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Principles of infection control in long-term care facilities

Michael J Richards, MD, FRACP
Rhonda L Stuart, MBBS, FRACP, PhD
Section Editor
Anthony Harris, MD, MPH
Deputy Editor
Elinor L Baron, MD, DTMH


Long-term care facilities (LTCFs) represent a diverse group of healthcare settings that serve individuals of all ages and provide variable degrees of care; LTCFs are increasingly addressing a broader range of acute care needs. LTCFs include nursing homes, skilled-nursing facilities providing postacute care, assisted living facilities, retirement homes, rehabilitation centers, long-term care hospitals, long-term psychiatric facilities, and institutions for individuals with intellectual disabilities. For many residents, these facilities are a home as well as a place of nursing, medical, and/or psychosocial care.

The Association for Practitioners in Infection Control and the Society for Hospital Epidemiology have developed guidelines for infection prevention and control in LTCFs [1].

Staffing and support for infection control in LTCFs lag behind infection control programs in acute care hospitals [2-6]. Challenges to infection control in LTCFs include high patient-staff ratios, high staff turnover, and inadequate implementation of infection control policies [1].

Issues related to infection prevention and control in LTCFs will be reviewed here. Causes of infection in LTCFs facilities are discussed separately. (See "Causes of infection in long-term care facilities: An overview".)


The United States population >65 years and over increased from 36.6 million to 47.8 million between 2005 and 2015 and is projected to increase to 98 million by 2060. Around 3 percent of the population >65 years in the United States lived in institutional settings in 2015. [7].

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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  1. Smith PW, Bennett G, Bradley S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008; 29:785.
  2. Garibaldi RA, Brodine S, Matsumiya S. Infections among patients in nursing homes: policies, prevalence, problems. N Engl J Med 1981; 305:731.
  3. Khabbaz RF, Tenney JH. Infection control in Maryland nursing homes. Infect Control Hosp Epidemiol 1988; 9:159.
  4. Smith PW, Helget V, Sonksen D. Survey of infection control training program graduates: long-term care facility and small hospital practitioners. Am J Infect Control 2002; 30:311.
  5. Roup BJ, Roche JC, Pass M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006; 34:122.
  6. Mody L, Langa KM, Saint S, Bradley SF. Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan. Am J Infect Control 2005; 33:489.
  7. U.S. Department of Health and Human Services. A profile of older Americans: 2016. https://www.giaging.org/documents/A_Profile_of_Older_Americans__2016.pdf (Accessed on September 05, 2017).
  8. Smith PW. Infection control in the long-term healthcare facility. Geriatrics 1989; 44 Suppl A:11.
  9. Dwyer LL, Harris-Kojetin LD, Valverde RH, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc 2013; 61:342.
  10. McGeer A, Campbell B, Emori TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991; 19:1.
  11. Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012; 33:965.
  12. High KP, Bradley SF, Gravenstein S, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:149.
  13. Stevenson KB. Regional data set of infection rates for long-term care facilities: description of a valuable benchmarking tool. Am J Infect Control 1999; 27:20.
  14. McKibben LJ, Stange PV, Sneller VP, et al. Use of standing orders programs to increase adult vaccination rates. MMWR Recomm Rep 2000; 49:15.
  15. Centers for Disease Control and Prevention. Prevention strategies for seasonal influenza in healthcare settings. http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm (Accessed on October 10, 2016).
  16. Arden NH. Control of influenza in the long-term-care facility: a review of established approaches and newer options. Infect Control Hosp Epidemiol 2000; 21:59.
  17. Cahill CK, Rosenberg J. Guideline for prevention and control of antibiotic-resistant microorganisms in california long-term care facilities. Centers for Disease Control. J Gerontol Nurs 1996; 22:40.
  18. Nicolle LE, Bentley D, Garibaldi R, et al. Antimicrobial use in long-term-care facilities. Infect Control Hosp Epidemiol 1996; 17:119.
  19. Loeb M, Bentley DW, Bradley S, et al. 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.
  20. Bentley DW, Bradley S, High K, et al. Practice guideline for evaluation of fever and infection in long-term care facilities. Clin Infect Dis 2000; 31:640.
  21. Nicolle LE. Antimicrobial stewardship in long term care facilities: what is effective? Antimicrob Resist Infect Control 2014; 3:6.
  22. Rhee SM, Stone ND. Antimicrobial stewardship in long-term care facilities. Infect Dis Clin North Am 2014; 28:237.
  23. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44:159.
  24. van Buul LW, van der Steen JT, Veenhuizen RB, et al. Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc 2012; 13:568.e1.
  25. Mody L. Optimizing antimicrobial use in nursing homes: no longer optional. J Am Geriatr Soc 2007; 55:1301.
  26. Katz PR, Beam TR Jr, Brand F, Boyce K. Antibiotic use in the nursing home. Physician practice patterns. Arch Intern Med 1990; 150:1465.
  27. Nicolle LE, Bentley DW, Garibaldi R, et al. Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee. Infect Control Hosp Epidemiol 2000; 21:537.
  28. Hayden MK, Lin MY, Lolans K, et al. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals. Clin Infect Dis 2015; 60:1153.