The California Department of Health has issued an updated All Facilities Letter (AFL 22-21) regarding Enhanced Standard Precautions for Skilled Nursing Facilities (SNFs) in 2022. This updated guidance aims to help SNFs safely care for residents with medical devices and unhealed wounds who are at increased risk for transmission of multidrug-resistant organisms (MDRO). SNFs are required to establish and maintain an infection prevention and control program under state and federal regulations. The updated Enhanced Standard Precautions (ESP) guidance simplifies implementation and reflects changes in the epidemiology of MDRO in California SNFs since 2019. The guidance emphasizes the importance of ESP as a prevention strategy before transmission and outbreaks occur. It provides a practical, resident-centered, and activity-based approach to implement measures to prevent MDRO transmission that are less restrictive than Contact Precautions. Recommendations for the use of gowns and gloves by healthcare providers are based on assessments of a resident's risk for being colonized and likelihood of transmitting MDRO. SNFs are advised to submit any questions or comments about the guidance to the CDPH Healthcare-Associated Infections Program via email.

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