Long-Term Care Settings

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

Reporting requirements

  • 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.



Summary documents

Infection transmission

Bloodborne pathogen (BBP) transmission and blood glucose monitoring (BGM)

Hand hygiene (HH) and personal protective equipment (PPE)

Environmental cleaning


Prevention strategies



  • 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)

Gastrointestinal illnesses

Other diseases/conditions


Urinary tract infections

Guidance documents

Other resources