03/28/2024

You Asked... We Answered

You Asked... 

What is the specific CDC-targeted multidrug-resistant organisms (MDRO) that require enhanced barrier precautions (EBP)?

We Answered… 

CMS provides this guidance in the QSO-24-08-NH memo on page 4 which directs providers to the CDC’s webpage, “Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs).”

CDC notes that the MDROs for which the use of EBP applies, and do not otherwise require contact precautions, are based on local epidemiology. At a minimum, they should include resistant organisms targeted by CDC but can also include other epidemiologically important MDROs as listed below:

Examples of MDROs Targeted by CDC include:

•       Pan-resistant organisms,
•       Carbapenemase-producing carbapenem-resistant Enterobacterales,
•       Carbapenemase-producing carbapenem-resistant Pseudomonas spp.,
•       Carbapenemase-producing carbapenem-resistant  Acinetobacter baumannii, and
•       Candida auris.

Additional epidemiologically important MDROs may include, but are not limited to:

•       Methicillin-resistant Staphylococcus aureus (MRSA),
•       ESBL-producing Enterobacterales,
•       Vancomycin-resistant Enterococci (VRE),
•       Multidrug-resistant Pseudomonas aeruginosa, and
•       Drug-resistant Streptococcus pneumoniae.

CDC isolation guidance states the following situations require contact precautions situations when residents infected or colonized with an MDRO:

• Presence of acute diarrhea, draining wounds or other sites of secretions or excretions that are unable to be covered or contained.
• For a limited time period, as determined in consultation with public health authorities, on units or in facilities during the investigation of a suspected or confirmed MDRO outbreak.
• When otherwise directed by public health authorities.