Infection surveillance is critical in long term care. It enables the effective Infection Preventionist to monitor facility trends and act proactively in response to potential outbreaks. CMS states that The facility must establish a system for surveillance based upon national standards of practice and the facility assessment, including the resident population and the services and care provided. The facility must establish routine, ongoing, and systematic collection, analysis, interpretation, and dissemination of surveillance data to identify infections (i.e., HAI and community-acquired), infection risks, communicable disease outbreaks, and to maintain or improve resident health status. In addition, the facility must know how to recognize and contain infectious disease outbreaks.

Daily Monitoring for Potential Outbreaks

Routine monitoring of physician orders for antibiotic starts, as well as daily review of nursing documentation can trigger the Infection Preventionist to take a closer look at infectious events for the possibility that an outbreak event is occurring. Any cluster of similar symptoms should warrant a closer look as rapid response is the key to limiting spread within the facility. The CDC definition of an outbreak is the occurrence of more cases than expected in a given area or among a specific group of people over a particular period of time. For some diseases, such as COVID-19, a single incidence of the disease is considered an outbreak, whereas others may require a larger sample.

Tracking, Surveillance & Response

For tracking purposes, a case definition must be developed which will specify the set of symptoms, lab results, or other parameters for a resident to be included in the outbreak definition. For some diseases, there are standard line listing forms which have predetermined parameters such as Norovirus. For others, an industry standard definition should be used, such as the McGeer’s Criteria or the NHSN criteria to develop your case definition and start a line listing for tracking purposes.

Once the case definition is established, nursing staff must be educated on the case definition and the need to add residents to the line listing as criteria are met. Staff should also be aware of the need to implement appropriate transmission-based precautions, make any necessary environmental modifications such as room changes or provision of equipment such as bedside commodes, and notify the Infection Preventionist as new cases are identified.

Ongoing surveillance should focus on monitoring for new cases and detection of potential trends in spread such as common locations, caregivers, or external contacts such as hospital or physician contacts or treatments such as dialysis. Routine monitoring of infection prevention practices such as hand hygiene and PPE use should be ongoing to ensure staff are following infection prevention and control practices properly to help curb the spread of disease. Staff who are ill should refrain from working in the facility, and the Infection Preventionist should be informed of staff members who also meet the case definition, so that they can be included in the outbreak tracking. The local Health Department should be notified and updated as needed, as they may provide additional guidance regarding management of any suspected or confirmed outbreak in the facility. Additional Tips for Applying CDC’s Infection Surveillance Guidance in Long-term Care Facilities (LTCF) can be found at apxj.pdf (

Rapid identification of and response to suspected outbreaks is key to keeping your residents and staff safe. Join us on October 18, 2022 for the next session in the series The Proficient Infection Preventionist as we provide insights into outbreak management strategies. Learn more and register.

Judy Caffrey, RN
Clinical Consultant

Learn more about the rest of the Proactive team.