Long-term Care Facilities (LTCFs) - HAN
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Overview
The Skilled Nursing Facilities and Assisted Living (SNFAL) team provides guidance and outreach to skilled nursing, assisted living, and supportive living facilities in the Chicago area.
Join the SNFAL team for our Chicago Long Term Care Roundtable webinars each month! The webinars cover COVID-19 updates and other infection control/prevention topics for nursing homes and long-term care facilities. We invite all facility leadership to complete this survey to receive calendar invites for future webinars.
Join the SNFAL team for our Chicago Long Term Care Roundtable webinars each month! The webinars cover COVID-19 updates and other infection control/prevention topics for nursing homes and long-term care facilities. We invite all facility leadership to complete this survey to receive calendar invites for future webinars.
COVID-19
COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2. It is primarily transmitted from person to person following close exposure to respiratory fluids carrying infectious virus.
Outbreak Definition:
Three or more residents and/or staff in a facility with:
at least one of the cases is a resident.
Outbreak Closure
After 14 days without additional cases, respiratory outbreaks can be finalized and considered over. If additional cases are identified after 14 days, a new outbreak should be reported.
Precautions: For residents with mild to moderate illness who are not moderately to severely immunocompromised, discontinue isolation when at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications and symptoms have improved. HCP who enter the room of a resident with suspected or confirmed SARS-CoV-2 infection should use a NIOSH approved particulate respirator with N95 filters or higher, gown, gloves, and eye protection.
Reporting: The table below shows COVID-19 reporting requirements for skilled nursing, assisted, and supportive living facilities. There may be a need to report cases and/or outbreaks to multiple entities. Reporting to one does NOT satisfy the need to report to the others.
Outbreak Definition:
Three or more residents and/or staff in a facility with:
- acute respiratory illness (ARI) and/or
- positive point-of-care test (as available) and/or
- laboratory-confirmed viral infection within 72 hours of each other
at least one of the cases is a resident.
Outbreak Closure
After 14 days without additional cases, respiratory outbreaks can be finalized and considered over. If additional cases are identified after 14 days, a new outbreak should be reported.
Precautions: For residents with mild to moderate illness who are not moderately to severely immunocompromised, discontinue isolation when at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications and symptoms have improved. HCP who enter the room of a resident with suspected or confirmed SARS-CoV-2 infection should use a NIOSH approved particulate respirator with N95 filters or higher, gown, gloves, and eye protection.
Reporting: The table below shows COVID-19 reporting requirements for skilled nursing, assisted, and supportive living facilities. There may be a need to report cases and/or outbreaks to multiple entities. Reporting to one does NOT satisfy the need to report to the others.
| Reporting Requirements | Skilled Nursing | Assisted Living | Supportive Living |
|---|---|---|---|
| CDPH | Report all COVID outbreaks to IDPH | Report all COVID outbreaks to IDPH | Report all COVID outbreaks to IDPH |
| OHCR (facilities licensed by IDPH) | Submit Long-Term Care Incident Report via OHCR Portal or by email for all acute respiratory illness outbreaks | Submit Long-Term Care Incident Report via OHCR Portal or by email for all acute respiratory illness outbreaks | N/A |
| NHSN (CMS certified facilities) | Report all staff and resident COVID cases AND vaccination using the Long-Term Care Facilities Component | N/A | N/A |
Testing Guidance:
Vaccination: CDC recommends the 2024–2025 updated COVID-19 vaccines: Pfizer-BioNTech, Moderna, or Novavax, to protect against serious illness from COVID-19. One dose is recommended for most individuals, but people aged 65 years and older and those who are moderately or severely immunocompromised should receive a second dose of 2024-2025 COVID-19 vaccine six months after their first dose.
Use this fact sheet to help address common concerns you may hear from your staff or residents about COVID-19,influenza (flu), and respiratory syncytial virus (RSV) vaccines.
For other COVID-19 guidance (e.g. source control and treatment), please refer to IDPH guidance on Acute Respiratory Illness Outbreaks.
Additional Resources:
- Symptomatic Individuals should be tested immediately after the onset of illness to identify cause of the illness.
- Asymptomatic Close Contacts should be tested on day 1, day 3, and day 5 after the exposure (but not earlier than 24 hours after exposure).
- For outbreaks, consider unit, department or facility wide testing. If using this approach, test staff and residents every 3-7 days until no new cases are identified for at least 14 days.
Vaccination: CDC recommends the 2024–2025 updated COVID-19 vaccines: Pfizer-BioNTech, Moderna, or Novavax, to protect against serious illness from COVID-19. One dose is recommended for most individuals, but people aged 65 years and older and those who are moderately or severely immunocompromised should receive a second dose of 2024-2025 COVID-19 vaccine six months after their first dose.
Use this fact sheet to help address common concerns you may hear from your staff or residents about COVID-19,influenza (flu), and respiratory syncytial virus (RSV) vaccines.
For other COVID-19 guidance (e.g. source control and treatment), please refer to IDPH guidance on Acute Respiratory Illness Outbreaks.
Additional Resources:
- Preventing and Controlling Acute Respiratory Illness Outbreaks in Skilled Nursing Facilities and Other Facilities Providing Skilled Care – Updated 9/30/2024
IDPH guidance covering recommendations for nursing homes and other long-term care (LTC) facilities that provided skilled nursing personal care (e.g. skilled nursing facilities). This guidance also covers infection prevention and control, testing, treatment, cohorting, PPE use, visitation, etc. - Preventing and Controlling Acute Respiratory Illness Outbreaks in Community Congregate Settings - Updated 1/29/2025
IDPH guidance covering recommendations for Assisted Living and Independent Living facilities. This guidance also covers infection prevention and control, testing, treatment, and PPE use. - Infection Control Guidance: SARS-CoV-2 (CDC) - Updated 5/8/2023
CDC guidance covering recommendations for all U.S. settings where healthcare is delivered. This guidance covers duration of isolation, recommended personal protective equipment, testing, and engineering controls. - CDPH COVID-19 Therapeutics and Prophylaxis - Learn more about COVID-19 therapeutics and prophylaxis for non-hospitalized patients.
- COVID-19 Vaccination Clinical & Professional Resources - CDC resources for healthcare providers related to the COVID-19 vaccines, including links to interim clinical recommendations.
- List N: Disinfectants for COVID-19 (EPA) - EPA created and regularly updates a list of disinfectant products that are effective against COVID-19.
Influenza
Influenza (flu) is a respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. Influenza A and B viruses commonly cause illness in humans and seasonal epidemics. The incubation period is usually 1–4 days after exposure. Most adults with influenza shed the virus in the upper respiratory tract and are infectious from the day before symptom onset to 5–7 days after symptom onset.
Precautions: Droplet precautions should be implemented for residents with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer.
Reporting: Report influenza outbreaks within 24 hours to the IDPH Redcap Outbreak Reporting Form.
Outbreak Definition:
Three or more residents and/or staff in a facility with:
at least one of the cases is a resident.
Outbreak Closure
After 14 days without additional cases, respiratory outbreaks can be finalized and considered over. If additional cases are identified after 14 days, a new outbreak should be reported.
Vaccination: All staff and residents of skilled nursing, assisted living, and supportive living facilities should get a flu vaccine every season with rare exceptions. Vaccination is particularly important for people who are at higher risk of serious complications from influenza. ACIP recommends adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: HD-IIV4, RIV4, or aIIV4. If none of these three vaccines are available, then any other age- appropriate influenza vaccine should be used. For additional information check the 2024-2025 ACIP Summary of Influenza Vaccine Recommendations.
Use this fact sheet to help address common concerns you may hear from your staff or residents about influenza (flu), COVID-19, and respiratory syncytial virus (RSV) vaccines.
Additional Resources:
Precautions: Droplet precautions should be implemented for residents with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer.
Reporting: Report influenza outbreaks within 24 hours to the IDPH Redcap Outbreak Reporting Form.
Outbreak Definition:
Three or more residents and/or staff in a facility with:
- acute respiratory illness (ARI) and/or
- positive point-of-care test (as available) and/or
- laboratory-confirmed viral infection within 72 hours of each other
at least one of the cases is a resident.
Outbreak Closure
After 14 days without additional cases, respiratory outbreaks can be finalized and considered over. If additional cases are identified after 14 days, a new outbreak should be reported.
Vaccination: All staff and residents of skilled nursing, assisted living, and supportive living facilities should get a flu vaccine every season with rare exceptions. Vaccination is particularly important for people who are at higher risk of serious complications from influenza. ACIP recommends adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: HD-IIV4, RIV4, or aIIV4. If none of these three vaccines are available, then any other age- appropriate influenza vaccine should be used. For additional information check the 2024-2025 ACIP Summary of Influenza Vaccine Recommendations.
Use this fact sheet to help address common concerns you may hear from your staff or residents about influenza (flu), COVID-19, and respiratory syncytial virus (RSV) vaccines.
Additional Resources:
- Preventing and Controlling Acute Respiratory Illness Outbreaks in Skilled Nursing Facilities and Other Facilities Providing Skilled Care – Updated 9/30/2024
IDPH guidance covering recommendations for nursing homes and other long-term care (LTC) facilities that provided skilled nursing personal care (e.g. skilled nursing facilities). This guidance applies to all respiratory viral pathogens including COVID-19, flu, and RSV. This guidance also covers infection prevention and control, testing, treatment, room assignments, PPE use, visitation, etc. - Preventing and Controlling Acute Respiratory Illness Outbreaks in Community Congregate Settings - Updated 1/29/2025
IDPH guidance covering recommendations for Assisted Living and Independent Living facilities. This guidance also covers infection prevention and control, testing, treatment, and PPE use. - Administrative Code Section 956.30 - Facilities should ensure that all staff are provided education on influenza and are offered the opportunity to receive the influenza vaccine during the influenza season (between September 1 and March 1 of each year). Sample Declination Form
- CDPH Respiratory Illness Prevention Posters (English|Spanish) - Print and post in high traffic areas to provide respiratory illness prevention guidance to visitors and staff.
Respiratory Syncytial Virus
Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. Infants and older adults are more likely to develop severe RSV and need hospitalization. People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.
Precautions: CDC recommends contact precautions for the duration of illness. However, for long term care, CDPH recommends droplet and contact precautions for residents with suspected or confirmed RSV for the duration of illness, including 24 hours fever free without the use of fever reducing medications.
Reporting: Use the IDPH REDCap Outbreak Reporting Tool to report all RSV outbreaks.
Outbreak Definition:
Three or more residents and/or staff in a facility with:
at least one of the cases is a resident.
Outbreak Closure
After 14 days without additional cases, respiratory outbreaks can be finalized and considered over. If additional cases are identified after 14 days, a new outbreak should be reported.
Vaccination: Vaccines are available to protect older adults from severe RSV. One dose of RSV vaccination is recommended for everyone ages 75 and older. The vaccine is also recommended for adults ages 60-74 who are at increased risk of severe RSV disease. For additional information check the 2024 MMWR RSV Recommendations.
Use this fact sheet to help address common concerns you may hear from your staff or residents about respiratory syncytial virus (RSV), influenza (flu), and COVID-19.
Additional Resources:
Precautions: CDC recommends contact precautions for the duration of illness. However, for long term care, CDPH recommends droplet and contact precautions for residents with suspected or confirmed RSV for the duration of illness, including 24 hours fever free without the use of fever reducing medications.
Reporting: Use the IDPH REDCap Outbreak Reporting Tool to report all RSV outbreaks.
Outbreak Definition:
Three or more residents and/or staff in a facility with:
- acute respiratory illness (ARI) and/or
- positive point-of-care test (as available) and/or
- laboratory-confirmed viral infection within 72 hours of each other
at least one of the cases is a resident.
Outbreak Closure
After 14 days without additional cases, respiratory outbreaks can be finalized and considered over. If additional cases are identified after 14 days, a new outbreak should be reported.
Vaccination: Vaccines are available to protect older adults from severe RSV. One dose of RSV vaccination is recommended for everyone ages 75 and older. The vaccine is also recommended for adults ages 60-74 who are at increased risk of severe RSV disease. For additional information check the 2024 MMWR RSV Recommendations.
Use this fact sheet to help address common concerns you may hear from your staff or residents about respiratory syncytial virus (RSV), influenza (flu), and COVID-19.
Additional Resources:
- CDPH RSV Poster - Flyers can be posted in high-traffic areas to inform residents on the new RSV vaccine.
- Preventing and Controlling Acute Respiratory Illness Outbreaks in Community Congregate Settings - Updated 1/29/2025
IDPH guidance covering recommendations for Assisted Living and Independent Living facilities. This guidance also covers infection prevention and control, testing, treatment, and PPE use.
Gastroenteritis
Gastroenteritis is an inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea. Infections causing gastroenteritis can be viral, bacterial, or parasitic in origin.
Norovirus
Norovirus is a very contagious virus that causes vomiting and diarrhea. Norovirus infections spread very rapidly. The incubation period is 12–48 hours. Healthcare facilities and other institutional settings are particularly at-risk for outbreaks because of increased person-to-person contact. Norovirus transmission occurs primarily through the fecal–oral route, either through direct person-to-person contact or indirectly via contaminated food or water. Precautions: Use Contact Precautions for a minimum of 48 hours after the resolution of symptoms. All staff members and others in contact with the ill resident or their environment should switch to hand hygiene with soap and water.
List G: Antimicrobial Products Registered with EPA for Claims Against Norovirus – List G products are registered for use against Norovirus. Find the EPA registration number on the product label. Look for “EPA Reg. No.” followed by two or three sets of numbers and search the registration number exactly as it appears on the label.
C. difficile
Clostridioides difficile (C. difficile or C. diff) is a spore-forming, gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD) and colitis (an inflammation of the colon). Precautions: Use Contact Precautions until 72 hours after diarrhea ceases. All staff members and others in contact with the ill resident or their environment should switch to hand hygiene with soap and water because alcohol-based hand rub (ABHR) is less effective against spores.
List K: Antimicrobial Products Registered with EPA for Claims Against Clostridium difficile Spores - List K products are registered for use against Clostridium difficile spores (C. diff). Find the EPA registration number on the product label-look for “EPA Reg. No.” followed by two or three sets of numbers and search the registration number exactly as it appears on the label.
Reporting: Use the Long-Term Care Facility Outbreak Report Form to report all GI outbreaks.
Additional Resources:
Norovirus
Norovirus is a very contagious virus that causes vomiting and diarrhea. Norovirus infections spread very rapidly. The incubation period is 12–48 hours. Healthcare facilities and other institutional settings are particularly at-risk for outbreaks because of increased person-to-person contact. Norovirus transmission occurs primarily through the fecal–oral route, either through direct person-to-person contact or indirectly via contaminated food or water. Precautions: Use Contact Precautions for a minimum of 48 hours after the resolution of symptoms. All staff members and others in contact with the ill resident or their environment should switch to hand hygiene with soap and water.
List G: Antimicrobial Products Registered with EPA for Claims Against Norovirus – List G products are registered for use against Norovirus. Find the EPA registration number on the product label. Look for “EPA Reg. No.” followed by two or three sets of numbers and search the registration number exactly as it appears on the label.
C. difficile
Clostridioides difficile (C. difficile or C. diff) is a spore-forming, gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD) and colitis (an inflammation of the colon). Precautions: Use Contact Precautions until 72 hours after diarrhea ceases. All staff members and others in contact with the ill resident or their environment should switch to hand hygiene with soap and water because alcohol-based hand rub (ABHR) is less effective against spores.
List K: Antimicrobial Products Registered with EPA for Claims Against Clostridium difficile Spores - List K products are registered for use against Clostridium difficile spores (C. diff). Find the EPA registration number on the product label-look for “EPA Reg. No.” followed by two or three sets of numbers and search the registration number exactly as it appears on the label.
Reporting: Use the Long-Term Care Facility Outbreak Report Form to report all GI outbreaks.
Additional Resources:
- Guideline for the Prevention and Control of Viral Acute Gastroenteritis Outbreaks in Illinois Long-Term Care Facilities - The guideline recommendations are applicable for the prevention and control of all types of viral acute gastroenteritis outbreaks in LTCFs, including outbreaks caused by Norovirus.
- CDPH LTC Acute Gastroenteritis Surveillance Line List – This line list template was created to help long term care facilities detect and investigate possible outbreaks of GI illness.
- Food Handler Illness Reporting Form (English | Spanish) - This document is intended to educate food handlers about the importance of staying home when sick and alerting the facility when they experience concerning GI symptoms.
- IDPH Norovirus Webinar (5-19-2023) - While these slides are specific to norovirus, the same infection prevention and control principles are applicable to outbreaks of other gastrointestinal pathogens.
- Controlling Outbreaks of Viral Gastroenteritis - CDPH guidance on GI outbreaks in congregate settings covering resident floors, hand hygiene, food preparation, facility disinfection, visitors, and laboratory testing.
- Enteric Precautions Sign - This door sign is intended to remind staff and visitors to wash hands with soap and water during a GI Outbreak.
- Family and Visitor Letter - This document is intended to be posted in your facility and shared with family, visitors, and residents to educate them about a norovirus outbreak and what the facility is doing in response. The document can be edited to reflect facility name and specfiic facility actions.
Legionellosis
Legionella bacteria are found naturally in freshwater environments, like lakes and streams. Legionella bacteria can become a health concern when they grow and spread in human-made building water systems. After Legionella grows and multiplies in a building water system, water containing Legionella can spread in droplets small enough for people to breathe in. Legionella bacteria can cause a serious type of pneumonia (lung infection) called Legionnaires’ disease and can also cause a less serious illness called Pontiac fever.
Precautions: Standard precautions, Legionnaires' disease is not communicable.
Reporting: Use the Legionnaires' Disease Case Report Form to report all cases.
Prevention: There are no vaccines that can prevent Legionnaires’ disease. The key to preventing Legionnaires’ disease is to reduce the risk of Legionella growth and spread. All facilities need to develop a policy for testing its water supply for Legionella bacteria. The policy should include a facility risk assessment, testing protocols, control measures, and documented results with corrective action when needed per Administrative Code Section 300.70.
Additional Resources:
Precautions: Standard precautions, Legionnaires' disease is not communicable.
Reporting: Use the Legionnaires' Disease Case Report Form to report all cases.
Prevention: There are no vaccines that can prevent Legionnaires’ disease. The key to preventing Legionnaires’ disease is to reduce the risk of Legionella growth and spread. All facilities need to develop a policy for testing its water supply for Legionella bacteria. The policy should include a facility risk assessment, testing protocols, control measures, and documented results with corrective action when needed per Administrative Code Section 300.70.
Additional Resources:
- Legionella Prevention Response (IDPH) - This document provides resources for Legionella outbreaks including an investigation process, clinician information, and water management links.
- Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings Toolkit (CDC) - This toolkit will provide guidance to help you develop, implement, and evaluate a Legionella water management program for your facility.
- Legionella Environmental Assessment Form (CDC) - This form can help you gain a thorough understanding of a facility’s water systems and aerosolizing devices and assists facility management with minimizing the risk of Legionnaires’ disease. This guide provides instructions and additional considerations for each question from the assessment form.
Scabies
Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite is spread by prolonged skin-to-skin contact with a person who has scabies. Symptoms occur 2–6 weeks after an initial infestation. For people who previously had scabies, symptoms appear much sooner, typically 1–4 days after exposure. Crusted scabies (Norwegian scabies) is a severe form of scabies that can occur in some persons who are immunocompromised, elderly, disabled, or debilitated. Persons with crusted scabies have thick crusts of skin that contain large numbers of scabies mites and eggs. Persons with crusted scabies are very contagious.
Precautions: Contact Precautions should be implemented for residents with scabies until 24 hours after initiation of effective therapy.
Reporting: Use the Long-Term Care Facility Outbreak Report Form to report all scabies outbreaks.
Additional Resources:
Precautions: Contact Precautions should be implemented for residents with scabies until 24 hours after initiation of effective therapy.
Reporting: Use the Long-Term Care Facility Outbreak Report Form to report all scabies outbreaks.
Additional Resources:
- Scabies Guidelines for Insitutional Settings (CDC) - Resources for developing guidelines for preventing, detecting, and responding to a single case, multiple cases, and crusted scabies cases.
- Scabies Treatment (CDC) - Guidance on medications for the treatment of classic scabies and crusted scabies.
- Management of Scabies in Illinois Healthcare & Residential Facilities - IDPH recommendations on the prevention and control of sporadic scabies cases including signs and symptoms, treatment options, and instructions for skin scraping
- Recommended Actions and Rationale for Preventing the Transmission of Scabies in Healthcare and Residential Facilities - IDPH list of recommended steps to take during a scabies outbreak in a SNF
Invasive Group A Streptococcus
Bacteria called group A Streptococcus (group A strep, GAS) can cause many different non-invasive and invasive infections. The vast majority of GAS infections are relatively mild noninvasive illnesses, such as strep throat and impetigo. Invasive GAS infection (iGAS) is defined by a culture or molecular test of GAS from either a normally sterile site (e.g., blood, cerebrospinal fluid) or a wound culture in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome.
Precautions: Residents with pneumonia or strep throat related to GAS should be on droplet precautions until 24 hours after initiation of effective therapy. Residents with major skin lesions related to GAS should be on droplet + contact precautions until 24 hours after initiation of effective therapy and until drainage stops or can be contained by dressing.
Reporting: Use the Invasive Group A Strep Case Report Form to report all cases.
Additional Resources:
Precautions: Residents with pneumonia or strep throat related to GAS should be on droplet precautions until 24 hours after initiation of effective therapy. Residents with major skin lesions related to GAS should be on droplet + contact precautions until 24 hours after initiation of effective therapy and until drainage stops or can be contained by dressing.
Reporting: Use the Invasive Group A Strep Case Report Form to report all cases.
Additional Resources:
- Investigating 1 Case of iGAS Infection (CDC) - Toolkit for investigating and controlling outbreaks in a long-term care facility when one invasive case of group A Streptococcus (iGAS) infection is identified.
- Antibiotic Regimens for Group A Streptococcus Carriage (CDC) - GAS carriage is the presence of GAS in the throat or on the skin of a person who has no signs or symptoms of infection (also called colonization). During an outbreak identify and treat asymptomatic carriers.
- GAS Invasive Fact Sheet (CDPH) - Fact sheet with GAS and iGAS information.
- GAS Enhanced Surveillance Tracking Sheet - Use this excel spreadsheet to maintain active surveillance for additional invasive or noninvasive cases among LTCF residents for 4 months from onset of most recent GAS case.
Tuberculosis
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. For most people with LTBI, M. tuberculosis remains in the inactive state in which the infected person has no symptoms and cannot spread the infection to others. But in other people, especially people who have a weak immune system, the bacteria become active, multiply, and cause TB disease. Progression to TB disease can take weeks to decades after initial infection. People with TB disease have symptoms or other manifestations of illness (e.g., an abnormal chest radiograph). The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.
Precautions: Airborne precautions should be implemented for residents with suspected or confirmed pulmonary TB, discontinue precautions only when resident on effective therapy is improving clinically and has 3 consecutive sputum smears negative for acid-fast bacilli collected on separate days. Airborne + contact precautions should be implemented for residents with extrapulmonary TB who have a draining lesion, discontinue precautions only when resident is improving clinically, and drainage has ceased or there are 3 consecutive negative cultures.
Additional Resources:
Precautions: Airborne precautions should be implemented for residents with suspected or confirmed pulmonary TB, discontinue precautions only when resident on effective therapy is improving clinically and has 3 consecutive sputum smears negative for acid-fast bacilli collected on separate days. Airborne + contact precautions should be implemented for residents with extrapulmonary TB who have a draining lesion, discontinue precautions only when resident is improving clinically, and drainage has ceased or there are 3 consecutive negative cultures.
Additional Resources:
- TB Screening and Testing of Health Care Personnel - All U.S. health care personnel should be screened for TB upon hire. The TB screening should include a baseline individual TB risk assessment, TB symptom evaluation, a TB test (e.g., TB blood test or TB skin test), and any additional evaluation for TB disease as needed.
- Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019 - Updated recommendations to the 2005 CDC guidelines.
- 2024 Tuberculosis Rate Map - This map contains TB rates for Chicago, Illinois, and the U.S. This map should be used to complete your long term care facility's TB risk assessment. Map is provided by IDPH and is updated annually.
- Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 - CDC's guidelines and recommendations that can be useful in fulling out a Tuberculosis Risk Assessment. For specific assistance, CDPH recommends the following sections:
- Appendix A: Administrative, environmental and respiratory-protection controls for selected health-care settings
- Appendix B: Tuberculosis (TB) risk assessment worksheet
- Appendix C: Risk classifications for various health-care settings and recommended frequency of screening for Mycobacterium tuberculosis infection among health-care workers (HCWs)
Transmission-based Precautions
Transmission-based Precautions are recommended to contain highly transmissible and/or epidemiologically important agents and are based on the mode of transmission of the specific pathogen. Transmission-based Precautions include Contact Precautions, Droplet Precautions, and Airborne Precautions.
In July 2019, the CDC released the Implementation of PPE Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms document. The CDC document introduced a new approach to Transmission-Based Precautions in nursing homes called Enhanced Barrier Precautions (EBP), which recommends gown and glove use for certain residents during specific high-contact resident care activities associated with MDRO transmission.
In July 2019, the CDC released the Implementation of PPE Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms document. The CDC document introduced a new approach to Transmission-Based Precautions in nursing homes called Enhanced Barrier Precautions (EBP), which recommends gown and glove use for certain residents during specific high-contact resident care activities associated with MDRO transmission.
- A Toolkit for Implementing PPE in Nursing Homes to Prevent the Spread of Multidrug and Extensively Drug-Resistant Organisms - (For Skilled Nursing Facilities Only) This toolkit aims to provide nursing homes with the necessary tools and resources to implement Enhanced Barrier Precautions (EBP) for residents with wounds requiring dressings or indwelling medical devices and successfully admit and care for those residents with an XDRO or epidemiologically important MDRO. This document summarizes best practices and assists with decision making when deciding whether to place a resident on contact precautions or EBP.
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CMS QSO-24-08-NH - New QSO provides new guidance for State Survey Agencies and long term care (LTC) facilities on the use of enhanced barrier precautions (EBP) to align with nationally accepted standards. The new guidance related to EBP is being incorporated into F880 Infection Prevention and Control.
- The following are examples of signs for Enhanced Barrier, Contact, Droplet, and Airborne Precautions that should be posted outside resident rooms when indicated.
- Enhanced Barrier Precautions (for Skilled Nursing Facilities)
- Contact + Droplet + N95 Precautions
- Contact Precautions
- Droplet Precautions
- Airborne Precautions
- CDC PPE Sequence for donning and doffing - Printable PPE education, can be posted in isolation rooms to remind staff how to safely put on and remove PPE.
IDPH SIREN Alerts
- Long-Term Care Facility Staffing Ratios and Daily Census Report - issued by IDPH June 2025 - Long-Term Care Facilities are required to submit a daily census report for all skilled and intermediate care residents on a quarterly basis
- Skilled Nursing Facility Acceptance and Care of Patients with Extensively Drug-Resistant Organisms (XDRO) - issued by IDPH May 2025 - Admission to licensed facilities should not be denied for residents solely based on a history of infection or colonization with multidrug-resistant organisms or extensively drug-resistant organisms
- New Extensively-Drug Resistant Organism (XDRO) Registry Reporting and Querying Requirements - issued by IDPH June 2024 - Health care facilities, including long-term acute care hospitals, skilled nursing, and intermediate care facilities, are now required to query new admissions from the XDRO registry
- Toolkit for Implementing PPE in Nursing Homes to Prevent the Spread of Multidrug- and Extensively Drug-Resistant Organisms - issued by IDPH February 2024 - Toolkit provides necessary tools and resources to properly implement Enhanced Barrier Precautions
Additional Resources
Federal/State Guidance:
Staff Training:
Infection Prevention Training for Long-term Care Facilities (CDC TRAIN) - The CDC online training course is designed for infection prevention and control (IPC) programs in nursing homes. The course is made up of 23 modules and sub-modules and can be completed in multiple sessions.
CBIC Long-term Care Certification - Applications are now open. The LTC-CIP provides a standardized measure of the basic knowledge, skills and abilities expected of professionals working in the long-term care field. The LTC-CIP is offered worldwide. The exam is an objective, multiple-choice examination consisting of 150 questions.
EVS/Housekeeping:
Hand Hygiene:
- Illinois Administrative Code Sections Relevant to LTCs:
- LTC Facility Self-Assessment Tool - The 2019 Nursing Home Infection Control Worksheet (ICWS) is a collaborative effort by CMS and CDC and meant to be used by facilities as a self-assessment tool. It comprises both regulatory requirements and best practices in infection prevention and control. A facility that uses this ICWS will identify gaps in practice and have a "roadmap" that can lead to an improved infection prevention and control program.
- Communicable Disease Topics from A to Z - Resources from IDPH's Communicable Disease Control Section organized by pathogen name including reporting guidelines and guidance documents
Staff Training:
Infection Prevention Training for Long-term Care Facilities (CDC TRAIN) - The CDC online training course is designed for infection prevention and control (IPC) programs in nursing homes. The course is made up of 23 modules and sub-modules and can be completed in multiple sessions.
CBIC Long-term Care Certification - Applications are now open. The LTC-CIP provides a standardized measure of the basic knowledge, skills and abilities expected of professionals working in the long-term care field. The LTC-CIP is offered worldwide. The exam is an objective, multiple-choice examination consisting of 150 questions.
EVS/Housekeeping:
- Facility Specific Cleaning and Disinfecting Matrix - A guide for environmental services and other healthcare workers.
- Options for Evaluating Environmental Cleaning (CDC) - This guide can help develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patient. An objective assessment of terminal room cleaning can be done using one or more of the methods discussed in Appendix B. The assessment results can be maintained by the facility and used internally to optimize programmatic and educational interventions. For additional audit tools see links below:
Hand Hygiene:
- FAQ: Use of Alcohol-Based Hand Rubs in Illinois Long-Term Care Facilities (IDPH) - Guidance and regulations for alcohol-based hand sanitizer in long-term care facilities.
- Hand Hygiene ICAR Audit Tool - Excel file template for hand hygiene audits.
- Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and other Long-Term Care Facilities during the COVID-19 Pandemic (OSHA) - Guidance focusing on protecting workers from occupational exposure to SARS-CoV-2.
- Respiratory Protection Program for Congregate Settings Template (OSHA) - Designed for use by personnel who have been suitably trained and charged with the responsibility of developing and implementing a respiratory protection plan (RPP) that addresses exposure to aerosol transmissible disease (ATD) pathogens and other respiratory hazards in congregate care facilities and environments.
- Medical Evaluation Questionnaire (OHSA) - Before wearing a respirator, workers must first be medically evaluated using the medical questionnaire or an equivalent method.
- Respiratory Protection Training Videos (OSHA) - Videos on fit testing, medical evaluations, respiratory protection for healthcare workers, the difference between respirators and surgical masks, donning & doffing, counterfeit respirators, maintenance and care, and the OSHA Respiratory Protection Standard.
- Respirator Trusted-Source Information (NIOSH) - Information ranging from basic respirator facts to more complex subjects on respirator function and performance.
Reporting Links
For Skilled Nursing, Assisted, and Supportive Living Facilities: Please report Acute Respiratory Illness Outbreaks, including COVID-19, Influenza, and RSV here.
For other outbreaks (e.g. Scabies, iGAS, and GI Illness) please report to the SNFAL Disease Reporting Form.
