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Infection Control and Prevention in Long Term Care

Infection control is a serious public issue, and it is vital for healthcare workers and others working with the public to understand how to prevent infection. Controlling and preventing infection in long-term care settings is possible.

In fact, the Centers for Disease Control and Prevention (CDC) says that when healthcare professionals are aware of infections and they take steps to prevent them, there is a 70% reduction in the occurrence of some healthcare associated infections, otherwise known as HAIs.

Chain of Infection

Every day in the United States, approximately 1 in 25 hospital residents has a hospital-acquired infection, and about 75,000 of these residents will die each year.

In long-term care, the Centers for Medicare and Medicaid (CMS) cite the most common infections as infections of the urinary tract, respiratory system, and skin, and pressure injury infections.

The chain of infection is a sequence of events that allows infections to be transmitted. Breaking any of the links in this chain will help stop the spread of infection.

If you know how to break the chain of infection, you can help save lives!


Contact transmission describes the way an infectious agent infects a susceptible host. Contact precautions are used to prevent the transmission of illnesses easily spread through contact with residents or contaminated items in their environment.

Direct Transmission

This occurs when an infection is transmitted from one person to another through direct physical contact. Direct contact is skin-to-skin contact that occurs when performing resident-care activities in which your hands come into contact with a resident’s skin.

Droplet transmission is also considered direct contact because transmission is spread by direct spray over a few feet during coughing, sneezing, or even talking.

Indirect Transmission

This occurs when an infection is transmitted through a contaminated object or person, as many microorganisms can live on surfaces for extended periods of time. Indirect contact occurs when you touch objects in the resident’s environment that they have touched.

It also includes objects another employee has touched after being in direct contact with the resident, including clothing, and the hands of a person who has not properly performed hand hygiene before and after interaction with another individual or contaminated surface.

Airborne Transmission

Airborne transmission occurs through the distribution of either tiny droplets or small particles floating in the air, which can be inhaled by another person. These airborne germs are tinier and lighter than droplets, can travel through ventilation systems, and can live for a long time in the air. To be truly airborne, the particles must be able to travel more than just a few feet through the air from the source to the host.

Airborne germs may be carried over long distances by air currents and can be inhaled by others, even those who have not had face-to-face contact with the infectious individual.

Bloodborne Pathogens

Every day, people encounter any number of harmful pathogens such as bacteria, viruses, fungi, and parasites, which, given the right circumstances, can result in an infection or illness. Certain types of harmful pathogens are called bloodborne pathogens.

Bloodborne pathogens are transmitted via contact with blood or other potentially infectious fluids, such as semen, saliva, and other bodily fluids. Exposure to a bloodborne pathogen occurs when blood or other potentially infectious materials come into contact with non-intact skin or mucous membranes, such as the eyes, nose, or mouth.

Hand Hygiene

Hand hygiene is the most important intervention to reduce the transmission of infections in healthcare settings and the first component of standard precautions. This includes handwashing with soap and water or using an alcohol-based hand rub, or ABHR. There are certain situations in which you MUST perform handwashing with soap and water rather than using an ABHR.

Standard Precautions

Standard precautions are based on the knowledge that all blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes potentially contain infectious agents. Standard precautions are protective interventions that are applied to all people every time you provide care or services regardless of whether they have a suspected or confirmed infection.

Their purpose is to reduce the risk of exposure to and the spread of bloodborne and other infectious pathogens.

Standard precautions apply to all clients, regardless of whether a suspected or confirmed infection had been identified. They are called “standard” because they apply to everyone.

Personal Protective Equipment

The use of personal protective equipment is a component of standard precautions. Using PPE provides an additional barrier between you and potentially infectious or injurious material. It is NOT a substitute for proper hand hygiene. You must always perform hand hygiene before applying and after removing PPE.

Other Components

Sharps Injury Prevention

Caution must be used when handling needles and other sharps, such as razors, broken glass, or anything else that can break the skin. These items should be disposed of in a sharps container.

Respiratory Hygiene and Cough Etiquette

You should provide instruction to residents to cover their nose and mouth with a tissue when sneezing and coughing, and to perform hand hygiene after touching respiratory secretions. Tissues should be disposed of in a trash receptacle.

Environmental Cleaning

Contaminated environmental surfaces and care equipment can lead to the transmission of infectious organisms. These items must be decontaminated regularly, especially those that are visibly contaminated and/or frequently touched.


You must handle, transport, process, and store all contaminated linens in a manner that prevents the spread of infectious organisms to another individual or surface. This will include preventing contact between your skin, mucous membranes, and clothing and contaminated linens.

Waste Disposal

You must recognize that blood, body fluids, human tissue, and single-use equipment that is contaminated by blood and body fluids is clinical waste and can harbor infectious organisms. Dispose of this waste in the proper container per organizational policy.

Room Placement

Whenever there is the potential for transmission of an infectious agent, the preferred placement is in a private room. When private rooms are limited, they should be prioritized for those individuals who have infections that are easily transmitted.

If private rooms are not available, the use of additional infection control measures might be in order. If you have any questions about the placement of individuals with infections, contact your infection control preventionist or nursing supervisor.

Transmission-Based Precautions

When Standard Precautions are not enough to prevent the transmission of infectious agents, other types are precautions are needed. In these situations, your organization will implement transmission-based precautions, which has 3 types:

  • Contact
  • Droplet
  • Airborne

Each has specific guidelines, but they all start with standard precautions.

A Shared Responsibility

Healthcare-associated infections can have a significant impact on an individual’s health, safety, and overall well-being. We are ALL responsible for ensuring that the appropriate strategies are used to prevent the spread of infections from one person to another.

Be sure you stay informed. Continue to keep up with the latest standards and revisions affecting your organization.


The Critical Role of an Infection Preventionist in LTC

One of the best ways to prevent infection is to have someone on staff with specialized training. For skilled nursing facilities, CMS has recently made it a requirement to have an infection preventionist on staff. In this webinar we identify the importance of the Phase 3 requirement that a trained Infection Preventionist be hired and assigned, what role they play in quality assessment and assurance, and what other benefits their specialized training may bring to the table.

Watch the Webinar →

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