Long-term care (LTC) facilities provide a variety of medical and non-medical services to people who have a chronic disease or disability. These settings may include but are not limited to: nursing homes (NH)/skilled nursing facilities, inpatient rehabilitation facilities, assisted living facilities (ALF), hospice, senior day care services, and long-term acute care hospitals.
Infection Prevention for Respiratory Outbreaks in Long-Term Care Settings. For additional information, see the July 2019 clinician letter from the State Health Commissioner.
Special considerations for infection prevention in these settings:
- An increasing number of individuals in the United States is receiving care in LTC facilities. These residents have growing medical complexity and care needs, and increasing exposure to devices and antibiotics.
- Patients/residents may transfer in and out of long-term care with some frequency, so appropriate communication of medical history, including antibiotic use, devices, past infections, and risk factors is critical.
- Scientific literature on the prevalence of healthcare-associated infections (HAI) and evidence-based prevention practices in these settings is limited.
- No standardized system for HAI surveillance has been adopted nationally.
VDH reports and projects
- Assisted living facility and nursing home infection prevention needs assessment report
- VHQC/VDH Clostridium difficile infection prevention collaborative for long-term care and acute care facilities (2012-2013)
- Urinary tract infection prevention collaborative (June 2011 – December 2011)
- Virginia reportable disease list
- Outlines diseases and conditions (including outbreaks) that are reportable to the local health department by physicians, directors of medical care facilities (such as nursing homes), and directors of laboratories.
- Assisted living facilities are required to call the health department whenever they suspect an outbreak may be occurring but are not required to report individual cases of the reportable diseases/conditions. If an ALF resident has a reportable disease/condition, his/her physician is responsible for reporting to the local health department.
- Part of the Regulations for Disease Reporting and Control
Successful Strategies for the Prevention of Urinary Tract Infections in Long-Term Care TOOLKIT (Fall 2011)
This toolkit compiles UTI definitions, regulations, tools, policy templates, educational resources, and presentations addressing appropriate management and treatment in long-term care settings. It also incorporates related material from Successful Strategies for Infection Prevention and Control in Assisted Living Facilities and Nursing Homes TOOLKIT.
Successful Strategies for Infection Prevention and Control in Assisted Living Facilities and Nursing Homes TOOLKIT
This toolkit contains infection prevention presentations, resources, and tools that have been adapted for the assisted living facility (ALF) and nursing home (NH) setting whenever possible. The toolkit has been made available to ALFs, NHs, local health departments, and licensing agencies in the Commonwealth of Virginia.
These documents have been developed from published evidence-based research, standards of practice, or recommendations obtained from the Centers for Disease Control and Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC), Occupational Safety and Health Administration (OSHA), Centers for Medicare and Medicaid Services (CMS), licensing agencies, professional organizations, or other recognized sources.
How to Use: These documents are meant to supplement the Successful Strategies for Infection Prevention in Assisted Living Facilities and Nursing Homes training and may be adapted for use in your facility. Resources were copied onto DVDs and shared so that facility staff may make copies, use materials to provide education to others, and customize tools as necessary. If a document is not available in a version that is editable but you wish to customize it, please contact the VDH HAI Program for help. Most fact sheets and guidelines are dated within the document. Other signs, templates, and Powerpoint presentations produced by VDH or other agencies have the date of production italicized in parentheses next to the name.
The toolkit is meant to introduce and summarize, and does not replace published standards and regulations. Refer to the toolkit component, “Infection Prevention Resources and Guidelines for Assisted Living Facilities and Nursing Homes”, to help access additional documents and contact your local health department or the VDH HAI Program with questions.
Individual toolkit components can be downloaded below.
- Title Page (Fall 2011)
- Overview: Infection Prevention Toolkit for Virginia ALFs and NHs (Fall 2011)
- Assisted Living and Nursing Home Organizational Partners (Summer 2011)
- Table of Contents (Fall 2011)
- Training Agenda (Fall 2011)
- Successful Strategies for Infection Prevention in Assisted Living Facilities and Nursing Homes: Introduction and Welcome (Summer 2011)
- Infection Prevention and Control: What Infections Are and What We Can Do to Prevent Their Spread in Our Facilities (Summer 2011)
- Infection Prevention and Control: Prevention Strategies (Summer 2011)
- Regulations for Assisted Living Facilities – Your Inspection and Infection Control (Summer 2011)
- Regulations for Nursing Homes – CMS §483.65 Infection Control (F441) (Summer 2011)
Bloodborne pathogen (BBP) transmission and blood glucose monitoring (BGM)
- FAQs: BBP
- FAQs: Safe Injection Practices
- Guidelines: OSHA BBP Summary
- In-Service: BBP and BGM-Service (Summer 2011)
- In-Service: OSHA BBP Standard for Assisted Living Facilities – this presentation can be used to fulfill the requirement for training on the OSHA Bloodborne Pathogens Standard. Facilities that implement this in-service should add how employees should seek counseling and follow-up care if an occupational exposure occurs. (May 2014)
- Log: BGM Checklist and Monitoring Tool (Fall 2011)
- Sign: Practice Safe BGM (Summer 2011)
- Sign: Single-Use Devices vs. Penlets (Summer 2011)
- Template: Administrator’s Checklist: Safe BGM and Injection Practices (Fall 2012)
- Template: BGM Protocol (Fall 2012)
- Template: BBP Exposure Control Plan (Summer 2011)
- CMS Regulatory Update: BGM (August 2010)
- VDSS Regulatory Update: BGM (February 2011)
Hand hygiene (HH) and personal protective equipment (PPE)
- FAQs: HH
- Log: HH and PPE Monitoring Tool (Summer 2011)
- In-Service: HH (Summer 2011)
- Sign: Sequence for Donning and Doffing PPE
- Sign: HH Brochure
- Sign: HH
- FAQs: Environmental Cleaning and Disinfection
- Log: Environmental Checklist (Summer 2011)
- Log: Environmental Checklist for Blood Spills (Summer 2011)
- FAQs: Vaccination
- Log: Vaccinations (general) (Fall 2011)
- Log: Resident Immunization Record (Fall 2011)
- Log: Influenza Vaccination Record (Fall 2011)
- For up-to-date vaccination recommendations and immunization resources, go to the VDH Division of Immunization’s website
- FAQs: Contact Precautions (for Providers)
- FAQs: Contact Precautions (for Residents)
- FAQs: Droplet Precautions (for Providers)
- FAQs: Droplet Precautions (for Residents)
- FAQs: Drug Resistance
- FAQs: Respiratory Hygiene
- FAQs: Standard Precautions (for Providers)
- FAQs: Standard Precautions (for Residents)
- Sign: Standard and Transmission-Based Precautions (Summer 2011)
- Sign: Contact Precautions (Fall 2011)
- Sign: Special Contact Precautions (Fall 2011)
- Sign: Droplet Precautions (Fall 2011)
- Sign: Cover your Cough
- Table: Infection Prevention Practices for Selected Diseases (Summer 2011)
- CDC 12 Steps to Prevent Antimicrobial Resistance in Long Term Care
- FAQs: Surveillance
- FAQs: How to Collect Specimens
- Guidance: Outbreak Identification
- Log: GI Illness (Staff) (Summer 2011)
- Log: GI Illness (Resident) (Summer 2011)
- Log: Respiratory Illness (Staff) (Summer 2011)
- Log: Respiratory Illness (Resident) (Summer 2011)
- Log: Resident Illness (general) (Summer 2011)
- Log: Monthly Infection Surveillance Tracking (Summer 2011)
- Sign: Outbreak (Summer 2011)
- For fact sheets, signs, prevention guidelines, and other materials on influenza, click here to access influenza educational resources for long-term care facilities (including assisted living facilities)
- FAQs: Carbapenem-resistant Enterobacteriaceae (CRE)
- FAQs: Methicillin-resistant Staphylococcus aureus (MRSA)
- FAQs: Respiratory Illnesses
- FAQs: Scabies
- FAQs: Vancomycin-resistant Enterococci (VRE)
Urinary tract infections
- FAQs: Urinary Tract Infections (UTI)
- Guidelines: Urinary Catheter Checklist (Summer 2011)
- Guidelines: Urinary Catheter Reminder (Summer 2011)
- FAQs: Working with Your Health Department
- Reportable Disease List (March 2011)
- FAQs: Virginia Department of Social Services (VDSS) – Division of Licensing Programs
- FAQs: Virginia Department of Health – Office of Licensure and Certification
- FAQs: Regulatory Requirements for ALFs
- FAQs: Regulatory Requirements for NHs
- FAQs: Recommended Training for Staff
- FAQs: Communicating Medical Information During Resident Transfer
- Form: Transfer Sheet
- Guidance: How to Educate Adult Learners (Summer 2011)
- Guidance: Sick Staff (for Administrators)
- Guidance: Sick Staff (for Providers)
- Form: Epi-1 (Disease Reporting) Form
- CDC resources
- Long-Term Care Settings
- Long-Term Care Facility Component – designed for use by nursing homes, skilled nursing facilities, chronic care facilities, and assisted living and residential care facilities. As of September 2012, contains modules to report urinary tract infections, C. difficile, methicillin-resistant Staphylococcus aureus and other drug-resistant infections, and prevention process measures including hand hygiene adherence.
- Guidelines and position papers
- SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility, 2008
- SHEA Position Papers
- Journal articles
- High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, and Yoshikawa TT.Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities. Clinical Infectious Diseases. 2009;48:149–171
- Loeb M, Bentley DW, Bradley S, Crossley K, Garibaldi R, Gantz N, McGeer A, Muder RR, Mylotte J, Nicolle LE, Nurse B, Paton S, Simor AE, Smith P, Strausbaugh L. Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term–Care Facilities: Results of a Consensus Conference, Infect Control Hosp Epidemiol 2001;22:120–124
- Nicolle LE, Bentley DW, Garibaldi R, Neuhaus EG, Smith PW, the SHEA Long‐Term–Care Committee.Antimicrobial Use in Long-Term–Care Facilities. Infect Control Hosp Epidemiol 2000;21:537–545
- Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, Gould CV, Juthani-Metha M, Lautenbach E, Loeb M, et al. Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology. 2012 Oct;33(10):965-977
- HCPro – offers training and resources on infection control, quality, patient safety, and other topics specific to a given healthcare setting