We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative ambulation in the hallway. Therapy staff wore gowns and gloves while working with him in the therapy gym, but what should restorative nursing staff do in the hallway?




CMS addresses the use of PPE in common areas in a FAQ document (questions #25 and #26 below). There is no definite yes/no answer regarding use of gowns/gloves in the hallway for EBP, but is based on the individual resident’s needs regarding the amount of extended high contact. For the example listed in this question, restorative staff should wear gown/gloves in the hallway while ambulating this resident.

CDC: Frequently asked questions about using EBP in nursing homes to prevent MDROs:

Question #25 – Are gowns and gloves recommended for Enhanced Barrier Precautions when transferring a resident from a wheelchair to chair in the dayroom or dining room?

In general, gowns and gloves would not be recommended when performing transfers in common areas such as dining or activity rooms, where contact is anticipated to be shorter in duration. Enhanced Barrier Precautions is primarily intended to apply to care that occurs within a resident’s room where high-contact resident care activities, including transfers, are bundled together with other high-contact activity, such as part of morning or evening care. This extended contact with the resident and their environment increases the risk of MDRO spreading to staff hands and clothes. Outside the resident’s rooms, Enhanced Barrier Precautions should be followed when performing transfers and assisting during bathing in a shared/common shower room and when working with residents in the therapy gym, specifically when anticipating close physical contact while assisting with transfers and mobility. Hand hygiene is recommended before and after resident contact.

Question #26 – Is Physical or Occupational Therapy considered a “high-contact” resident care activity?

Depending on the activity, therapy may be considered “high-contact” resident care. Therapists should use gowns and gloves when working with residents on Enhanced Barrier Precautions in the therapy gym or in the resident’s room if they anticipate prolonged, close body contact where transmission of MDROs to the therapist’s clothes is possible. EBP should not limit a resident’s ability to continue their medical therapy, so while the use of a gown and gloves is generally discouraged in hallways and other common areas, there may be individual circumstances (e.g., therapy that has to occur outside of the resident’s room or therapy gym) that prompt an evaluation for the need to use PPE outside of the room or gym, depending on the degree of assist/close contact.

As part of Standard Precautions, gowns and gloves should be removed and hand hygiene performed when moving to work with another resident. Therapists should also ensure reusable therapy equipment is cleaned and disinfected after each use and surfaces in the therapy gym receive routine cleaning and disinfection.


Angie Hamer, RN, RAC-CT
Clinical Consultant

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