04/04/2024

You Asked... We Answered

You Asked... 

Would coding of any skin impairment item in Section M of the Minimum Data Set (MDS) mean that enhanced barrier precautions (EBP) should be in place?

We Answered… 

No, the Centers for Medicare & Medicaid Services (CMS) states in the QSO-24-08-NH memo that shorter-lasting wounds, such as skin breaks or skin tears covered with an adhesive bandage (e.g., Band-Aid®) or similar dressing, would not require EBP. CMS states that wounds that would require EBP would generally include chronic wounds including but not limited to, pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous stasis ulcers.

The CMS memo does not cover all examples so facilities should make determinations based on the guidance provided in the memo. Facilities will want to first identify if the skin impairment requires a dressing, then determine if it is a simple dressing, and if it is a shorter-lasting wound to make a determination on EBP. If a resident has a wound requiring a dressing but there is debate in whether it is a chronic wound or if it is not a simple dressing, then the facility could implement EBP based on CDC guidance which only requires it to be a wound with a dressing to meet the criteria to implement EBP. Facilities should also consider partnering with their local health department, wound specialists, physicians, and their region’s infection prevention specialist.