Enhanced Barrier Precautions Duration: How Long Do Residents Stay on EBP?

If you've ever asked, "How long do residents stay on Enhanced Barrier Precautions (EBP)?"—you're not alone. This is a common question among nursing home staff, caregivers, and family members of residents in skilled nursing facilities. Enhanced Barrier Precautions are a critical infection prevention strategy used to limit the spread of multidrug-resistant organisms (MDROs), especially in residents with indwelling medical devices or open wounds. But knowing when EBP should begin—and more importantly, when it can be discontinued—is essential for both safety and quality of life in long-term care settings. This article breaks down exactly how long residents stay on EBP, when precautions can be lifted, and the factors that influence these decisions.

Understanding Enhanced Barrier Precautions

A 76-year-old male suddenly experiences difficulty speaking and walking, prompting his wife to bring him to the emergency department. He is diagnosed with a stroke and admitted to the hospital. Further testing reveals dysphagia (difficulty swallowing), and a feeding tube is inserted to prevent aspiration. After his hospital stay, he is transferred to a skilled nursing facility (SNF) for rehabilitation. Due to the presence of the feeding tube—an indwelling medical device—he is placed on Enhanced Barrier Precautions (EBP) at the SNF. During a visit, his wife asks the nursing staff a common question: how long will the resident stay on Enhanced Barrier Precautions?

What Are Enhanced Barrier Precautions and Why Are They Used?

Enhanced Barrier Precautions (EBP) are infection prevention measures used in nursing homes and skilled nursing facilities to reduce the spread of multi-drug resistant organisms (MDROs). EBP involves healthcare staff wearing gowns and gloves during high-contact resident care activities. These precautions are applied to residents who are either infected or colonized with MDROs identified by the CDC, as well as to those with open wounds or indwelling medical devices such as feeding tubes or catheters. Understanding when and why Enhanced Barrier Precautions are used helps determine how long a resident should remain on EBP.

High Contact Resident Activities That Require Enhanced Barrier Precautions

Certain resident care tasks are considered “high contact” and require the use of Enhanced Barrier Precautions (EBP) to help prevent the spread of infection. These activities include hygiene-related tasks such as washing, shaving, brushing teeth, dressing, and changing briefs. EBP should also be used when changing bed linens for residents who have wounds, indwelling medical devices, or are infected or colonized with CDC-specified multidrug-resistant organisms (MDROs). Additionally, EBP is necessary during any wound care procedures or when handling indwelling devices such as PICC lines, urinary catheters, or feeding tubes. Understanding which activities require EBP can help clarify how long residents may need to stay on Enhanced Barrier Precautions.

Indwelling Medical Devices That Determine Enhanced Barrier Precautions Duration

The duration of Enhanced Barrier Precautions (EBP) often depends on the presence of indwelling medical devices. Staff may discontinue EBP during high-contact care activities once these devices are removed. Common indwelling devices include central venous catheters (such as hemodialysis catheters and PICC lines), indwelling urinary catheters, feeding tubes, and tracheostomy tubes. Similarly, EBP can be discontinued for residents with wounds once those wounds have fully healed. These clinical factors play a key role in determining how long a resident will stay on Enhanced Barrier Precautions in a skilled nursing facility.

How Long Should Residents Infected or Colonized with MDROs Remain on Enhanced Barrier Precautions?

Residents who are infected or colonized with a multidrug-resistant organism (MDRO) listed by the CDC should remain on Enhanced Barrier Precautions (EBP) for the entire duration of their stay in the facility. According to CDC guidance, re-testing residents to determine if EBP can be discontinued is not recommended. For these residents, the answer to how long they stay on EBP is clear: EBP should continue for the full length of their stay in the nursing home or skilled nursing facility.

Conclusion: Enhanced Barrier Precautions Timeline

The 76-year-old resident, recently diagnosed with a stroke, had a feeding tube placed during his hospital stay due to difficulty swallowing. Upon transfer to the skilled nursing facility for rehabilitation, he was placed on Enhanced Barrier Precautions (EBP) because of the indwelling medical device. He begins speech therapy to improve his ability to swallow and, over time, is able to safely tolerate both solids and liquids by mouth. Once he is placed on an oral diet and the feeding tube is removed, the order for Enhanced Barrier Precautions is discontinued.

Frequently Asked Questions About Enhanced Barrier Precautions Duration

• How long do enhanced barrier precautions last for MDRO colonization? Enhanced barrier precautions should remain in place for MDRO colonization for the duration of a resident’s stay in the facility.
• Can enhanced barrier precautions be discontinued early? Enhanced Barrier Precautions can be discontinued if ordered for an indwelling medical device or wound and the medical device is removed or the wound has healed.
• What happens if a resident refuses enhanced barrier precautions? If a resident refuses enhanced barrier precautions staff should provide education to the resident on the reason EBP are being used and the importance of its use.
• Do enhanced barrier precautions continue after discharge? No, enhanced barrier precautions do not continue after discharge from the facility.