Long-term care (LTC) facilities provide a variety of medical and non-medical services designed to meet a person’s health or personal care needs during a short or long period of time. These settings may include but are not limited to nursing homes (NH)/skilled nursing facilities, inpatient rehabilitation facilities, assisted living facilities (ALF), hospice, and senior day care services.
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 indwelling medical 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.
Hot Topics:
Quick Guides for Nursing Homes: This new series of resources is for infection preventionists in nursing homes. These quick guides cover key concepts and action items on each topic, including how to communicate with residents and staff. Great for new IPs as well as anyone who needs guidance at their fingertips!
- Airborne Precautions
- Bed Bugs
- C. difficile
- Candida auris
- Carbapenem-Resistant Organisms (CROs) and Carbapenemase-Producing Organisms (CPOs)
- Central Lines
- Cleaning and Disinfection During Outbreaks
- Contact Precautions
- COVID-19
- Droplet Precautions
- Education
- Enhanced Barrier Precautions
- Environment of Care
- Group A Strep
- Hand Hygiene
- Infection Control Breach
- Influenza
- Linen Management
- Norovirus
- Outbreak Response
- Personal Protective Equipment
- Resident Placement
- Safe Transport and Accepting New Admissions/Readmissions
- Scabies
- Urinary Catheters
- Wound Care
Infection Prevention Information and Resources for LTC
Resources to assist providers, administrators, LTC infection preventionists, and health department personnel with infection prevention and control in the long-term care setting.
Infection Prevention Resources
Antimicrobial Resistance & Stewardship
- Antimicrobial resistance
- Antimicrobial stewardship
Bloodborne pathogen (BBP) prevention and blood glucose monitoring (BGM)
- FAQs: BBP
- FAQs: Safe Injection Practices
- Guidelines: OSHA BBP Summary
- In-Service: BBP and BGM (Fall 2012)
- 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)
- Template: Administrator’s Checklist: Safe BGM and Injection Practices (Fall 2012)
- Template: BGM Protocol (Fall 2012)
- Template: BBP Exposure Control Plan (Summer 2011)
- Webinar: Safe Injection Practices and Assisted Monitoring of Blood Glucose in Long-Term Care Facilities (September 2021)
- CMS Regulatory Update: BGM (August 2010)
- VDSS Regulatory Update: BGM (February 2011)
COVID-19
Guidance
- CDC
- Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic (5/08/2023)
- Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 (9/23/2022)
- Strategies to Mitigate Healthcare Personnel Staffing Shortages (9/23/2022)
- Congregate Living Settings Recommendations (for assisted living facilities)
- CMS
- OSHA
- VDH
Testing Resources
- CMS Nursing Home Testing Requirements (9/23/2022)
- Connect to Test resource to help find available COVID tests; applicable to all types of LTCFs
- VDH: COVID-19 Testing Information for Healthcare Providers
- CDC COVID-19 Data Tracker Tool
Therapeutics Resources
Trainings
- CDC
- CMS
- VDH
- CDC and CMS COVID-19 Updated Guidance for Infection Prevention in Healthcare Facilities (6/14/2023) (Slides), (Video), (Q&A)
- CDC and CMS COVID-19 Infection Prevention and Control Recommendations Update (11/09/2022) (Slides), (Video), (Q&A)
- COVID-19 Testing Training
- N95 Respiratory Fit Testing Train-the-Trainer Course
Vaccine Resources
- HQIN Vaccine Administration and Tracking Tools (Filter on left by Vaccination & Nursing Homes)
- Vaccine Hesitancy Resources
- VDH: COVID-19 Vaccination Response for LTCFs
- CDC: COVID-19 Vaccination
- CMS COVID-19 Vaccine Immunization Requirements for Residents and Staff
- A Descriptive Analysis of COVID-19 Vaccine Uptake in Long-term Care Facilities, Virginia - 2021
Enhanced Barrier Precautions
- CMS Enhanced Barrier Precautions Memo (3/20/24)
- VDH Resources
- EBP Poster (12/2023)
- EBP Frequently Asked Questions (08/02/2024)
- EBP Implementation Algorithm (08/31/2022)
- EBP Quick Guide for Nursing Home IPs (09/2023)
- Enhanced Barrier Precautions for Nursing Homes presentation (3/27/2024)
- CDC Resources
- EBP Website
- Presentations
- Pre-implementation tool
- Observation tool and summary spreadsheet
- Sample letters
- Nursing home leadership
- Nursing home residents, families, friends, and volunteers
- Nursing home staff
- EBP example sign
- Frequently asked questions
Environmental Cleaning and Disinfection
- Cleaning and Disinfection During an Outbreak: Quick Guide for Nursing Home IPs
- Environment of Care: Quick Guide for Nursing Home IPs
- Environmental Cleaning and Disinfection Responsibilities Chart
- FAQs: Environmental Cleaning and Disinfection
- Log: Environmental Checklist (Summer 2011)
- Log: Environmental Checklist for Blood Spills (Summer 2011)
Gastrointestinal Illnesses
- C. difficile: Quick Guide for Nursing Home IPs
- FAQs: Clostridium difficile
- FAQs: Gastrointestinal (GI) illnesses
- Guidelines: Norovirus (Feb 2023)
- Norovirus: Quick Guide for Nursing Home IPs
Group A Streptococcus
- VDH Wound Care Infection Prevention and Control Tool
- CDC Toolkit: Controlling Group A Strep Outbreaks in Long-Term Care Facilities
- Group A Strep: Quick Guide for Nursing Home IPs
- Wound Care: Quick Guide for Nursing Home IPs
Hand Hygiene (HH) and Personal Protective Equipment (PPE)
- Hand Hygiene Competency (Word) (fillable PDF)
- Hand Hygiene Competency Validation Tool (Word) (fillable PDF)
- Hand Hygiene: Quick Guide for Nursing Home IPs
- PPE Competency Template (Word) (fillable PDF)
- PPE Competency Validation Tool– One Step Doffing Process (Word) (fillable PDF)
- PPE Competency Validation Tool – Two Step Doffing Process (Word editable) (fillable PDF)
- PPE: Quick Guide for Nursing Home IPs
- 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
Influenza
- VDH webpage on Influenza Information for Healthcare Professionals and Facilities: Fact sheets, signs, prevention guidelines, and other resources for long-term care facilities
Multidrug-Resistant Organisms
- Candida auris (auris)
- Carbapenem-resistant organisms
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-resistant Enterococci
Respiratory Illnesses and Respiratory Hygiene
- Influenza: Quick Guide for Nursing Home IPs
- Long-Term Care Quick Start Guide: Preparing for Respiratory Virus Season (CDC)
- Masking Signage (CDC)
- Viral Respiratory Pathogens Toolkit for Nursing Homes (CDC)
- FAQs: Respiratory Hygiene
- FAQs: Respiratory Illnesses
- Resource Guide for Developing a Respiratory Protection Program
- Sign: Cover your Cough
Scabies and Bed Bugs
Standard and Transmission-Based Precautions
- Airborne Precautions: Quick Guide for Nursing Home IPs
- Contact Precautions: Quick Guide for Nursing Home IPs
- Droplet Precautions: Quick Guide for Nursing Home IPs
- FAQs: Contact Precautions (for Providers)
- FAQs: Contact Precautions (for Residents)
- FAQs: Droplet Precautions (for Providers)
- FAQs: Droplet Precautions (for Residents)
- FAQs: Standard Precautions (for Providers)
- FAQs: Standard Precautions (for Residents)
- Sign: Standard and Transmission-Based Precautions (Summer 2011)
- Sign Examples: Airborne, Contact, Droplet Precautions (CDC)
Tuberculosis
Urinary Tract Infections
- FAQs: Urinary Tract Infections (UTI)
- Guidelines: Urinary Catheter Checklist (Summer 2011)
- Guidelines: Urinary Catheter Reminder (Summer 2011)
- 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.
- Urinary Catheters: Quick Guide for Nursing Home IPs
Vaccination
- 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
Other Resources
- Quick Guide for Nursing Home IPs: Central Lines
- Quick Guide for Nursing Home IPs: Education
- Quick Guide for Nursing Home IPs: Infection Control Breach
- Quick Guide for Nursing Home IPs: Linen Management
- Quick Guide for Nursing Home IPs: Outbreak Response
- Quick Guide for Nursing Home IPs: Resident Placement
- Quick Guide for Nursing Home IPs: Safe Transport and Accepting New Admissions/Readmissions
- Fact sheet: Chain of Infection
- Fact sheet: Microbiology 101 (Summer 2011)
- Table: Infection Prevention Practices for Selected Diseases (Summer 2011)
- FAQs: Working with Your Health Department
- 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)
Surveillance and Reporting Requirements
Communicable Disease and Outbreak Reporting Requirements
- General Reportable Disease 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
- Confidential morbidity report form
- Suspected outbreak reporting portal
- Virginia reportable disease list
- COVID-19
- A variance to the Disease Reporting and Control Regulations became effective on April 4, 2022 to exempt Virginia physicians, laboratories, and directors of medical facilities from reporting negative or inconclusive SARS-CoV-2 antigen test results and all SARS-CoV-2 antibody testing results. See the VDH clinician letter from April 5, 2022 for more information.
- Results that entities should continue to report:
- All (positive, negative, and inconclusive) Nucleic Acid Amplification Tests (NAAT)
- All POSITIVE antigen tests
- LTCF COVID-19 Test Results Reporting Requirements (4/16/2022)
- VDH Portal for Reporting Point-of-Care COVID-19 Lab Results Instructions: This portal will assist testing sites in meeting the requirement of the CARES Act to report every diagnostic and screening test performed to detect SARS-CoV-2 or to diagnose a possible case of COVID-19. This portal allows the rapid entry of person-level test results for positive results. Non-required test options have been disabled from the VDH point of care portal. All COVID-19 test results should be reported to VDH within 24 hours. Testing sites that are not conducting POC tests should report results per standard protocols.
- Results that entities should continue to report:
- A variance to the Disease Reporting and Control Regulations became effective on April 4, 2022 to exempt Virginia physicians, laboratories, and directors of medical facilities from reporting negative or inconclusive SARS-CoV-2 antigen test results and all SARS-CoV-2 antibody testing results. See the VDH clinician letter from April 5, 2022 for more information.
National Healthcare Safety Network
- NHSN Long-Term Care Facility Component
- National Healthcare Safety Network (NHSN) LTCF COVID-19 Module
- Weekly Healthcare Personnel COVID-19 Vaccination | HPS | NHSN | CDC
Surveillance Definitions
- 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
Surveillance Resources
- 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)
- VDH Disease Reporting and Control Regulations website
LTC-Focused Projects and Communications
Virginia Long-Term Care Infrastructure Pilot Projects (VLIPP)
Newsletters
- Virginia Long-Term Care Clinician Network Monthly Update: newsletters from February 2023 onward
- Past issues of the Virginia COVID-19 Long-Term Care Task Force monthly newsletter
Regional Infection Prevention Teams in Action
This quarterly newsletter spotlights the essential role and accomplishments of the VDH Regional Infection Preventionists.
Other Key Resources and Educational Opportunities
Infection Prevention Guidelines, Resources, and Trainings
CDC
- Long-Term Care Settings website
- Nursing Home Infection Preventionist Training Course
- Project Firstline
HQIN
- Best Practices Pocket Cards
- HQIN Resources (can filter resources based on topic and setting)
SPICE (State Program for Infection Control and Epidemiology) - North Carolina
VDH
- Glossary of infection prevention terms
- Infection prevention resources and guidelines
- Request an Infection Prevention and Control Assessment with the VDH HAI/AR Program
- VDH Clinician Letters - recent communications from the State Health Commissioner to Virginia healthcare facilities
VIPTC (Virginia Infection Prevention Training Center)
- VIPTC website – courses and trainings
Regulatory Resources
Virginia Department of Behavioral Health and Developmental Services (DBHDS)
- DBHDS website
Virginia Department of Social Services (DSS)
- DSS website – assisted living facilities
Virginia Department of Health - Office of Licensure and Certification
- VDH OLC website – Division of Long-Term Care Services
- FAQs: Virginia Department of Health - Office of Licensure and Certification
- FAQs: Regulatory Requirements for NHs
Archive
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Last Updated: August 23, 2024