,633 --> 00:54:27,100 terms of what residents were C. auris positive. 1040 00:54:27,100 --> 00:54:27,700 1041 00:54:27,700 --> 00:54:33,600 So they overall determined that for that specific instance in 1042 00:54:33,600 --> 00:54:36,233 implementing contact precautions, they would have to 1043 00:54:36,233 --> 00:54:43,900 spend about $945 per residence in that isolation room. 1044 00:54:43,900 --> 00:54:45,466 1045 00:54:45,466 --> 00:54:49,633 And again, like I don't see Carolyn on the call, but if you 1046 00:54:49,633 --> 00:54:54,166 guys would like more information about their study, please feel 1047 00:54:54,166 --> 00:54:59,833 free to reach out to your HAI program, but it was shared by 1048 00:54:59,833 --> 00:55:02,100 Washington State HAI program. 1049 00:55:02,100 --> 00:55:04,600 1050 00:55:04,600 --> 00:55:05,266 Thank you, Bola. 1051 00:55:05,266 --> 00:55:08,333 And I want to thank the audience again for joining us today. 1052 00:55:08,333 --> 00:55:08,866 1053 00:55:08,866 --> 00:55:12,166 Thank you to our speakers, Doctor Bola Ogundimu and Doctor 1054 00:55:12,166 --> 00:55:15,266 Heather Jones, greatly appreciate you sharing with this 1055 00:55:15,266 --> 00:55:16,100 audience today. 1056 00:55:16,100 --> 00:55:16,866 1057 00:55:16,866 --> 00:55:21,800 And we will be working on putting all of this information 1058 00:55:21,800 --> 00:55:24,233 on the web so that you are able to refer back to us. 1059 00:55:24,233 --> 00:55:25,800 Thank you so much again for joining us. 1060 00:55:25,800 --> 00:55:26,200 1061 00:55:26,200 --> 00:55:29,533 And just real quick, Kara, I wanted to respond. 1062 00:55:29,533 --> 00:55:32,566 There's been a lot of people that are asking about the link 1063 00:55:32,566 --> 00:55:33,233 for the FAQs. 1064 00:55:33,233 --> 00:55:33,900 1065 00:55:33,900 --> 00:55:38,566 The best that I can share now is if you will go into your search 1066 00:55:38,566 --> 00:55:43,433 engine and type CDC Enhanced Barrier precautions. 1067 00:55:43,433 --> 00:55:44,000 1068 00:55:44,000 --> 00:55:48,066 You will be able to get to our primary slide and you scroll all 1069 00:55:48,066 --> 00:55:51,866 the way down and then it will take you to a link that says 1070 00:55:51,866 --> 00:55:53,600 frequently asked questions. 1071 00:55:53,600 --> 00:55:58,166 That is one of the best areas to find more defined answers to 1072 00:55:58,166 --> 00:56:00,133 many of the questions that have been asked today.