AAPACN 2024: Hot Topics for Skilled Nursing Facilities

AAPACN 2024 is a wrap, but the learning doesn’t stop there. If you weren’t able to attend — or missed something you wanted to catch — the following is the first of a three-part blog series providing highlights from the conference.

At AAPACN 2024, attendees chose from 28 breakout sessions offered in three tracks to learn about regulatory updates and best practices from experts and leaders in the skilled nursing industry. In one of those breakout sessions, I provided a comprehensive overview of the latest updates, guidelines, and regulations from the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and CDC’s National Healthcare Safety Network (NHSN). Our discussion also covered the latest data around infection control in skilled nursing facilities (SNFs) and how it has impacted elderly residents.

Here’s the first recap of major takeaways from my presentation, “Don’t Let Your Infection Control Program Live in Isolation,” which include two common themes that were important at AAPACN 2024: infection surveillance and Enhanced Barrier Precautions (EBP).

Enhanced Barrier Precautions

The use of EBP is an approach introduced by CDC in 2019 to help nursing homes decrease transmission of CDC-targeted and epidemiologically important MDROs when contact precautions are not appropriate. Recommendations include the use of gowns and gloves for certain residents during specific high-contact resident care activities associated with MDRO transmission, but do not restrict residents to their rooms.

According to a June 2021 white paper by the Healthcare Infection Control Practices Advisory Committee (HICPAC), over half of nursing home residents may be colonized with an MDRO. HICPAC noted that using contact precautions to prevent MDRO transmission would require restricting residents to their rooms, which can have a negative impact on a resident’s quality of life and psychosocial well-being. As a result, many nursing homes only implement contact precautions when a resident is infected with an MDRO.

After CDC released updated EBP recommendations in July 2022, “Implementation of PPE use in nursing homes to prevent spread of MDROs,” CMS decided to follow suit to align with nationally accepted standards. On March 20, 2024, CMS issued new guidance for State Survey Agencies and long-term care (LTC) facilities regarding the use of EBP, which includes:

• Use of EBP during high-contact care activities for residents with chronic wounds or indwelling medical devices, regardless of their MDRO status, in addition to residents who have an infection or colonization with a CDC-targeted or other epidemiologically important MDRO when contact precautions do not apply
• Incorporation into F880 Infection Prevention and Control to assist LTC surveyors when evaluating the use of enhanced barrier precautions in nursing homes (so be sure to document proper start and end dates of any precautions implemented)
• Flexibility for facilities to use discretion when implementing EBP, balancing the need to maintain a homelike environment for residents

Specific EBP guidance includes:

• “EBP refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities.
• EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing.
• EBP are indicated for residents with any of the following:
  • Infection or colonization with a CDC-targeted MDRO when Contact Precautions do not otherwise apply
  • Wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO

• Wounds generally include chronic wounds, not shorter-lasting wounds, such as skin breaks or skin tears covered with an adhesive bandage (e.g., Band-Aid®) or similar dressing. Examples of chronic wounds include, but are not limited to, pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous stasis ulcers.
• Indwelling medical device examples include central lines, urinary catheters, feeding tubes, and tracheostomies. A peripheral intravenous line (not a peripherally inserted central catheter) is not considered an indwelling medical device for the purpose of EBP.
• EBP should be used for any residents who meet the above criteria, wherever they reside in the facility.
• Facilities have discretion in using EBP for residents who do not have a chronic wound or indwelling medical device and are infected or colonized with an MDRO that is not currently targeted by CDC.”

For further details, please see QSO-24-08-NH and/or this CDC EBP video.

Additional topics

In addition to regulatory updates and EBP, my presentation also included:

• Antimicrobial stewardship
• Social drivers of health and infection control

Plus, we took a thorough look at two infections prominent in SNFs which have surged since the pandemic:

• Candida auris ( auris)
• Respiratory Syncytial Virus (RSV)

Further guidance about C. auris is available through these CDC resources:

• Treatment and Management of  aurisInfections and Colonization
• Information for Infection Preventionists
• Infection Prevention and Control for Candida auris

Further information about RSV is available through these CDC resources:

• Symptoms and Care

In part two of our three-part series, we will continue to discuss other hot topics at AAPACN 2024.

Learn more

To get details about how the right technology can help your facility better track EBP and enhance infection surveillance, visit our clinical solutions page for more information, and set up a demo.

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