ETC 51 - Implementing Enhanced Standard Precaution (ESP) and Its Impact in a Skilled Nursing Facility

Background: The All Facilities Letter (AFL) issued by the California Department of Public Health (CDPH) on October 5, 2022, informed all skilled nursing facilities (SNFs) on the updated guidelines of Enhanced Standard Precaution (ESP) to SNFs for safely caring for residents with medical devices and unhealed wounds who are at increased risk for transmission of multidrug-resistant organisms (MDRO) in compliance with state and federal regulations. ESP is a resident-centered and activity-based approach for preventing MDRO transmission in SNFs. The purpose of this study was to assess the level of compliance with the ESP among healthcare workers (HCW) in SNFs and its relationship with healthcare-associated infection (HAI) utilizing McGeer’s criteria.

Methods: ESP education and competencies were developed to increase awareness and compliance of ESP during the six moments of care (morning and evening care; toileting & changing incontinence briefs; caring for devices, giving medical treatments; wound care; mobility assistance and preparing to leave the room; and cleaning the environment). Adherence Monitoring Tool from CDPH was utilized to gather data and just in time, feedback was provided when opportunities in non-compliance were identified.

Results: Healthcare-associated infection rate in SNF decreased to 40%-60% as the ESP practices compliance rate during high contact activities increased from 30% to 90%.

Conclusions: ESP is an essential factor in reducing healthcare-associated infection in SNFs. It provides SNFs a framework for reducing MDRO transmission through HCW use of gowns and gloves while caring for residents at high risk for MDRO transmission at bedside care during specific activities with greater risk for MDRO contamination of HCW hands, clothes, and the environment.