Infection Prevention and Control Resources

With the latest updates to the State Operations Manual, it is more important than ever to promote resident safety and well-being through infection prevention and control. A robust and successful infection control program requires many thoughtfully designed and well-operating pieces—from antibiotic stewardship and physician engagement to immunization planning and tracking, reduced hospital readmissions, and comprehensive clinical surveillance. Explore the resources below to learn how you can bolster your infection control program.

  • CDC Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes Updated (4/21)

    By CDC - April 05, 2021
    Summary of Recent Changes

    Updates as of March 29, 2021

    • Two prior guidance documents, “Responding to COVID-19 in Nursing Homes” and “Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes” were merged with this guidance.
    • The criteria for health department notification was updated to be consistent with Council of State and Territorial Epidemiologist (CSTE) guidance for reporting.
    • Information on the importance of vaccinating residents and healthcare personnel (HCP) was added along with links to vaccination resources.
    • Visitation and physical distancing measures were updated.
    • Added  proper use and handling of personal protective equipment (PPE).
    • Added  universal PPE use to align with the interim infection prevention and control guidance for HCP.
    • Added considerations for situations when it might be appropriate to keep the room door open for a resident with suspected or confirmed SARS-CoV-2 infection.
    • A description was included about when it may be appropriate for a resident with a suspected SARS-CoV-2 infection to “shelter-in-place.”
    • Added management of residents who had close contact with someone with SARS-CoV-2 infection which includes a description of quarantine recommendations including resident placement, recommended PPE, and duration of quarantine.
    • Added addressing circumstances when quarantine is recommended for residents who leave the facility.
    • Added responding to a newly identified SARS-CoV-2-infected HCP or resident.
    • Added addressing quarantine and work exclusion considerations for asymptomatic residents and HCP who are within 90 days of resolved infection.
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  • Using Observational Audits to Assess Staff Skills to Prevent COVID-19 Infection: AHRQ ECHO Tools (4/21)

    By AHRQ - April 05, 2021

    Two new resources from AHRQ are part of the agency’s ongoing efforts to protect nursing home residents and staff from COVID-19. Both are intended to support the use of observational audits, which help facilities understand if staff members are fully complying with infection prevention practices:

    ·  Competency Check vs. Observational Audit: Validate Nursing Home Staff Performance to Improve Infection Prevention Processes for COVID-19. This comparison tool helps skilled nursing facilities differentiate between competency validation for regulatory compliance and observational auditing for quality assurance performance improvement activities.

    ·  Observational Audits: A Pathway to Improving Infection Prevention and Preventing the Spread of COVID-19. This step-by-step guide helps facilities establish a process for observational auditing to provide a true assessment of performance in the actual work environment, and helps facilities collect data to support improvements in infection prevention.

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  • National Healthcare Safety Network (NHSN) Long-term Care Facility COVID-19 Reporting Module Website UPDATED (4/21)

    By CDC - April 05, 2021

    CDC’s NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), with a secure reporting platform for reporting outcomes and process measures in a systematic way. Reported data are immediately available for use in strengthening local and national surveillance, monitoring trends in infection rates, assisting in identifying resource insecurities, and informing progress toward infection prevention goals.

    The NHSN Long-term Care Facility Component supports the nation’s COVID-19 response through the LTCF COVID-19 Module. Facilities eligible to report data to NHSN’s COVID-19 Module include nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities.

    Data reported into the LTCF COVID-19 Module Surveillance Reporting Pathways facilitate assessment of the impact of COVID-19 through facility reported surveillance data. Examples of data reported in the pathways include:

    • Counts of residents and facility personnel newly positive for COVID-19 based on viral test results.
    • COVID-19 vaccination status of residents newly positive for COVID-19.
    • Re-infections in residents and facility personnel previously infected with COVID-19.
    • COVID-19 related death counts among residents and facility personnel.
    • Staffing shortages.
    • Availability and surge capacity use of personal protective equipment (PPE) and alcohol-based hand rub.
    • Monoclonal therapeutic availability and use.
    • Ventilator capacity and supplies for facilities with ventilator-dependent units.

    The Point-of-Care (POC) Test Reporting Tool is a separate reporting option for LTCFs to report SARS-CoV-2 test results provided by a POC device. NHSN routes reported POC laboratory test result data to the public health agency at the local or state level with jurisdictional authority and responsibility for receiving those data. Important: the reporting of POC test result data in this tool does not take the place of answering POC related questions in the Resident Impact and Facility Capacity surveillance reporting pathway.

    Weekly reporting of COVID-19 vaccination data for residents and healthcare personnel is another option available to LTCFs. Additional information about surveillance and vaccination reporting, please visit the Weekly HCP & Resident COVID-19 Vaccination webpage.

    LTCF data submission options include manual data entry, CSV file submission by individual facilities or bulk CSV file upload for multiple facilities, and/or NHSN DIRECT CDA Automation for the Point-of-Care (POC) Test Reporting Tool. Information about the Direct protocol can be found here. Send questions to NHSNCDA@CDC.GOV with Subject line “Direct Submissions for POC data.”

    For additional information about the LTCF COVID-19 Module, reporting options, data collection forms, form instructions, archived and upcoming trainings, and future updates, please review the resources on this page.

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  • Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM): CMS Memo QSO-21-15-ALL (4/21)

    By CMS - April 02, 2021
    Memo # QSO-21-15-ALL

    Posting Date 2021-03-26

    Fiscal Year 2021


    Burden Reduction Final Rule Interpretive Guidelines: The Centers for Medicare & Medicaid Services (CMS) is releasing interpretive guidelines and updates to Appendix Z of the State Operations Manual (SOM) as a result of the revisions of the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (CoPs) (CMS 3346-F) Final Rule.

    Expanded Guidance related to Emerging Infectious Diseases (EIDs): CMS is also providing additional guidance based on best practices, lessons learned and general recommendations for planning and preparedness for EID outbreaks. 

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  • Postacute Sequelae of SARS-CoV-2 Infection (4/21)

    By ASPR TRACIE / HHS - April 01, 2021
    ASPR TRACIE (part of the US Department of Health and Human Services) received a request for information on clinical presentation, disease progression, and related information from clinicians in the field treating COVID-19 patients after the acute phase of the virus has passed, frequently referred to as “COVID long haulers.”
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  • SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests - New FDA Webpage (4/21)

    By FDA - April 01, 2021
    The FDA posted a new web page SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests for clinical laboratory staff and health care providers about the impact of viral mutations on COVID-19 molecular, antigen, and serology tests. This web page builds on the letter the FDA issued January 8, 2021, alerting clinical laboratory staff and health care providers to the potential for false negative results due to the impact of viral mutations on molecular SARS-CoV-2 tests. The web page includes specific molecular tests impacted by viral mutations and recommendations for those tests, including, new information on Cepheid Xpert Xpress SARS-CoV-2, Xpert Xpress SARS-CoV-2 DoD, and Xpert Omni SARS-CoV-2 tests. The FDA will update this page as significant new information about viral mutations and impact on COVID-19 tests becomes available. The FDA will announce any updates by email to CDRH In Vitro Diagnostics email list subscribers and in COVID-19 Update press releases.

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  • COVID-19 Vaccine Effectiveness Among Health Care Workers and Other Front-Line Workers (4/21)

    By CDC - March 31, 2021

    Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021


    Weekly / April 2, 2021 / 70(13);495–500



    What is already known about this topic?

    Messenger RNA (mRNA) COVID-19 vaccines have been shown to be effective in preventing symptomatic SARS-CoV-2 infection in randomized placebo-controlled Phase III trials.

    What is added by this report?

    Prospective cohorts of 3,950 health care personnel, first responders, and other essential and frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks. Under real-world conditions, mRNA vaccine effectiveness of full immunization (≥14 days after second dose) was 90% against SARS-CoV-2 infections regardless of symptom status; vaccine effectiveness of partial immunization (≥14 days after first dose but before second dose) was 80%.

    What are the implications for public health practice?

    Authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.

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  • CMS COVID-19 Nursing Homes Best Practices Toolkit and New QIN-QIO Virtual Assistance UPDATED (2/21)

    By CMS - March 23, 2021

    New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

    CMS has released a new toolkit UPDATED (3/25/21) developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

    “The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

    The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

    Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

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  • CDC Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (3/21)

    By CDC - March 19, 2021

    Guidance released March 10, 2021 regarding Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC affects only select elements of the current Nursing Home ICAR tool until an updated version of the tool is available. Please reference this guidance when using the ICAR tool to ensure alignment with updated considerations for COVID-19 vaccination status (e.g., visitation, HCP work restriction, resident quarantine).


    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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  • OSHA Updates Enforcement Memorandum for Respirator Fit Testing Programs (3/21)

    By OSHA - March 18, 2021
    OSHA's interim enforcement response plan memoranda provide instructions and guidance to Area Offices and compliance safety and health officers (CSHOs) for handling COVID-19-related complaints, referrals, and severe illness reports. The Interim Enforcement Response Plan for COVID-19 was issued on April 13, 2020, updated on May 19, 2020. On March 12, 2021, the May 19, 2020, memorandum on this topic was rescinded, and the new Updated Interim Enforcement Response Plan for COVID-19 went into and remains in effect until further notice.
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  • CDC Study: Pfizer COVID-19 Vaccine Effectiveness During SNF Outbreaks (3/21)

    By CDC - March 15, 2021


    ·         What is already known about this topic?

    Skilled nursing facility (SNF) residents, generally older and with more underlying medical conditions than community-dwelling adults, were not included in COVID-19 vaccine clinical trials. Little is known about COVID-19 vaccine effectiveness in SNF residents.

    ·         What is added by this report?

    A retrospective cohort analysis in two Connecticut SNFs found partial vaccination with Pfizer-BioNTech COVID-19 vaccine (from >14 days after dose 1 through 7 days after dose 2) to be 63% (95% confidence interval = 33%–79%) effective against SARS-CoV-2 infection.

    ·         What are the implications for public health practice?

    Even with partial vaccination, Pfizer-BioNTech COVID-19 vaccine provides protection to SNF residents. To optimize vaccine impact among this population, high coverage with the complete 2-dose series is recommended.

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  • Visiting Loved Ones in a Nursing Home – English and Spanish Graphic Available (3/21)

    By CMS - March 15, 2021

    On March 10, 2021, the Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE). Today, CMS is releasing a graphic to further explain the expanded visitation options.

    According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation.

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  • New OSHA National Emphasis Program Targets Include Nursing Home Workers/COVID-19 Safety (3/21)

    By OSHA - March 14, 2021

    OSHA launches program to protect high-risk workers from coronavirus,
    focuses on employers that retaliate against workers with safety concerns

    WASHINGTON, DC – In response to President Biden's executive order on protecting worker health and safety, the U.S. Department of Labor's Occupational Safety and Health Administration has launched a national emphasis program focusing enforcement efforts on companies that put the largest number of workers at serious risk of contracting the coronavirus. The program also prioritizes employers that retaliate against workers for complaints about unsafe or unhealthy conditions, or for exercising other rights protected by federal law.

    "This deadly pandemic has taken a staggering toll on U.S. workers and their families. We have a moral obligation to do what we can to protect workers, especially for the many who have no other protection," said Principal Deputy Assistant Secretary of Labor for Occupational Safety and Health Jim Frederick. "This program seeks to substantially reduce or eliminate coronavirus exposure for workers in companies where risks are high, and to protect workers who raise concerns that their employer is failing to protect them from the risks of exposure."

    NEP inspections will enhance the agency’s previous coronavirus enforcement efforts, and will include some follow-up inspections of worksites inspected in 2020. The program’s focused strategy ensures abatement and includes monitoring the effectiveness of OSHA’s enforcement and guidance efforts. The program will remain in effect for up to one year from its issuance date, though OSHA has the flexibility to amend or cancel the program as the pandemic subsides.

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  • Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination (3/21)

    By CDC - March 11, 2021

    CDC guidance for SARS-CoV-2 infection may be adapted by state and local health departments to respond to rapidly changing local circumstances.

    On this page


    Work restriction for asymptomatic healthcare personnel and quarantine for asymptomatic patients and residents

    SARS-CoV-2 Testing

    Use of Personal Protective Equipment


    This guidance applies to all healthcare personnel (HCP) while at work and all patients and residents while they are being cared for in a healthcare setting.

    CDC has released public health recommendations for vaccinated persons, which describe circumstances when non-pharmaceutical interventions (e.g., quarantine) could be relaxed for fully vaccinated persons in non-healthcare settings. CDC continues to evaluate the impact of vaccination and the emergence of novel SARS-CoV-2 variants on healthcare infection prevention and control recommendations; updated recommendations will be added to this page regularly as new information becomes available.

    Except as noted in Updated Recommendations, HCP should continue to follow all current infection prevention and control recommendations, including those addressing work restrictions, quarantine, testing, and use of personal protective equipment to protect themselves and others from SARS-CoV-2 infection.

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  • COVID-19 Prevention / Management in Long-Term Care: CMS Recommendations (3/21)

    By CMS - March 10, 2021

    NOTE: CMS revised guidance on March 10, 2021 for nursing home visitation during the COVID-19 Public Health Emergency, which supersedes the visitation guidance in this memo. See CMS memorandum QSO-20-39-NH Revised, Nursing Home Visitation-COVID-19. 


    The new recommendations include:

    ·  Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.

    ·  As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.

    ·  Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.

    ·  Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.

    ·  To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.

    “The Trump Administration is calling on the nursing home industry and state and local leaders to join us by taking action now to ensure the safety of their residents, who are among our most vulnerable citizens. The Administration urges them to carefully review our recommendations, and implement them immediately,” said CMS Administrator Seema Verma.

    Today’s recommendations will help State and local governments, and nursing homes, as they consider creative ways to stop the spread of the virus, such as designating units within facilities – or entire facilities – solely for residents with confirmed COVID-19. An example of such an arrangement is in Wilmington, Massachusetts, in which a 142-bed facility has been designated as a solely COVID-19-positive facility. Residents across the region who are infected with COVID-19 can be moved to this facility to receive appropriate care and avoid transmitting the virus within their facilities. This approach also eases the challenges of preventing transmission, like extensive PPE usage and isolation practices, for individual facilities. The Massachusetts arrangement, developed in coordination with the state’s government, is a prime example of the arrangements envisioned in the recommendations announced today.

    The recommendations also speak to enhanced screening and transmission prevention practices. Previous CMS guidance, developed with CDC and issued in mid-March, advised nursing homes to restrict all but the most urgent visitors and staff. Today’s guidance builds on this by recommending temperature screenings for all visitors and that all staff utilize adequate PPE when interacting with patients, to the extent PPE is available.

    Nursing homes are unique in the healthcare system because, unlike other healthcare facilities, they are full-time homes as well as settings of care. Importantly, nursing home residents, given their advanced age and corresponding health issues, are at particular risk of complications arising from COVID-19. Because they are large concentrations of particularly vulnerable individuals, nursing homes have been a major focus for the Trump Administration in its aggressive efforts to combat the virus.

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